ANTHEM HDHP 1500
The Anthem High Deductible Health Plan (HDHP) pairs lower-per-paycheck cost, high-deductible medical coverage with the ability to open a tax-free Health Savings Account (HSA) that also helps you save on current as well as future expenses. This combination gives you more control over your money and rewards you for making healthy, cost-conscious choices.
With this plan, you can choose any in-network or out-of-network provider each time you receive care. But keep in mind: You will generally receive higher benefits when you use in-network providers.
Key Features of a High Deductible Health Plan
- Lower premiums, higher deductible. Your deductible is higher, but you also have lower premiums.
- You may elect to participate in a Health Savings Account (HSA). See Tax-Advantaged accounts for details.
- Qualified in-network preventive care at no cost to you. For example, you pay nothing out-of-pocket for eligible in-network annual physicals, immunizations, routine cancer screenings, and more.
How it works
- You pay your initial medical care costs until you meet the annual deductible (with the exception of eligible in-network preventive care, which has no out-of-pocket costs).
- Once the deductible is met, you and the plan share costs for eligible expenses until you meet your out-of-pocket maximum. This is your coinsurance.
- If you meet the out-of-pocket maximum, the plan pays 100% of your eligible expenses for the rest of the year.
How the HDHP Works
Fund your HSA
You can set aside tax-free money from your paycheck to help cover your costs — now, or in the future.
Deductible
You pay 100% of costs until you meet the annual deductible. You can use your HSA to pay your deductible.
Coinsurance
After meeting the deductible, you and the plan share the cost of certain services, with the plan paying the majority. You can use your HSA to pay your coinsurance.
Out-of-Pocket Maximum
You’re protected with an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.
Keep in mind
You pay nothing for in-network preventive care — it’s covered in full.
Contact Info
Documents
Budgeting for your costs with a Health Savings Account (HSA)
With the HDHP, you pay less in per-paycheck costs and assume more financial responsibility when you receive care. So, it’s important to plan ahead for your out-of-pocket expenses. Here are some ideas to consider:
- Think about your costs. Contribute at least enough to your HSA to cover your expected out-of-pocket costs, such as your annual deductible and coinsurance. Remember — because you’re keeping more of your paycheck by paying lower medical plan per-paycheck costs, you may have extra money available to put in your HSA.
- Plan ahead. You can only spend HSA money that’s actually been deposited into your account. Adjust your contributions as necessary during the year to make sure you have money available when you need it. And if you don’t, remember to reimburse yourself later so you take full advantage of your HSA’s tax savings.
- Look long term. You will never forfeit any money left in your HSA — it rolls over year after year. If you know about future expenses — or if you want to save for your health care costs in retirement — set aside a little extra each paycheck so your balance can grow over time.
Money-saving Tips
Use your HSA to budget for deductibles and other out-of-pocket expenses while also saving money – your HSA contributions are tax-free! Make the most of your coverage. Take advantage of these resources to manage your care and your costs.
Anthem HDHP 1500
| Anthem HDHP | ||
|---|---|---|
| In-Network | Out-of-Network | |
| Annual Deductible | ||
| Individual | $1,500 | $2,500 |
| Family | $3,000* | $5,000* |
| Out of Pocket Maximum | ||
| Individual | $4,500 | $9,000 |
| Family | $8,150 | $18,000 |
| Coinsurance | 20% | 40% |
| Services | ||
| Preventive Care | Covered 100%; deductible waived | Not covered |
| Office Visit - PCP | 20%; after deductible | 40%; after deductible |
| Office Visit - Specialist | 20%; after deductible | 40%; after deductible |
| X-ray | 20%; after deductible | 40%; after deductible |
| Laboratory | 20%; after deductible | 40%; after deductible |
| Diagnostic Complex Imaging | 20%; after deductible | 40%; after deductible |
| Inpatient Hospitalization | 20%; after deductible | 40%; after deductible |
| Outpatient - Ambulatory Surgical Center | 20%; after deductible | 40%; after deductible |
| Outpatient - Hospital | 20%; after deductible | 40%; after deductible |
| Urgent Care | 20%; after deductible | 40%; after deductible |
| Emergency Room | 20%; after deductible (20% +$250 copay; after deductible, if non-emergency) | 20%; after deductible (40% +$250 copay; after deductible, if non-emergency) |
| Ambulance | 20%; after deductible | |
| Physical Therapy | 20%; after deductible | 40%; after deductible |
| Chiropractic | 20%; after deductible | 40%; after deductible |
| Pharmacy Benefits (provided by Express Scripts) | ||
| Pharmacy - Retail | ||
| Generic | 20%; after deductible | 40%; after deductible |
| Preferred | ||
| Non-Preferred | ||
| Pharmacy - Mail Order | ||
| Generic | 20%; after deductible through ESI or CVS | Not covered |
| Preferred | ||
| Non-Preferred | ||
| Specialty Drugs | ||
| 30%; after deductible (min $150 / max $360) | Not covered | |
| *Annual Deductible is met when total deductible is met using combined amount between all enrolled members for family coverage | ||
Prescription Drug Benefits through Express Scripts (ESI)
When you enroll in an Anthem medical plan you automatically receive prescription drug benefits through Express Scripts (ESI). All plan prescription drug benefits are administered through ESI.
Express Scripts prescription drug tiers
The cost of your prescription drugs depends on the tier of the medication:
- Generic — Generic drugs contain the same active ingredients as their brand-name equivalents and meet the same federal standards for safety, but typically cost significantly less.
- Preferred brand (or formulary) — Preferred brand name prescription drugs are favored by a prescription plan based on drug effectiveness and cost.
- Non-Preferred brand (or Non-formulary) — Non-Preferred brand name prescription drugs are not on a prescription plan's favored list (or formulary) based on drug effectiveness and cost. Non-Preferred drugs still may be covered, but may require prior authorization and cost more.
Mail order
You must use the mail order program or your local CVS pharmacy for maintenance medications, or you will pay an even higher amount or the full cost of any prescription after you fill two times at a retail pharmacy. On the third fill, you must fill your prescription in a 90-day supply either at a CVS pharmacy or through the Express Scripts Pharmacy. You can avoid paying the higher cost by choosing the three-month refill option either through home delivery from the Express Scripts Pharmacy or from a CVS pharmacy. You will pay the same copayment for your three-month supply whether you fill through home delivery from the Express Scripts Pharmacy or from a CVS Pharmacy.
Why use mail order:
- Prescriptions are shipped to you for free — no waiting in line at the pharmacy.
- You save money with a reduced cost for a three-month supply.
- You can set up automatic refills.
Save Money
The cost of prescription drugs is rising faster than many other health care services and supplies. But, there's a way for you to save on your cost of prescriptions.
Ask your doctor about generic medications. Generic medications are generally just as effective as brand-name medications, but they cost between 30% and 75% less.