Anthem BCBS
Anthem BCBS is a national insurance carrier with a large network of doctors and facilities throughout the country. Anthem BCBS administers our medical plans and their pharmacy benefit manager Carelon administers the prescription drug plan.
There are two Anthem BCBS medical plans offered to you: the High Deductible Plan (HSA) and the traditional PPO medical plan. While the plan designs are different between the HSA and PPO, the provider networks are the same.
Resources
High Deductible Plan
| Plan Features | In-Network | Non-Network |
| Annual Deductible (non-embedded) | $2,000 EE | $4,000 Family | $4,000 EE | $8,000 Family |
| Coinsurance (after deductible) | 80% | 60% |
| Out of Pocket Maximum (non-embedded) Includes deductible and coinsurance |
$3,500 EE | $6,850 Family | $7,000 EE | $14,000 Family |
| Preventative Care / Screenings / Immunizations | No charge – covered at 100% | Deductible then 60% coinsurance |
| Primary Care Visit | Deductible then 80% coinsurance | Deductible then 60% coinsurance |
| Specialist Visit | Deductible then 80% coinsurance | Deductible then 60% coinsurance |
| Diagnostic Lab | Deductible then 80% coinsurance | 60% after deductible |
| Urgent Care | Deductible then 80% coinsurance | Deductible then 60% coinsurance |
| Emergency Room | Deductible then 80% coinsurance | Deductible then 60% coinsurance |
| Prescription Drugs | ||
| Generic | Deductible then 80% coinsurance | Deductible then 60% coinsurance |
| Brand Preferred | Deductible then 80% coinsurance | Deductible then 60% coinsurance |
| Brand Non-Preferred | Deductible then 80% coinsurance | Deductible then 60% coinsurance |
Monthly Contributions
High Deductible Health Plan: Tier 1 – Salary < $56,325
| Standard rate | Discounted rate (Health Screening) |
Discounted rate (Tobacco-free) |
Discounted rate (Health screening AND (Tobacco-free) |
|
| Employee Only | $99.44 | $79.54 | $69.61 | $49.72 |
| Employee + Spouse | $124.80 | $99.84 | $87.36 | $62.40 |
| Employee + Child(ren) | $120.32 | $96.26 | $84.23 | $60.16 |
| Family | $275.45 | $220.36 | $192.81 | $137.72 |
High Deductible Health Plan: Tier 2 – Salary > $56,325
| Standard rate | Discounted rate (Health Screening) |
Discounted rate (Tobacco-free) |
Discounted rate (Health screening AND (Tobacco-free) |
|
| Employee Only | $99.44 | $79.55 | $69.61 | $49.72 |
| Employee + Spouse | $148.96 | $119.17 | $104.27 | $74.48 |
| Employee + Child(ren) | $138.22 | $110.58 | $96.76 | $69.11 |
| Family | $400.74 | $320.59 | $280.52 | $200.37 |
PPO Plan
| Plan Features | In-Network | Non-Network |
| Annual Deductible (non-embedded) | $1,000 EE | $3,000 Family | $2,000 EE | $6,000 Family |
| Coinsurance (after deductible) | 80% | 60% |
| Out of Pocket Maximum (non-embedded) Includes deductible and coinsurance |
$5,000 EE | $10,000 Family | $5,500 EE | $11,000 Family |
| Preventative Care / Screenings / Immunizations | No charge – covered at 100% | 60% after deductible |
| Primary Care Visit | $10 | 60% after deductible |
| Specialist Visit | $25 | 60% after deductible |
| Diagnostic Lab | 80% after deductible | 60% after deductible |
| Urgent Care | $50 | 60% after deductible |
| Emergency Room | $200 | 60% after deductible |
| Prescription Drugs | ||
| Generic | $10 | Not Covered |
| Brand Preferred | 25% | Not Covered |
| Brand Non-Preferred | 50% | Not Covered |
Monthly Contributions
PPO Plan: Tier 1 – Salary < $56,325
| Standard rate | Discounted rate (Health Screening) |
Discounted rate (Tobacco-free) |
Discounted rate (Health screening AND (Tobacco-free) |
|
| Employee Only | $328.15 | $262.52 | $229.71 | $164.08 |
| Employee + Spouse | $578.12 | $462.50 | $404.68 | $289.06 |
| Employee + Child(ren) | $530.49 | $424.39 | $371.34 | $265.24 |
| Family | $923.13 | $738.50 | $646.19 | $461.57 |
PPO Plan: Tier 2 – Salary > $56,325
| Standard rate | Discounted rate (Health Screening) |
Discounted rate (Tobacco-free) |
Discounted rate (Health screening AND (Tobacco-free) |
|
| Employee Only | $328.15 | $262.52 | $229.71 | $164.08 |
| Employee + Spouse | $602.28 | $481.82 | $421.60 | $301.14 |
| Employee + Child(ren) | $548.39 | $438.71 | $383.87 | $274.19 |
| Family | $1,048.43 | $838.74 | $733.90 | $524.21 |
