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 Classic PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$500/$1,500
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
No Charge
Primary Care Visit
$30 copay
Specialist Visit
$50 copay
Urgent Care
$30 copay
Emergency Room
$150 + 20% after deductible (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$5 – $15 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$50 copay
Specialty
30% up to $250 per prescription
Mail-Order Rx (Up to 90-Day Supply)
Generic
$10–$30 copay
Preferred Brand
$75 copay
Non-Preferred Brand
$125 copay
Specialty
30% up to $250 per prescription
Out-of-Network
Deductible (Individual/Family)
$1,500/$4,500
Out-of-Pocket Max (Individual/Family)
$12,000/$24,000
Preventive Care
40% after deductible
Primary Care Visit
40% after deductible
Specialist Visit
40% after deductible
Urgent Care
40% after deductible
Emergency Room
$150 + 20% after deductible (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
50% coinsurance up to $250 per prescription
Preferred Brand
50% coinsurance up to $250 per prescription
Non-Preferred Brand
50% coinsurance up to $250 per prescription
Specialty
50% coinsurance up to $250 per prescription
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Monthly Plan Cost
Employee Only: $78.00
Employee and Spouse: $171.00
Employee and Child(ren): $140.00
Employee and Family: $240.00
Documents
Anthem HSA PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,700/$4,100
Out-of-Pocket Max (Individual/Family)
$4,250/$8,500
Preventive Care
No Charge
Primary Care Visit
10%*
Specialist Visit
10%*
Urgent Care
10%*
Emergency Room
10%*
Retail Rx (Up to 30-Day Supply)
Generic
$55 – $15 copay*
Preferred Brand
$40 copay*
Non-Preferred Brand
$60 copay*
Specialty
30% up to $250 per prescription*
Mail-Order Rx (Up to 90-Day Supply)
Generic
$10–$30 copay*
Preferred Brand
$100 copay*
Non-Preferred Brand
$150 copay*
Specialty
30% up to $250 per prescription*
*After deductible
Out-of-Network
Deductible (Individual/Family)
$5,100/$10,200
Out-of-Pocket Max (Individual/Family)
$12,750/$25,500
Preventive Care
30%*
Primary Care Visit
30%*
Specialist Visit
30%*
Urgent Care
30%*
Emergency Room
10%*
Retail Rx (Up to 30-Day Supply)
Generic
30% up to $250 per prescription*
Preferred Brand
30% up to $250 per prescription*
Non-Preferred Brand
30% up to $250 per prescription*
Specialty
30% up to $250 per prescription*
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Monthly Plan Cost
Employee Only: $49.00
Employee and Spouse: $108.00
Employee and Child(ren): $88.00
Employee and Family: $151.00
Anthem Classic HMO – CA Employees Only
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
None/None
Out-of-Pocket Max (Individual/Family)
$2,000/$4,000
Preventive Care
No Charge
Primary Care Visit
$20 copay
Specialist Visit
$40 copay
Urgent Care
$20 copay
Emergency Room
$200 (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$5–$20 copay
Preferred Brand
$40 copay
Non-Preferred Brand
$60 copay
Specialty
30% up to $250 per prescription
Mail-Order Rx (Up to 90-Day Supply)
Generic
$10–$40 copay
Preferred Brand
$100 copay
Non-Preferred Brand
$150 copay
Specialty
30% up to $250 per prescription
Monthly Plan Cost
Employee Only: $54.00
Employee and Spouse: $118.00
Employee and Child(ren): $97.00
Employee and Family: $166.00