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MEDICAL & PRESCRIPTION

MEDICAL & PRESCRIPTION

Anthem Blue Access PPO 1800

HOW THE PLAN WORKS

Preventive Care: The plan pays 100% for in-network preventive care.

Annual Deductible: For non-preventive care there is an annual deductible that must be met. The annual deductible is $1,800 for Individual coverage and $3,600 for Family Coverage when you use in-network providers.

Preventative Prescription Medication: This plan covers generic preventative medications at 100%.

Out-of-Pocket Maximum: This is the most that you will have to pay for covered services in a plan year. All medical and prescription drug deductibles, copayments and coinsurance apply toward the out-of-pocket maximum. Once you meet the out-of-pocket maximum then the plan pays 100% of your eligible expenses, including the cost of all office visits and prescription drugs, for the remainder of the year.

LiveHealth Online (LHO):
This is Anthem’s telemedicine option. MDLive lets you get the care you need – including most prescriptions (when appropriate) – for a wide range of minor conditions. You can connect with a board certified provider via video chat or phone, when, where and how it works best for you. LHO has a copay of $10 for Visual Edge’s PPO Plans. Download the LHO flyers in the Resource Box for additional information.

Anthem Blue Access Network Providers Non-Network Providers
Calendar Year Deductible: Single/Family $1,800 / $3,600 $3,600 / $7,200
Coinsurance 20% after deductible 50% after deductible
Maximum Out of Pocket Limit: Single / Family
(Includes the deductible)
$5,300 / $10,600 $10,600 / $21,200
Office Visit $25 copay 50% after deductible
Specialist Office Visit $40 copay 50% after deductible
Surgical Services 20% after deductible 50% after deductible
Complex X-Ray and Lab – CT, PET, MRI, MRA 20% after deductible 50% after deductible
Urgent Care Centers $75 copay 50% after deductible
Emergency Medical Care $300/20% after deductible
In-Patient Hospital Services 20% after deductible 50% after deductible
Out-Patient Hospital Services 20% after deductible 50% after deductible
Prescription Drugs:
Retail (30 day supply)
generic/brand/non-brand/specialty
$15/ $45/25% $350 Max 50% coinsurance/ Min $70
Mail Order (90 day supply)
generic/brand/non-brand/specialty
$30/$135/25% $350 Max Not Covered
Employee Bi-Weekly Costs:
Employee Only $127
Employee + Spouse $281
Employee + Child(ren) $258
Family $415

Anthem Blue Access PPO 5000

HOW THE PLAN WORKS

Preventive Care: The plan pays 100% for in-network preventive care.

Annual Deductible: For non-preventive care there is an annual deductible that must be met. The annual deductible is $5,000 for Employee only coverage and $10,000 for Family Coverage, Employee + Spouse, Employee + Child(ren)

Preventative Prescription Medication: This plan covers generic preventative medications at 100%.

Out-of-Pocket Maximum: This is the most that you will have to pay for covered services in a plan year. All medical and prescription drug deductibles, copayments and coinsurance apply toward the out-of-pocket maximum. Once you meet the out-of-pocket maximum then the plan pays 100% of your eligible expenses, including the cost of all office visits and prescription drugs, for the remainder of the year.

LiveHealth Online (LHO):
This is Anthem’s telemedicine option. MDLive lets you get the care you need – including most prescriptions (when appropriate) – for a wide range of minor conditions. You can connect with a board certified provider via video chat or phone, when, where and how it works best for you. LHO has a copay of $10 for Visual Edge’s PPO Plans. Download the LHO flyers in the Resource Box for additional information.

Anthem Blue Access Network Providers Non-Network Providers
Calendar Year Deductible: Single/Family $5,000/ $10,000 $10,000 / $20,000
Coinsurance 20% after deductible 40% after deductible
Maximum Out of Pocket Limit: Single / Family
(Includes the deductible)
$6,850 / $13,700 $13,700 / $27,400
Office Visit $25 copay 40% after deductible
Specialist Office Visit $50 copay 40% after deductible
Surgical Services 20% after deductible 40% after deductible
Complex X-Ray and Lab – CT, PET, MRI, MRA 20% after deductible 40% after deductible
Urgent Care Centers $75 copay 40% after deductible
Emergency Medical Care $250 copay
In-Patient Hospital Services 20% after deductible 40% after deductible
Out-Patient Hospital Services 20% after deductible 40% after deductible
Prescription Drugs:
Retail (30 day supply)
generic/brand/non-brand/specialty
$20/$40/$70 50% after deductible Min $70
Mail Order (90 day supply)
generic/brand/non-brand/specialty
$40/$120/$210 Not Covered
Employee Bi-Weekly Costs:
Employee Only $70
Employee + Spouse $166
Employee + Child(ren) $154
Family $246

Anthem HSA 3200

HOW THE PLAN WORKS

Preventive Care: The plan pays 100% for in-network preventive care.

Annual Deductible: You pay all non-preventive care costs, including prescription drugs, up to the annual deductible. The annual deductible is $3,200 for Individual and $6,400 for family when you use in-network providers.

