Medical & Prescription
We offer you a comprehensive benefits program to help you and your family protect your health and financial security. Your benefits are a valuable part of your compensation; we encourage you to learn how your plans work so you can get the most from them. You have two (2) plan options through Anthem.
Watch this video to learn more about your HDHP & PPO Plans
Medical Highlights (In-Network)
HDHP Plan
Type of Deductible
Embedded
Calendar Year Deductible (Individual / Family)1,2
$3,300 / $6,600
Your Coinsurance3
0%
Out-of-Pocket Maximum (Individual / Family)
$3,800 / $7,600
Physician Visit (Primary / Specialist)
Deductible, then coinsurance
Preventive Care Services4
Covered 100%
Emergency Room Visit
Deductible, then coinsurance
Urgent Care Visit
Deductible, then coinsurance
PPO Plan
Type of Deductible
Embedded
Calendar Year Deductible (Individual / Family)1,2
$1,500 / $4,500
Your Coinsurance3
20%
Out-of-Pocket Maximum (Individual / Family)
$5,000 / $10,000
Physician Visit (Primary / Specialist)
$25 / $50 copay
Preventive Care Services4
Covered 100%
Emergency Room Visit
$ 250 copay, then coinsurance
Urgent Care Visit
$ 75 copay
Both plan options are embedded. An embedded deductible means that each person covered on the plan (employee, spouse, child) has a personal deductible. When each personal deductible is met, coverage begins for that individual only.
1. When enrolling in a High Deductible Health Plan, all covered services are subject to the deductible except Preventive Care services.
2. Deductible year runs on the calendar year
3. Coinsurance kicks in once the calendar year deductible is met
4. Preventive care services include but are not limited to routine wellness exams, pelvic exams, pap testing, PSA tests, immunizations, annual diabetic eye exam, routine vision and hearing exams. Covers preventive care services rendered in a physician's office and outpatient service centers.
WHAT IS A...
Deductible: Amount you have to pay for a covered medical expense before your coinsurance kicks in.
Coinsurance: A percentage of the claim amount you pay (after your deductible is met), while your insurance plan pays for the rest. For example: You pay 0% and the plan pays 100%.
Copay: Fixed fee you may need to pay for healthcare services (i.e., office visits, prescriptions).
Out-of-Pocket Maximum: You will not have to pay more than this amount during your plan year – once you reach it, your insurance plan will cover all additional eligible expenses.
Rx Highlights (CarelonRx)
HDHP Plan
Retail Pharmacy (30 day supply)
Tier 1 - Generic
Level 1: Deductible, then $10 copay
Level 2: Deductible, then $20 copay
Tier 2 - Brand Name Formulary
Level 1: Deductible, then $35 copay
Level 2: Deductible, then $45 copay
Tier 3 - Brand Name Non-Formulary
Level 1: Deductible, then $75 copay
Level 2: Deductible, then $85 copay
Tier 4 - Specialty
Level 1: Deductible, then 25% to $350 max
Level 2: Deductible, then 25% to $450 max
Mail-Order Pharmacy (90 day supply)
Tier 1 - Generic
Deductible, then $20 copay
Tier 2 - Brand Name Formulary
Deductible, then $88 copay
Tier 3 - Brand Name Non-Formulary
Deductible, then $188 copay
Tier 4 - Specialty
Deductible, then 25% to $350 max
PPO Plan
Retail Pharmacy (30 day supply)
Tier 1 - Generic
Level 1: $10 copay
Level 2: $20 copay
Tier 2 - Brand Name Formulary
Level 1: $35 copay
Level 2: $45 copay
Tier 3 - Brand Name Non-Formulary
Level 1: $75 copay
Level 2: $85 copay
Tier 4 - Specialty
Level 1: 25% to $350 max
Level 2: 25% to $450 max
Mail-Order Pharmacy (90 day supply)
Tier 1 - Generic
$20 copay
Tier 2 - Brand Name Formulary
$88 copay
Tier 3 - Brand Name Non-Formulary
$188 copay
Tier 4 - Specialty
25% to $350 max
You will be responsible for the copay amount until your total expenses have reached the out of pocket maximum
Contact the provider of these benefits by calling this phone number or visiting this website: Anthem Customer Service - (800) 331-1476, anthem.com
HDHP MEDICAL & Rx COSTS
(Based on 26 pays per year)
Employee Only
You Pay: $0.00
Your Employer Pays: $290.08
Employee + Spouse
You Pay: $199.41
Your Employer Pays: $409.47
Employee + Children
You Pay: $178.74
Your Employer Pays: $343.40
Employee + Family
You Pay: $306.45
Your Employer Pays: $534.79
PPO MEDICAL & Rx COSTS
(Based on 26 pays per year)
Employee Only
You Pay: $115.49
Your Employer Pays: $207.80
Employee + Spouse
You Pay: $343.49
Your Employer Pays: $335.11
Employee + Children
You Pay: $303.27
Your Employer Pays: $278.67