How the Plan Works

Review terms related to the health plan to help you better understand how each plan works.

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.

BlueGreenOrange

In-network deductible (individual/family)
$950/$1,900

 

Out-of-network deductible (individual/family)
$1,950/$3,900

In-network deductible (individual/family)
$1,700/$3,400

 

Out-of-network deductible (individual/family)
$2,700/$5,400

In-network deductible (individual/family)
$2,800/$5,600

 

Out-of-network deductible (individual/family)
$3,800/$7,600

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

You can choose coverage for Employee-only, Employee & Spouse/Domestic Partner, Employee & Children, or Employee & Family.

Per-Paycheck Contribution

This is the amount that is deducted from each of your paychecks for your health plan coverage. Under the Blue Plan, you pay a higher per paycheck contribution and a lower deductible as compared to the Green and Orange Plans. Under the Orange Plan, your per paycheck contribution is the lowest but with the highest deductible, as compared to the Blue and Green Plans.

Coinsurance

This is the percentage of the cost that you pay for covered health care and prescription drugs after you've met the deductible.
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%

Providers in the Anthem Blue Cross and Blue Shield network have agreed to specific prices for covered services. It costs less to use providers in the network. You will pay higher coinsurance when you use out-of-network providers. If you choose to visit an out-of-network provider, the visit will be subject to the separate out-of-network deductible and coinsurance. In addition, out-of-network doctors may charge more than Reasonable and Customary (R&C) charges, and you will be responsible for any charges that are above the R&C amount.

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

This is the most you will pay out of your pocket in a given calendar year for your deductible and coinsurance. When you reach the out-of-pocket maximum, the plan begins paying 100% for eligible covered services for the remainder of that calendar year. For all plan options, there are separate deductible and out-of-pocket maximums for your in-network and out-of-network utilization. They do not cross-apply.

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.
BlueGreenOrange
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.
Certain medical services require precertification for you to receive benefits. To precertify, contact Anthem Blue Cross and Blue Shield at 1-855-285-4212. Note: If precertification is not required, it does not mean that a service will necessarily be covered. Please see the Summary Plan Description for a list of covered services and exclusions, and the Medical page to see the list of Services Requiring Precertification.