MEDICAL & PRESCRIPTION

Anthem BCBS PPO with HRA

Preventive Care: The plan pays 100% for in-network preventive care.  Due to Healthcare Reform, your Anthem BCBS medical plan options cover all in-network age and gender appropriate testing at 100% with no patient responsibility.  This includes all well baby visits for newborns, child and adult vaccinations, annual physicals, and other testing such as mammograms for women over the age of 40.  Please note the provider must code these services as preventive for Anthem BCBS to apply your claim as preventive.  If you have a prior history or they are evaluating a symptom or condition, likely the visit will not be coded as preventive and you will have a patient responsibility to the cost of the claim.

Annual Deductible: For non-preventive care there is an annual deductible that must be met. The annual deductible is $6,000 for Individual coverage and $12,000 for Family coverage (Employee + 1 or more dependents) when you use in-network providers.

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 20% 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. The medical and prescription drug deductible, copayments and coinsurance all 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.

Your out-of-pocket maximum is $8,700 for Individual coverage and $17,400 for Family coverage.

Embedded Deductible and Out of Pocket Maximums:  Your plan has an embedded Deductible, which means the plan pays for Covered Services in these two scenarios — whichever comes first: *When an individual family member reaches his or her individual Deductible. At this point, only that person is considered to have met the Deductible; OR *When a combination of family members’ expenses reaches the family Deductible. At this point, all covered family members are considered to have met the Deductible.

LiveHealth Online (LHO): This is Anthem’s telemedicine option. LHO provides 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. Download the LHO flyers in the Resource Box for additional information.

Health Reimbursement Arrangement (HRA): Singles are responsible for 50% of all deductible eligible expenses.

You will be reimbursed 50% of each deductible expense, up to $3,000 and up to $1,500 in coinsurance.   You must submit your Anthem explanation of benefits (EOB) along with a claim submission into Chard Snyder to be eligible for reimbursement.

For those covering dependents, you will also be responsible for the first 50% of deductible eligible expenses. 

You will be reimbursed 50% of each deductible expense, up to $6,000 and up to $3,000 in coinsurance.  You must submit your Anthem explanation of benefits (EOB) along with a claim submission into Chard Snyder to be eligible for reimbursement.