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.
Medical Plan Glossary:
- 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 Blue Cross PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$250/$750
Out-of-Pocket Max (Individual/Family)
$2,000/$6,000
Preventive Care
$0
Primary Care Visit
$20
Specialist Visit
$40
Urgent Care
$50
Emergency Room
$100
Retail Rx (Up to 30-Day Supply)
Generic
$5
Preferred Brand
$40
Non-Preferred Brand
Not covered
Specialty
$50
Mail-Order Rx (Up to 100-Day Supply)
Generic
$10
Preferred Brand
$80
Non-Preferred Brand
Not covered
Specialty
$50* (limited to a 30 day supply)
*After deductible
Out-of-Network
Deductible (Individual/Family)
$1,000/$3,000
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
Not covered
Primary Care Visit
40%*
Specialist Visit
40%*
Urgent Care
$50/visit + 40%*
Emergency Room
$100
Retail Rx (Up to 30-Day Supply)
Generic
$30
Preferred Brand
$60
Non-Preferred Brand
Not covered
Specialty
Not covered
Mail-Order Rx (Up to 100-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Plan Cost
Full-Time Team Members Monthly Cost
Team Member Only: $160.00
Team Member and 1 Dependent: $570.00
Team Member and Family: $890.00
Full-Time Team Members Bi-Weekly Cost
Team Member Only: $80.00
Team Member and 1 Dependent: $285.00
Team Member and Family: $445.00
Part-Time Team Members Monthly Cost
Team Member Only: $170.00
Team Member and 1 Dependent: $595.00
Team Member and Family: $930.00
Part-Time Team Members Bi-Weekly Cost
Team Member Only: $85.00
Team Member and 1 Dependent: $297.50
Team Member and Family: $465.00