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CoreSource PPO Plan (Pre July 1, 2004 Retirees)

Note: The information on this page applies to retirees on the CoreSource PPO Plan who retired before July 1, 2004.

CoreSource PPO Plan
Group Number: 4138
Customer Service: 866-280-4120
Website: www.coresource.com
Contracting Provider Network for California residents: www.anthem.com/ca *
Contracting Provider Network for Non-California residents:  www.phcs.com

*(If you are traveling outside the state of California and you need to access medical care, you can access a list of Multiplan contracted providers at www.multiplan.com)

RX Coverage under the CoreSource PPO Plan is provided by:

Caremark
Member Services: 866-772-9436
Group Number: 13940
Website: www.caremark.com
Announcements
Welcome to Caremark - one of the nation’s leading administrators of prescription benefit services. With this program, you can:
  • Fill prescriptions at thousands of participating pharmacies across the country
  • Enjoy the ease of home prescription delivery from the mail service pharmacy
  • Look up your prescription history and benefit information on the Internet
Effective September 1, 2006, the Blue Cross of California (BCCA) network will replace the Interplan and Private Health Care Systems networks.  How does this affect you? This change will provide a wider provider network, thus more in-network possibilities and the increased frequency of in-network discounts.
Resources
CoreSource PPO Summaries (Pre July 1, 2004 Retirees)
 Benefit Summary  
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32807475.gifThis is the CoreSource PPO Benefit Summary for retirees who retired before July 1, 2004.  Refer to the Summary Plan Description for a complete listing of benefits, limitations and/or exclusions.  This document is for illustration purposes only.
  File size: 80 K

 Summary Plan Description (2008)  
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This is the CoreSource PPO Summary Plan Description for retirees who retired before July 1, 2004. 

  File size: 475 K

 Amendment #1 to SPD  
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Amendment #1 to SPD.  Please download the Summary Plan Description PLUS Amendment #1.  The two combined documents wrap around to form a complete Plan Document.
  File size: 244 K

Print  
CoreSource PPO Downloads
 CoreSource PPO - Claim Form  
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This is the CoreSource PPO Medical Claim Form.  You must complete claim forms and file claims to receive payment (Note, you MUST file your claims in a timely fashion, failure to file a claim in a timely fashion WILL result in the claim being denied and the entire claim will be your financial responsibility.)
  File size: 31 K

 CoreView Participant Instructions  
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DOWNLOAD
 Check it out!!   These are the CoreView Participant Instructions. CoreView is a service for CoreSource PPO Plan participants that makes personalized health plan information available 24 hours a day, 7 days a week. From a secure website, you can access detailed claim data, track out-of-pocket expenses, update contact information and more. 
  File size: 47 K

 CoreSource PPO - Pre-Admission Review Process  
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 CoreSource Healthcare Management is a program that monitors a proposed inpatient hospital stay to help assure that any treatment is medically necessary and appropriate.

The Pre-Admission Review Process is REQUIRED for all hospital visits -- failure to obtain pre-certification may result in additional out of pocket charges.
  File size: 48 K

 CoreSource PPO Decision Support Tools  
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 This is the CoreSource PPO Decision Support Tools Brochure.
  File size: 138 K

Caremark Rx Brochures
 Caremark Participating Pharmacies List  
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 This is the Caremark Participating Pharmacies List.
  File size: 47 K

 Caremark Prescription Benefits Guide  
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 This is the Caremark Prescription Benefits Guide.
  File size: 658 K

Caremark Rx Forms
 Caremark Mail Service Order Form  
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DOWNLOAD
 This is the Caremark Mail Service Order Form.
  File size: 102 K

 Caremark Retail Claim Form  
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DOWNLOAD
 This is the Caremark Retail Claim Form
  File size: 122 K


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