ANTHEM PPO 6000
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.
How the Anthem PPO Works
- Lower premiums, higher deductible. Your deductible is considerably higher, but you also have lower premiums.
- Deductible: For care that doesn’t charge a copay, such as hospital services, you pay 100% of the costs until you meet the annual deductible.
- Coinsurance: After meeting the deductible, you and the plan share the cost of certain services, with the plan paying the majority.
- Out-of-Pocket Maximum: You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.
Access to LiveHealth Online.
You can connect virtually with a board-certified doctor any time, and from anywhere. This service is available through your Anthem medical plan, and you'll pay a copay until the deductible is met, then coinsurance will apply. Access LiveHealth Online today. LiveHealth Online is available on all Anthem plans (amounts the person pays varies by plan).
Important note for Massachusetts residents: The Anthem 6000 Plan doesn’t meet the Massachusetts state requirements for residents to have Creditable Coverage for health care. If you live in Massachusetts, you may want to choose a different coverage option in order to avoid the Massachusetts penalty for not having Creditable Coverage.
Keep in mind
You pay nothing for in-network preventive care — it’s covered in full.
Contact Info
Documents
Anthem PPO 6000
| Anthem 6000 | ||
|---|---|---|
| In-Network | Out-of-Network | |
| Annual Deductible | ||
| Individual | $6,000 | $24,450 |
| Family | $12,000* | $48,900* |
| Out of Pocket Maximum | ||
| Individual | $8,550 | $24,450 |
| Family | $17,100 | $48,900 |
| Coinsurance | 30% | None |
| Services | ||
| Preventive Care | Covered 100%; deductible waived | Not covered |
| Office Visit - PCP | 30%; after deductible | 0%; after deductible |
| Office Visit - Specialist | 30%; after deductible | 0%; after deductible |
| X-ray | 30%; after deductible | 0%; after deductible |
| Laboratory | 30%; after deductible | 0%; after deductible |
| Diagnostic Complex Imaging | 30%; after deductible | 0%; after deductible |
| Inpatient Hospitalization | 30%; after deductible | 0%; after deductible |
| Outpatient - Ambulatory Surgical Center | 30%; after deductible | 0%; after deductible |
| Outpatient - Hospital | 30%; after deductible | 0%; after deductible |
| Urgent Care | 30%; after deductible | 0%; after deductible |
| Emergency Room | 30%; after deductible | 30%; after deductible |
| Ambulance | 30%; after deductible | 30%; after deductible |
| Physical Therapy | 30%; after deductible | 0%; after deductible |
| Chiropractic | 30%; after deductible | 0%; after deductible |
| Pharmacy Benefits (provided by Express Scripts) | ||
| Pharmacy - Retail | ||
| Generic | 30%; after deductible | 0%; after deductible |
| Preferred | ||
| Non-Preferred | ||
| Pharmacy - Mail Order | ||
| Generic | 30%; after deductible through ESI or CVS | Not covered |
| Preferred | ||
| Non-Preferred | ||
| Specialty Drugs | ||
| 30%; after deductible | Not covered | |
| *Family amount can be satisfied by any combination of family members but an Individual would never be greater than their own Individual amount ($6000 In-Network) | ||
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.