Preventative Prescription Medication: This plan covers generic preventative medications at 100%.

Coinsurance: Once you have met the deductible, you will pay coinsurance for services received. When you use in-network providers, your coinsurance cost will be 10% for individual and family. 

Out-of-Pocket Maximum: This is the most that you will have to pay for covered services in a plan year. All medical and prescription drug deductibles, copayments and coinsurance apply toward the out-of-pocket maximum. Once you meet the out-of-pocket maximum, then the plan pays 100% of your eligible expenses, including the cost of all office visits and prescription drugs, for the remainder of the year.

LiveHealth Online (LHO):
This is Anthem’s telemedicine option. MDLive lets you get the care you need – including most prescriptions (when appropriate) – for a wide range of minor conditions. You can connect with a board certified provider via video chat or phone, when, where and how it works best for you. LHO has a copay of $59 for Visual Edge’s HSA Plans. Download the LHO flyers in the Resource Box for additional information.

Health Savings Account: After the deductible is met your in-network coinsurance payment is 10% and the plan covers the other 90%.

Anthem HSA 3200
Network Providers Non-Network Providers
Calendar Year Deductible: Single/Family $3,200/ $6,400 $5,600/$11,200
Coinsurance 10% after deductible 30% after deductible
Maximum Out of Pocket Limit: Single / Family
(Includes the deductible)
$3,500 / $7,000 $7,000/$14,000
Office Visit 10% after deductible 30% after deductible
Specialist Office Visit 10% after deductible 30% after deductible
Surgical Services 10% after deductible 30% after deductible
Complex X-Ray and Lab – CT, PET, MRI, MRA 10% after deductible 30% after deductible
Urgent Care Centers 10% after deductible 30% after deductible
Emergency Medical Care 10% after deductible
In-Patient Hospital Services 10% after deductible 30% after deductible
Out-Patient Hospital Services 10% after deductible 30% after deductible
Prescription Drugs:
Retail (30 day supply)
generic/brand/non-brand/specialty
$10/$35/ $70/25%$250 Max. 50% after deductible; Min $70
Mail Order (90 day supply)
generic/brand/non-brand/specialty
$20/$105/$210/25%$250 Max Not Covered
Employee Bi-Weekly Costs:
Employee Only $95
Employee + Spouse $198
Employee + Child(ren) $180
Family $295

Anthem HSA 5000

HOW THE PLAN WORKS

Preventive Care: The plan pays 100% for in-network preventive care.

Annual Deductible: You pay all non-preventive care costs, including prescription drugs, up to the annual deductible. The annual deductible is $5,000 for Individual and $10,000 for family when you use in-network providers.

Preventative Prescription Medication: This plan covers generic preventative medications at 100%.

Coinsurance: Once you have met the deductible, you will pay coinsurance for services received. When you use in-network providers, your coinsurance cost will be 10% for individual and family. 

Out-of-Pocket Maximum: This is the most that you will have to pay for covered services in a plan year. All medical and prescription drug deductibles, copayments and coinsurance apply toward the out-of-pocket maximum. Once you meet the out-of-pocket maximum, then the plan pays 100% of your eligible expenses, including the cost of all office visits and prescription drugs, for the remainder of the year.

LiveHealth Online (LHO):
This is Anthem’s telemedicine option. MDLive lets you get the care you need – including most prescriptions (when appropriate) – for a wide range of minor conditions. You can connect with a board certified provider via video chat or phone, when, where and how it works best for you. LHO has a copay of $59 for Visual Edge’s HSA Plans. Download the LHO flyers in the Resource Box for additional information.

Health Savings Account: After the deductible is met your in-network coinsurance payment is 10% and the plan covers the other 90%.

Anthem HSA 5000 Network Providers Non-Network Providers
Calendar Year Deductible: Single/Family $5,000/ $10,000 $10,000 / $20,000
Coinsurance 10% after deductible 30% after deductible
Maximum Out of Pocket Limit: Single / Family
(Includes the deductible)
$6,750 / $13,500 $20,000/$40,000
Office Visit 10% after deductible 30% after deductible
Specialist Office Visit 10% after deductible 30% after deductible
Surgical Services 10% after deductible 30% after deductible
Complex X-Ray and Lab – CT, PET, MRI, MRA 10% after deductible 30% after deductible
Urgent Care Centers 10% after deductible 30% after deductible
Emergency Medical Care 10% after deductible
In-Patient Hospital Services 10% after deductible 30% after deductible
Out-Patient Hospital Services 10% after deductible 30% after deductible
Prescription Drugs:
Retail (30 day supply)
generic/brand/non-brand/specialty
$10/$35/ $70/25% Max $250 50% after deductible; Min $70
Mail Order (90 day supply)
generic/brand/non-brand/specialty
$20/$105/$210/25% Max $250 Not Covered
Employee Bi-Weekly Costs:
Employee Only $50
Employee + Spouse $105
Employee + Child(ren) $95
Family $156