Human Resources

Overview

This is a traditional PPO medical plan. Under this plan, all covered services (except emergency room, in-network urgent care, prescriptions, and transplants) are subject to the annual deductible. The deductible is a dollar amount of out-of-pocket costs you must pay each year before the plan will begin paying its share of your healthcare expenses. You pay flat-dollar copays for prescriptions and emergency/urgent care, with most other in-network services covered with a 20% coinsurance after you meet your deductible.

This plan uses the Anthem Blue Access PPO network in Indiana, the Anthem National PPO (BlueCard PPO) network in other states, and the Anthem Blue Cross Blue Shield Global Core network overseas. You can visit any provider or facility, but you receive a higher level of benefits when you use in-network providers.

2024 Cost Shares

Deductible

• In-Network: $500 individual (per member) / $1,500 family maximum
• Out-of-Network: $900 individual (per member) / $2,700 family maximum

Coinsurance

• In-Network: 20% after deductible
• Out-of-Network: 40% after deductible

Out-of-Pocket Maximum (Medical)

• In-Network: $2,400 per member / $7,200 per family
• Out-of-Network: $6,850 per member / $13,700 per family

Out-of-Pocket Maximum (Prescriptions)

• In-Network: $7,050 per member / $11,700 per family

Preventive Medical Services

• In-Network: $0 (plan pays 100% - not subject to deductible)
• Out-of-Network: 40% after deductible

In- and out-of-network deductibles and out-of-pocket maximums are separate and do not accumulate toward each other. Additionally, the out-of-pocket maximum for in-network prescriptions is separate from the medical out-of-pocket maximum.

Additional Services

The following programs are available to Anthem PPO members:

• Sydney Health App – Access your account information including claims history and ID cards, find a physician, or estimate costs for care from your smartphone or tablet 24/7.
• LiveHealth Online Telehealth – Use Anthem’s LiveHealth Online to virtually visit with an urgent, allergy, or dermatology care provider for just $59 per visit. You can also schedule virtual visits with a licensed psychologist, psychiatrist, or therapist.
• AllClear ID Protection – Identity repair, credit monitoring, and identity monitoring from AllClear ID is provided to all Anthem members at no cost. Visit allclearid.com/anthem to enroll. Renewal required annually.
• Learn to Live Emotional Well-Being – Digital support and resources to help you and your family live your happiest, healthiest lives including 1:1 coaching, support teams, webinars, and more.
• Discounts – Find discounts on products and services that help promote better health including vision and hearing services, fitness trackers, gym memberships, and more.
• Complimentary Clinical Review – If you are someone with a complex medical condition, you may want to learn as much as possible about your diagnosis, available treatment options, or a second opinion about the typical treatment plans that may be right for you. Through an exclusive offering for Anthem members, you can now receive a virtual Complimentary Clinical Review from top-ranked experts in specialties such as heart, cancer, gynecology and urology at the Cleveland Clinic. This clinical review is available to you at no extra cost.