Full-Time Health Benefits

Each plan has a network of doctors and hospitals associated with it. You must use the plan’s network providers, or the plan will not pay for services.

Note, the definition of a medical emergency is the sudden onset of a medical condition that, in the absence of medical attention would place your health in serious jeopardy or seriously impair body functions, organs, or parts.

What you pay for care and services (for example, copays and coinsurance) is the same under the Advantage PPO and Prudent Buyer PPO plans. Coverage under the Kaiser HMO is slightly different.

Refer to each plan’s description below for details.

You and your employer share in the monthly premium cost for the plan you choose. Your share is called your co-contribution. The co-contribution varies by plan:

With the Advantage PPO, participants and the plan share the cost of health care through copays and coinsurance.

Here’s how it works:

When comparing the Advantage PPO and Prudent Buyer PPO plans, you will see that cost-sharing (copays and coinsurance) for care is the same. But, the Prudent Buyer PPO network is larger and the co-contribution is higher.

Here’s how the plan works:

With the Kaiser HMO, participants may pay more for care at the time of service, when compared with the PPO plans.

Here’s how the plan works:

Your medical plan pays only for care you receive from network doctors at network facilities. That’s why it’s important for you to choose network providers.

To learn if your doctor is part of the Advantage PPO network or Prudent Buyer network—or to find a provider who is:

• Call the JBT Doctor/Facility Helpline at 833-346-3365.
• Visit the Anthem Blue Cross website.

To find an Advantage PPO network provider:

1. Scroll to Find a Doctor.
2. Choose Guests.
3. Under What state do you want to search in, select California.
4. Under What type of plan do you want to search with, select Medical (Employer-Sponsored).
5. Under Select a plan/network, select Advantage PPO.
6. Then, choose your category (doctor, hospital, etc.) and specialty (family practice, dermatology etc.).
7. Finally, choose your location and how far you’re willing to travel.
8. You’ll see a list of providers.

To find a Prudent Buyer PPO network provider:

1. Scroll to Find a Doctor.
2. Choose Guests.
3. Under What state do you want to search in, select California.
4. Under What type of plan do you want to search with, select Medical (Employer-Sponsored).
5. Under Select a plan/network, select Blue Cross PPO (Prudent Buyer)— Large Group.
6. Then, choose your category (doctor, hospital, etc.) and specialty (family practice, dermatology etc.).
7. Finally, choose your location and how far you’re willing to travel.
8. You’ll see a list of providers.

To find a Kaiser doctor, browse doctors by region, or call Kaiser Member Services in your area.

With these PPO plan options, you fill your prescriptions at retail pharmacies in the CVS Caremark network or through CVS Caremark mail-order service. Without your doctor obtaining authorization from CVS Caremark, there is no coverage for brand name drugs when a generic is available. Also, if you use an out-of-network pharmacy, your plan will not cover the cost of your prescription.

Here’s what you’ll pay for most prescriptions:

Kaiser HMO members need to fill prescriptions through Kaiser’s retail or mail-order pharmacies. If you use a non-Kaiser pharmacy, your plan will not cover the cost of your prescription.

Here’s what you’ll pay for most prescriptions:

Here’s how the plan works:

Here’s how the plan works:

Whether you’re enrolled in the Advantage PPO or Prudent Buyer PPO medical plan option, you and your covered children have chiropractic benefits through Landmark Healthplan. To find a provider in your area, call 800-298-4875 (option 2) or visit the Landmark Healthplan website.

You can also use a chiropractor in your Advantage or Prudent Buyer network, but your benefit will be less. If you use a chiropractor who is not in your Anthem network or the Landmark Healthplan network, your services will not be covered.

Chiropractic benefits are not available to members enrolled in the Kaiser HMO.

Here’s how the plan works:

Participants in the Advantage PPO or Prudent Buyer PPO plan can take advantage of JBT’s special mammography network. If you use a Mammography Network Center facility, your mammogram will be covered at no cost to you.

The plan covers a yearly mammogram for female participants and any female covered dependents who are 40 and older.

Use this list to locate a Mammography Network Center facility in your area—but, before you make your appointment, be sure to reconfirm the facility’s participation and that you’re eligible for this benefit.

Note, if you don’t use a Mammography Network Center provider, and instead choose a provider within the Advantage PPO or Prudent Buyer PPO network, whichever you selected, the plan pays a maximum benefit of $163; you are responsible for the balance. If you go out-of-network, the plan does not pay benefits.

Contact JBT at 800-528-4357 before scheduling an appointment.

Participants in the Advantage PPO or Prudent Buyer plan will pay much less by using a designated hospital for hip or knee replacement surgery.

The plan provides an allowance of up to $35,000 for inpatient hospital charges for routine hip and knees replacements, and designated hospitals agree to keep their charges at or under this cost. The plan pays 90% of the allowance after you meet the deductible.

If you do not use a designated hospital, you will pay the difference between the hospital’s charge and JBT’s $35,000 allowance, in addition to the 10% coinsurance.

When considering and scheduling one of these surgeries, be sure to confirm that your facility is on the designated hospital list. Call JBT at 800-528-4357 before scheduling your doctor’s appointment and surgery.