Health Insurance Exchange
Quick Reference Guide
Individual Health Care Difference between Individual plans purchased:
“On the Exchange” or “Off the Exchange”
Exchange
 On the Exchange - refers to individual plans purchased
Anthem Blue Cross –
Individual Exchange
Network Names
Exchange Member
ID Card Sample
through the Health Insurance Marketplace (Covered
California)
 Off the Exchange - refers to individual plans purchased
through another channels such as a broker, sales agent, or
directly through a health insurance company (such as
Anthem Blue Cross)
Network Name for plans sold ON Exchange:
 PPO: Pathway X PPO
 EPO: Pathway X – Tiered
 HMO: Pathway X – HMO
Network Name for plans sold OFF Exchange:
 PPO: Pathway PPO
 EPO: Pathway Tiered
 HMO: Pathway HMO
On Exchange Plan will have Covered California logo.
Off Exchange plan will not.
[PPO/EPO Member ID Card]
Health Insurance Exchange Quick Reference Guide – August 2014
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Plan Type/Name
Alpha Prefixes on
Exchange Member
ID Cards
Exchange Plans
Contact Information



Prefix
Pathway X HMO
JQO
Pathway HMO
JQL
Pathway X EPO - Tiered
JQR
Pathway EPO - Tiered
JQN
Pathway X PPO
JQP
Pathway PPO
JQM
Pathway X PPO
VXB
Pathway XPPO
VXD
Provider Services for Exchange plans: 855-854-1438
Member Services for Exchange plans: 855-453-7031
UM Pre Authorization: 800-274-7767
Claims Mailing Address:
PO Box 60007
Los Angeles, CA 90060-0007
ON EXCHANGE
Member Plan Name / Contract Code / Plan Type / Metal Tier
Plan Marketed Name
Anthem Bronze DirectAccess
Anthem Bronze DirectAccess
Anthem Bronze DirectAccess w/HSA
Anthem Bronze DirectAccess w/HSA
Anthem Catastrophic Direct Access
Anthem Catastrophic Direct Access
Anthem Gold DirectAccess, a Multi-State Plan
Anthem Gold DirectAccess, a Multi-State Plan
Anthem Gold Guided Access
Anthem Platinum Direct Access
Anthem Platinum Direct Access
Anthem Platinum Guided Access
Anthem Silver Direct Access, a Multi-State Plan
Anthem Silver DirectAccess, a Multi-State Plan
Anthem Silver DirectAccess, a Multi-State Plan
Anthem Silver DirectAccess, a Multi-State Plan
Anthem Silver DirectAccess, a Multi-State Plan
Anthem Silver DirectAccess, a Multi-State Plan
Anthem Silver DirectAccess, a Multi-State Plan
Anthem Silver DirectAccess, a Multi-State Plan
Anthem Silver Guided Access
Anthem Silver Guided Access - cbmv
Anthem Silver Guided Access - cbmw
Anthem Silver Guided Access cbmx
Exchange
On
On
On
On
On
On
On
On
On
On
On
On
On
On
On
On
On
On
On
On
On
On
On
On
Contract Code
0RWW
0RWU
0RX0
0RWY
0RYR
0RYP
0RYF
0RYD
0RYB
0RYM
0RYK
0RYH
0RXP
0RXS
0RXR
0RXT
0RXJ
0RXL
0RXM
0RXN
0RXU
0RXY
0RXX
0RXW
Health Insurance Exchange Quick Reference Guide – August 2014
Benefit Structure
EPO
PPO
EPO
PPO
EPO
PPO
EPO
PPO
HMO
EPO
PPO
HMO
EPO
EPO
EPO
EPO
PPO
PPO
PPO
PPO
HMO
HMO
HMO
HMO
Metal Tier
Bronze
Bronze
Bronze
Bronze
Catastrophic
Catastrophic
Gold
Gold
Gold
Platinum
Platinum
Platinum
Silver
Silver Subsidy
Silver Subsidy
Silver Subsidy
Silver
Silver Subsidy
Silver Subsidy
Silver Subsidy
Silver
Silver Subsidy
Silver Subsidy
Silver Subsidy
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OFF EXCHANGE
Member Plan Name / Contract Code / Plan Type / Metal Tier
Plan Marketed Name
Anthem Catastrophic Direct Access
Anthem Catastrophic Direct Access
Anthem Core Direct Access
Anthem Core Direct Access
Anthem Core Direct Access w/
Child Dental
Anthem Core Direct Access w/
Child Dental
Anthem Core DirectAccess
Anthem Core DirectAccess
Anthem Core DirectAccess
Anthem Core DirectAccess
Anthem Core DirectAccess
Anthem Core DirectAccess
Anthem Core DirectAccess w/
Child Dental
Anthem Core DirectAccess w/Child
Dental
Anthem Core DirectAccess w/HSA
Anthem Core DirectAccess w/HSA
Anthem Essential DirectAccess
Anthem Essential DirectAccess
Anthem Essential DirectAccess
Anthem Essential DirectAccess
Anthem Essential DirectAccess
Anthem Essential DirectAccess
Anthem Essential DirectAccess w/
Child Dental
Anthem Essential DirectAccess w/
Child Dental
Anthem Essential Guided Access
Anthem Preferred DirectAccess
Anthem Preferred DirectAccess
Anthem Preferred DirectAccess w/
Child Dental
Anthem Preferred DirectAccess w/
Child Dental
Anthem Preferred Guided Access
Anthem Premier DirectAccess
Anthem Premier DirectAccess
Anthem Premier DirectAccess w/
Child Dental
Anthem Premier DirectAccess w/
Child Dental
Anthem Premier Guided Access
Exchange
Off
Off
Off
Off
Off
Contract Code
0RYS
0RYQ
0RWT
0RWR
0RYU
Benefit Structure
EPO
PPO
EPO
PPO
EPO
Metal Tier
Catastrophic
Catastrophic
Bronze
Bronze
Bronze
Off
0RYT
PPO
Bronze
Off
Off
Off
Off
Off
Off
Off
0RX5
0RWX
0RX4
0RWV
0RX3
0RX2
0RX7
EPO
EPO
PPO
PPO
EPO
PPO
EPO
Bronze
Bronze
Bronze
Bronze
Bronze
Bronze
Bronze
Off
0RX6
PPO
Bronze
Off
Off
Off
Off
Off
Off
Off
Off
Off
0RX1
0RWZ
0RXQ
0RXE
0RYA
0RXK
0RX9
0RY9
0T1K
EPO
PPO
EPO
EPO
EPO
PPO
PPO
PPO
EPO
Bronze
Bronze
Silver
Silver
Silver
Silver
Silver
Silver
Silver
Off
0RYV
PPO
Silver
Off
Off
Off
Off
0RXV
0RYE
0RYG
0T1M
HMO
PPO
EPO
EPO
Silver
Gold
Gold
Gold
Off
0T1L
PPO
Gold
Off
Off
Off
Off
0RYC
0RYN
0RYL
0T1P
HMO
EPO
PPO
EPO
Gold
Platinum
Platinum
Platinum
Off
0T1N
PPO
Platinum
Off
0RYJ
HMO
Platinum
Health Insurance Exchange Quick Reference Guide – August 2014
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