MEDICAL COVERAGE
Graves Directional Drilling offers the following plans through Anthem.
Insurance Carrier:
Anthem Medical Insurance
Medical Plan:
$2,500 / 10% Copay Plan
$6,000 / 30% Copay Plan
In-Network: Primary Care Visits
$30 Copay $70 Copay $70 Copay
$30 Copay $70 Copay $70 Copay
Specialist Care Visits
Urgent Care
Emergency Room Care
Deductible applies; then $350 copay
Deductible applies; then $350 copay
Preventative Visit Copay Diagnostic Testing (X-Ray / Blood Work)
$0
$0
Deductible; then 10% coinsurance
Deductible; then 30% coinsurance
Advanced Imaging
Deductible; then 10% coinsurance
Deductible; then 30% coinsurance
Plan Coinsurance
90%
70%
Employee Deductible
$2,500 $5,000
$6,000
Family Deductible
$12,000
Employee Out-of-Pocket Max
$4,500 (includes deductible) $9,000 (includes deductible)
$8,500 (includes deductible)
Family Out-of-Pocket Max
$17,000 (includes deductible)
Inpatient Hospital
Deductible; then 10% coinsurance Deductible; then 10% coinsurance
Deductible; then 30% coinsurance Deductible; then 30% coinsurance
Outpatient Hospital or Facility
Out-of-Network Plan Coinsurance
50%
50%
Employee Deductible
$7,500
$18,000 $54,000 $25,000 $76,500
Family Deductible
$22,500 $13,500 $40,500
Employee Out-of-Pocket Max
Family Out-of-Pocket Max
Prescription Drugs 30-day supply Tier 1 - Generic
$10 Copay $60 Copay $90 Copay
$15 Copay
Tier 2 - Preferred
100% Coinsurance 100% Coinsurance
Tier 3 - Non-Preferred
Tier 4 - Specialty
20% Coinsurance
100% Coinsurance
Employee Weekly Deduction Employee Only
$78.97
$50.19
Employee + Spouse Employee + Child(ren)
$221.05 $201.68 $343.76
$160.62 $145.56 $255.99
Family
4 | Graves Directional Drilling 2025 Benefits Guide
Made with FlippingBook - professional solution for displaying marketing and sales documents online