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HMO Site of Service Health Plan

For non-preventive care, members pay set copays for services such as office visits, specialist care, and prescriptions. There are no deductibles for most services, making it easier to budget for your healthcare throughout the year.

Anthem Contact Information:
Anthem Blue Cross & Blue Shield
1155 Elm Street, Suite 200
Manchester, NH 03101-1505
Member Services 
Phone: (833) 621-0307
Fax #: (603) 695-7067

Effective July 1, 2024 (FY25)

HMO 250 Plan:

Effective July 1, 2025 (FY26)

HMO 250 Plan: 

HMO 500 Plan: 

Both HMO plans include access to Anthem’s extensive in-network providers and facilities, giving you peace of mind and consistent care without the need for referrals in most cases.

Site of Service Components

LABS ∙ X-RAYS AND ULTRASOUNDS ∙ HIGH COST IMAGING ∙ OUTPATIENT SURGERY ∙ PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY

Site of service chart. Using a site of service location vs. using a NON-site of service location

*USWAA employees and retirees not subject to Rehabilitative Therapy copays for non-SOS locations.

Traditional Components of the HMO (Not affected by Site of Service)

  • Preventative Care
  • Primary Care
  • Specialty Care
  • Inpatient Care
  • Inpatient Labs and Imaging
  • Skilled Nursing and Rehabilitation Facility Care Inpatient
  • Durable Medical Equipment
  • Emergency Room and Urgent Care Visits
  • Mental Health and Substance Abuse Care
  • Pharmacy Care

SOS Resources

SmartShopper

This can also help you earn incentives:

  1. Call (866) 832-2436 or search www.SmartShopper.com and select the lower cost location that will earn an incentive.
  2. Schedule your appointment with the location you've selected and have the service completed.
  3. Once the claim has been processed, the incentive check will be mailed to you.

Remember SOS and SmartShopper are not the same. Always select a SOS location to avoid copays.

Away from Home Care Program​

Offered for HMO members thru Anthem Blue Cross and Blue Shield

  • Away From Home Care Brochure
    This brochure shows how the Away from Home Care provides healthcare coverage while you are away from your Home, such as a child going to college out of state. 
  • Away From Home Care Participating States Booklet
    This booklet shows the states in the US that participate in Anthem's Away From Home Care program. There are some areas within the participating states that do not offer the program so call Anthem to verify the area you are going to is a participant.
  • Away From Home Letter & Application Form
    Detailed description of the Away From Home program and application form including phone number & mailing address. 

​Away from Home Care Contact Information:
Away From Home Care
Anthem Blue Cross and Blue Shield
Mailstop: ME0103-W070
2 Gannett Dr.
South Portland, ME  04106
Phone: (877) 326-6200
Fax #:  (207) 822-8902
Email: AFHCAE@Anthem.com

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