Medical Plans

All three medical plan options:

  • Use the same Anthem network of providers
  • Cover in-network preventive care at 100%
  • Offer telehealth visits at no cost
  • Include prescription drug coverage
  • Administer mail-order prescriptions by Carelon Rx

Anthem Contact Info

  • Group#: W29725
  • Medical: 833.578.4443
  • 24/7 NurseLine: 800.337.4770
  • Visit: anthem.com

To get the Sydney Health App, scan this QR code using your smartphone camera.

HDHP $3,400

This is the middle plan when it comes to deductibles. All in-network services are covered 100% after you meet your deductible.

Is a High Deductible Health Plan which means:

  • You’ll pay the cost of services, including prescriptions, until you meet the deductible.
  • To help pay for those costs, you can set aside money in a tax-advantaged Health Savings Account (HSA) or save these funds for future needs.

HDHP $3,800

Good option if you’re looking to pay a lower premium. This plan has the highest deductible and out-of-pocket maximum. All in-network services are covered 80% after you meet your deductible.

Is a High Deductible Health Plan which means:

  • You’ll pay the cost of services, including prescriptions, until you meet the deductible.
  • To help pay for those costs, you can set aside money in a tax-advantaged Health Savings Account (HSA) or save these funds for future needs.

PPO $2,800

This plan costs the same as the $3,400 HDHP and has a copay for office visits as well as for most prescription drugs.

  • All in-network services are covered 80% after you meet your deductible.
  • Copays for prescriptions and office visits do not apply toward your deductible.
  • Is a PPO Plan which means:
    • To help pay for out-of-pocket costs, you can set aside money in a tax-advantaged Healthcare FSA to pay for IRS-approved medical expenses. Be careful to plan your FSA election carefully because any funds left in your account will be forfeited.

Medical Coverage At-A-Glance

HDHP $3,400 HDHP $3,800 PPO $2,800
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Deductible

Individual $3,400 $6,800 $3,800 $7,600 $2,800 $5,600
Family $6,800 $13,600 $7,600 $15,200 $5,600 $11,200
Annual Out-of-Pocket Limit

Individual $3,400 $6,800 $7,600 $15,200 $5,600 $11,200
Family $6,800 $13,600 $15,200 $30,400 $11,200 $22,400
Office Visit/Exam 100% after deductible 70% after deductible 80% after deductible 60% after deductible $40 Copay (Primary)
$60 Copay (Specialist) 		60% after deductible
Telehealth Visit $0 Copay; deductible waived Not covered $0 Copay; deductible waived Not covered $0 Copay Not covered
Coinsurance 100% after deductible 70% after deductible 80% after deductible 60% after deductible 80% after deductible 60% after deductible
Allergy Injections 100% after deductible 70% after deductible 80% after deductible 60% after deductible $10 Copay 60% after deductible
Allergy Testing 100% after deductible 70% after deductible 80% after deductible 60% after deductible 80% after deductible 60% after deductible
Diagnostic Testing 100% after deductible 70% after deductible 80% after deductible 60% after deductible No charge 60% after deductible
Emergency Room Services 100% after deductible 100% after deductible 80% after deductible 80% after deductible 80% after deductible 80% after deductible
Urgent Care Services 100% after deductible 70% after deductible 80% after deductible 60% after deductible $40 Copay 60% after deductible
Inpatient Professional Services 100% after deductible 70% after deductible 80% after deductible 60% after deductible 80% after deductible 60% after deductible
Inpatient Facility Services 100% after deductible 70% after deductible 80% after deductible 60% after deductible 80% after deductible 60% after deductible
Outpatient Professional
Services/Surgery/Facility		 100% after deductible 70% after deductible 80% after deductible 60% after deductible 80% after deductible 60% after deductible
Wellness/Preventive (including immunizations and screenings)
Well Child Visit Covered in full Covered in full Covered in full Covered in full Covered in full Covered in full
Adult Routine Screening Covered in full Covered in full Covered in full Covered in full Covered in full Covered in full
Prescription Drugs
Generic 100% after deductible 50% after deductible 80% after deductible 50% after deductible $10 copay 50% after deductible
Brand Formulary 100% after deductible 50% after deductible 80% after deductible 50% after deductible $50 copay 50% after deductible
Brand Non-Formulary 100% after deductible 50% after deductible 80% after deductible 50% after deductible $100 copay 50% after deductible
Specialty 100% after deductible 50% after deductible 80% after deductible 50% after deductible $200 copay 50% after deductible
Preventive Generic Maintenance Covered in full 70% after deductible Covered in full 60% after deductible Covered in full 50% after deductible

Learn about how to save money on prescriptions. See page 14 in your Benefits Guide.

Employee Bi-Weekly Rates Per Pay Period

The costs below do not include the $75 per pay period spousal surcharge or wellness discount, if applicable.

HDHP $3,400 HDHP $3,800 PPO $2,800
Employee $112.72 $104.52 $112.72
Employee + spouse $285.30 $252.38 $285.30
Employee + child(ren) $236.36 $210.46 $236.36
Family $323.99 $285.49 $323.99