HealthLink Network Programs and Services Overview

	Network included in HealthLink Program
HealthLink Program	HMO (Tier I)	PPO (Tier II)	Workers’ Compensation	Out-of-Network*
Open Access III (OA III)	✔	✔		✔
Open Access II (OA II)	✔			✔
Open Access I (OA I)	✔
PPO		✔		✔
Workers’ Compensation			✔

* Note out-of-network coverage is provided in accordance with the Member’s health plan.

Open Access Network Programs

HealthLink Open Access is a non-gatekeeper plan, and certain Payors may require pre-certification. Members may self-refer to participating Providers and Facilities.

Open Access III (OAIII) is a three-tier program: This program has three levels of benefits. The highest level of benefit is available to Members who self-refer to HealthLink HMO participating Providers or Facilities. A second, lower level of benefit is available to Members who self-refer to HealthLink PPO participating Providers or Facilities. The third, lowest level of benefit is available to Members who self-refer to out-of-network Providers or Facilities. HealthLink HMO contracted Providers and Facilities participate in Tier I. HealthLink PPO contracted Providers and Facilities participate in Tier II. Out-of-network Providers and Facilities are considered Tier III.

Open Access II (OAII) is a two-tier program: This program has two levels of benefits. The highest level of benefit is available to Members who self-refer to HealthLink HMO participating Providers and Facilities. A second, lower level of benefit is available to Members who self-refer to out-of-network providers. Only HealthLink HMO contracted Providers and Facilities participate in the OAII network program.

Open Access I (OAI) is a single-tier program: This program has one level of benefit. Members may self-refer to HealthLink HMO participating Providers and Facilities only. There are no PPO or out-of-network benefits. Only HealthLink HMO contracted Providers and Facilities participate in the OAI network program.

If a Provider or Facility is contracted in both the HMO and PPO network, the Member’s highest level of benefits will be applied at Tier I, which would be the HMO Agreement.

PPO Network Program

HealthLink PPO is a non-gatekeeper plan, and certain Payors may require pre-certification. Members may self-refer to participating Providers and Facilities.

Anthem Worker’s Compensation (AWC) Network Program

AWC is a certified Workers Compensation PPO network program, licensed or registered in the states in which it conducts business. More than two million employees are enrolled in Workers’ Compensation plans that access the AWC networks. The AWC service area includes portions of Missouri, Illinois, Arkansas, Iowa, and Indiana. AWC’s objective is to assist employers in managing the financial risk associated with work-related illness and injury by providing access to participating health care professionals physicians and facilities.