How do the Anthem Tier 1 and Tier 2 hospital work?

Anthem Blue Cross (Anthem) Tiered Preferred Provider Organization (Tiered PPO) network is one of the strongest you’ll find in California, with some of the best hospitals in the country. That includes Ronald Reagan UCLA Medical Center and Cedars-Sinai Medical Center in Los Angeles, Sharp Memorial Hospital in San Diego and UCSF Medical Center in San Francisco.

These plans have the flexibility of a PPO with the lower costs of a two-tier hospital network. Plus, all of our Tiered PPO plans include out-of-network benefits. Members will pay less when they stay in our network, but they’ll also have the choice to go out of the network. The two types of in-network hospitals in the two-tier network are preferred in-network (Tier 1) and in-network (Tier 2): }

• Tier 1 — preferred in-network

The member’s share of the costs for covered services will be less with a Tier 1 hospital, compared to a Tier 2 hospital. We’ve negotiated the lowest out-of-pocket costs for covered services with Tier 1 hospitals. Members would also be responsible for lower coinsurance on most plans.2 }

• Tier 2 — in-network

These hospitals have higher out-of-pocket costs. They are a part of the Anthem network, but without the deep discounts offered by Tier 1 hospitals. With Tier 2 facilities, members would be responsible for a higher coinsurance on most plans.

Note: Tiered PPO plans cover emergency treatment at any hospital, wherever members may travel in the U.S. and abroad — even if it’s not in our network.