Plans
Deductible
This is the amount you must pay each year for your covered health care and prescription drugs before the plan begins to share eligible health care costs with you. The exception is for preventive care and preventive prescriptions, which are covered before you meet your deductible.
There are separate in- and out-of-network deductibles for all three plans and they do not cross apply. If you are using providers outside of the Anthem Blue Cross and Blue Shield network, you’ll pay more for coverage, and be subject to a separate, higher deductible.
Family coverage includes coverage for Employee & Spouse/Domestic Partner, Employee & Child(ren), and Employee & Family. If you elect family coverage under the Blue or Green Plans, benefits begin once the entire family deductible is met (except for preventive care benefits and preventive prescription drugs). If you elect family coverage under the Orange Plan, benefits begin for a family member once that family member satisfies the individual deductible. Benefits begin for the entire family once the entire family deductible is met.
Blue | Green | Orange |
In-network deductible (individual/family)
Out-of-network deductible (individual/family) | In-network deductible (individual/family)
Out-of-network deductible (individual/family) | In-network deductible (individual/family)
Out-of-network deductible (individual/family) |
The individual deductible must be met before benefits begin for the individual.
The entire family deductible must be met before benefits begin for any covered family member. Any combination of you and/or one or more of your dependents can incur expenses to meet the family deductible. | The individual deductible must be met before benefits begin for the individual. The entire family deductible must be met before benefits begin for any covered family member. Any combination of you and/or one or more of your dependents can incur expenses to meet the family deductible. | The individual deductible must be met before benefits begin for the individual. Benefits begin for a family member once that family member satisfies the individual deductible. Benefits begin for the entire family once the entire family deductible is met. Any combination of you and/or one or more of your dependents can incur expenses to meet the family deductible. |
Coverage Level
Per-Paycheck Contribution
Coinsurance
Under the BLUE Plan option, you pay: In-network - 20% Out-of-network - 40% | Under the GREEN Plan option, you pay: In-network - 20% Out-of-network - 40% | Under the ORANGE Plan option, you pay: In-network - 10% Out-of-network - 30% |
You can see if your provider participates in the network by visiting Anthem.com.
To compare costs and quality in-network covered services and prescriptions, visit Anthem.com to access the Find Care tool.
Out-of-Pocket Maximum
For example, if you spend $200 on in-network services under the Green Plan, Employee-only plan, this $200 applies to your $1,700 in-network deductible and $4,200 in-network out-of-pocket maximum, and won’t apply to your out-of-network deductible or out-of-pocket maximum.
Blue | Green | Orange |
The Blue Plan out-of-pocket maximums are (individual/family): In-network - $3,450/$6,900 Out-of-network - $6,450/$12,900 | The Green Plan out-of-pocket maximums are (individual/family): In-network - $4,200/$8,400 Out-of-network - $7,200/$14,400 | The Orange Plan out-of-pocket maximums are (individual/family): In-network - $4,800/$9,600 Out-of-network - $7,800/$15,600 |
If you elect Family coverage under the Blue health plan, there is no individual out-of-pocket maximum. Claims will be paid at 100% by the Plan only when the family out-of-pocket maximum is met. Any combination of you and/or one or more of your dependents can incur expenses to meet the family out-of-pocket maximum. | Once the individual out-of-pocket maximum is reached by one family member, claims for that individual will be paid at 100%. Once the family’s combined expenses reach the family out-of-pocket maximum, claims will be paid at 100% for all covered family members’ eligible expenses for the remainder of the calendar year. | Once the individual out-of-pocket maximum is reached by one family member, claims for that individual will be paid at 100%. Once the family’s combined expenses reach the family out-of-pocket maximum, claims will be paid at 100% for all covered family members’ eligible expenses for the remainder of the calendar year. |
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