Medical
Medical coverage provides healthcare protection for you and your family. You can visit any provider, but in-network doctors offer the highest level of benefits and lower out-of-pocket costs by charging reduced, contracted rates. Out-of-network providers set their own fees, so you may be responsible for charges above the Reasonable and Customary (R&C) limits. Preventive care—such as physical exams, flu shots, and screenings—is covered at 100% when you use in-network providers. The main differences between plan options are how much you pay per paycheck and what you pay when you receive care.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums– the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Anthem CDHP PPO/HSA
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,650/$3,300
Out-of-Pocket Max (Individual/Member/Family)
$4,000/$8,000
Preventive Care
$0
Primary Care Visit
20%*
Specialist Visit
20%*
Urgent Care
20%*
Emergency Room
20%*
Retail Rx (Up to 30-Day Supply)
Generic
$15*
Preferred Brand
$50*
Non-Preferred Brand
$70*
Specialty
30%* ($250 max copay per fill)
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30*
Preferred Brand
$50*
Non-Preferred Brand
$70*
Specialty
30%* ($500 max copay per fill)
Out-of-Network
Deductible (Individual/Family)
$1,650/$3,300
Out-of-Pocket Max (Individual/Family)
$10,000/$20,000
Preventive Care
$0
Primary Care Visit
50%*
Specialist Visit
50%*
Urgent Care
50%*
Emergency Room
20%*
Retail Rx (Up to 30-Day Supply)
Generic
$15
Preferred Brand
$50
Non-Preferred Brand
$70
Specialty
30% ($250 max copay per fill)
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30
Preferred Brand
$125
Non-Preferred Brand
$175
Specialty
30% ($500 max copay per fill)
Anthem Value PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,000/Max 3 separate deductibles per family
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
$0
Primary Care Visit
$30
Specialist Visit
$50
Urgent Care
$30
Emergency Room
20% +150 deductible (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$15
Preferred Brand
$50
Non-Preferred Brand
$70
Specialty
30% ($250 max copay per fill)
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30
Preferred Brand
$50
Non-Preferred Brand
$70
Specialty
30% ($500 max copay per fill)
Out-of-Network
Deductible (Individual/Family)
$2,000/Max 3 separate deductibles per family
Out-of-Pocket Max (Individual/Family)
$10,000/$20,000
Preventive Care
50%*
Primary Care Visit
50%*
Specialist Visit
50%*
Urgent Care
50%*
Emergency Room
20%* +150 deductible (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Copay + 50% of Rx drug max allowed amount + costs in excess of the Rx drug max allowed amount
Mail-Order Rx (Up to 90-Day Supply)
Not Covered
Anthem Value HMO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
None
Out-of-Pocket Max (Individual/Family)
$3,500/$7,000
Preventive Care
$0
Primary Care Visit
$30
Specialist Visit
$50
Urgent Care
$50
Emergency Room
$150
Retail Rx (Up to 30-Day Supply)
Generic
$15
Preferred Brand
$50
Non-Preferred Brand
$70
Specialty
30% ($250 max copay per fill)
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30
Preferred Brand
$125
Non-Preferred Brand
$175
Specialty
30% ($500 max copay per fill)
Kaiser HMO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
None
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
$0
Primary Care Visit
$30
Specialist Visit
$300
Urgent Care
$30
Emergency Room
$150
Retail Rx (Up to 30-Day Supply)
Generic
$10
Brand
$30
Specialty
30% ($250 max copay per fill)
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Brand
$60
*After Deductible