ANTHEM PPO 750
The Anthem PPO offers lower out-of-pocket costs in exchange for higher paycheck contributions. With this plan, your costs are more predictable, but you’ll likely still have out-of-pocket expenses. 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
- Copay: You pay a small fee at the time of service for in-network doctor visits and prescriptions. Copays count towards your deductible.
- 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.
Keep in mind
You pay nothing for in-network preventive care — it’s covered in full.
Contact Info
Documents
Anthem PPO 750
| Anthem PPO | ||
|---|---|---|
| In-Network | Out-of-Network | |
| Annual Deductible | ||
| Individual | $750 | $1,500 |
| Family | $2,250* | $4,500* |
| Out of Pocket Maximum | ||
| Individual | $3,750 | $8,000 |
| Family | $7,750 | $17,000 |
| Coinsurance | 20% | 40% |
| Services | ||
| Preventive Care | Covered 100%; deductible waived | Not covered |
| Office Visit - PCP | $25 copay; deductible waived | 40%; after deductible |
| Office Visit - Specialist | $40 copay; deductible waived | 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 | $25 copay; deductible waived | 40%; after deductible |
| Emergency Room | 20% + $150 copay; deductible waived (20% +$250 copay; after deductible, if non-emergency) | 20% + $150 copay; deductible waived (40% +$250 copay; after deductible, if non-emergency) |
| Ambulance | 20%; after deductible | |
| Physical Therapy | $40 copay; deductible waived | 40%; after deductible |
| Chiropractic | $40 copay; deductible waived | 40%; after deductible |
| Pharmacy Benefits (provided by Express Scripts) | ||
| Pharmacy - Retail | ||
| Generic | $10 | 50%; after deductible |
| Preferred | $30 | |
| Non-Preferred | $55 | |
| Pharmacy - Mail Order | ||
| Generic | $20 / $60 / $110 through ESI or CVS | Not covered |
| Preferred | ||
| Non-Preferred | ||
| Specialty Drugs | ||
| 30% (min $150 / max $360) | 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 ($750 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.