Medical and Pharmacy Coverage
Sterling Estates offers the following Medical plans through Anthem BlueCross BlueShield and offers “In and Out-of-Network” benefits. Insurance Carrier:
Anthem BlueCross BlueShield Medical Insurance
Medical Plan:
$1,500 / 20% Coinsurance Plan
In-Network: Office Visit Copay - Primary Care Office Visit Copay - Specialist Care
$30 $60 $75
Urgent Care Copay Emergency Room Care Preventative Visit Copay
$350; then 20% Coinsurance
$0
Diagnostic Testing & Blood Work (Office)
$60
Imaging
Deductible; then 20% Coinsurance
Coinsurance
80%
Employee Deductible Family Deductible
$1,500 $4,500 $4,500 $9,000
Employee Out-of-Pocket Max Family Out-of-Pocket Max
Inpatient Hospital
Deductible; then 20% Coinsurance Deductible; then 20% Coinsurance
Outpatient Hospital or Facility
Out-of-Network: Coinsurance Employee Deductible
50%
$4,500 $13,500 $13,500 $27,000
Family Deductible
Employee Out-of-Pocket Max Family Out-of-Pocket Max
Prescription Drugs: ( 30 Day Supply) Tier 1 - Typically Generic Tier 2 - Typically Preferred Brand Tier 3 - Typically Non-Preferred Brand
$15 $35 $60
Tier 4 - Typically Specialty
25% Coinsurance up to $350
Employee Semi-Monthly Deduction Employee Only
$68.75 $247.50 $178.75 $247.50
Employee + Spouse Employee + Child(ren)
Family
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STERLING ESTATES 2023 BENEFITS GUIDE
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