How the Plan Works

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.

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

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.

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

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.

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.

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.