B enefit E nrollment O verview
L ook inside for information about : Y our insurance plans and benefits
2023 P lan Y ear
Medical and Pharmacy Coverage
Lyle Health is proud to offer you a comprehensive benefits overview. We encourage you to take the time to review the enrollment guide prior to enrollment. Keep in mind that the benefits you select during this enrollment will be effective May 1 st , 2023.
Insurance Carrier:
Anthem BlueCross and BlueShield
Plan Type:
Platinum Pathway
Silver Pathway
In-Network: Office Visit Copay - Primary Care Office Visit Copay - Specialist Care
$10 / visit $30 / visit $100 / visit $350 / visit
$40 / visit $80 / visit $100 / visit
Urgent Care Copay Emergency Room Care
20% Coinsurance
Diagnostic Testing & Blood Work
Lab - $30 per visit / X-Ray - $10 per visit
Lab - $80 per visit / X-Ray - $40 per visit
Advanced Imaging
$75 / visit
20% Coinsurance
Coinsurance Deductible
30%
20%
$0 Individual / $0 Family
$3,000 Individual / $6,000 Family $7,000 Individual / $14,000 Family
Out-of-Pocket Max Inpatient Hospital
$2,500 Individual / $5,000 Family Deductible; then 100% Coinsurance
50% Coinsurance 50% Coinsurance
Outpatient Hospital or Facility
$500 / visit
Out-of-Network: Deductible
$2,000 Individual / $4,000 Family
$9,000 Individual / $18,000 Family
Coinsurance
50%
50% Coinsurance
Out-of-Pocket Max
$7,500 Individual / $15,000 Family
$21,000 Individual / $42,000 Family
Prescription Drugs: ( 30 Day Supply) Tier 1 - Generic
$5
50% Coinsurance 50% Coinsurance 50% Coinsurance 50% Coinsurance
Tier 2 - Preferred
$50
Tier 3 - Non-Preferred
30% Coinsurance up to $500 / Prescription 30% Coinsurance up to $1,000 / Prescription
Tier 4 - Specialty
L yle H ealth benefits overview 2
Dental Coverage
Regular dental exams can help you and your dentist detect problems in the early stages when treatment is simpler and costs are lower.
Keeping your teeth and gums clean and healthy will prevent most tooth decay and periodontal disease, and is an important part of maintaining your medical health.
Your PPO dental plan is through Anthem BlueCross and BlueShield and offers “in and out-of-network” benefits.
Insurance Carrier:
Anthem BlueCross and BlueShield
Plan Description:
Dental Insurance
Calendar Year Deductible
$50 Individual / $150 Family
Calendar Year Maximum
$1,000
Preventive Services
100%
Basic Services
80%
Major Services
50%
Orthodontia (dependent children only)
N/A
Endo/Perio
Basic
3
L yle H ealth benefits overview
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