Anthem Blue Access PPO HSA Option E6 IN PPO Large 96R6 01 01 2025 L12026MR02 L12026 English EOC CY

ABCBS-LG ASO PPO v08 96R6 Benefit Booklet (Referred to as “Booklet” in the following pages) Anthem Blue Access PPO HSA Richmond Community Schools Trust 01-01-2025 Si necesita ayuda en español para entender este documento, puede solicitarla sin costo adicional, llamando al número de servicio al cliente que aparece en el reverso de su Tarjeta de Identificación. If you need Spanish-language assistance to understand this document, you may request it at no additional cost by calling Member Services at the number on the back of your Identification Card. Plan Administered by: Anthem Insurance Companies, Inc. 220 Virginia Avenue Indianapolis, Indiana 46204 Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.