Medical & Prescription Drugs Insured by Anthem Blue Cross Blue Shield 2024 Medical Benefit Overview
PRIMARY Plan
BASIC Plan
Network Benefits
Non-Network Benefits
Network Benefits
Non-Network Benefits
Physician Office Visit
0% after Deductible 30% after Deductible
$30 after Deductible 30% after Deductible
Specialist Office Visit
0% after Deductible 30% after Deductible
$50 after Deductible 30% after Deductible
Deductible
Embedded
Embedded
Single
$3,200
$9,000
$4,000
$12,000
Family
$6,000
$18,000
$8,000
$24,000
Coinsurance
0%
30%
0%
30%
Out-of-Pocket Maximum
Embedded
Embedded
Single
$3,200
$9,600
$5,000
$15,000
Family
$6,000
$19,200
$10,000
$30,000
Preventive Care
100% Coverage
30% after Deductible
100% Coverage
30% after Deductible
Hospital Services
0% after Deductible 30% after Deductible
0% after Deductible 30% after Deductible
Out-Patient Services
0% after Deductible 30% after Deductible
0% after Deductible 30% after Deductible
Maternity Services
0% after Deductible 30% after Deductible
0% after Deductible 30% after Deductible
Emergency Room Services
0% after Deductible
$250 after Deductible
Urgent Care Centers
0% after Deductible 30% after Deductible
$75 after Deductible 30% after Deductible
Mental & Nervous In-Patient
0% after Deductible 30% after Deductible
0% after Deductible 30% after Deductible
Out-Patient
0% after Deductible 30% after Deductible
0% after Deductible 30% after Deductible
Substance Abuse In-Patient
0% after Deductible 30% after Deductible
0% after Deductible 30% after Deductible
Out-Patient
0% after Deductible 30% after Deductible
0% after Deductible 30% after Deductible
Retail Prescription Drugs Generic
0% after Deductible 50% after Deductible
*$10 after Deductible 50% after Deductible
Preferred
0% after Deductible 50% after Deductible
*$35 after Deductible 50% after Deductible
Non-Preferred
0% after Deductible 50% after Deductible
*$75 after Deductible 50% after Deductible
Mail Order Prescription Drugs Generic
0% after Deductible
Not Covered
$25 after Deductible
Not Covered
Preferred
0% after Deductible
Not Covered
$105 after Deductible
Not Covered
Non-Preferred
0% after Deductible
Not Covered
$225 after Deductible
Not Covered
Preventive Rx Meds
Covered in full!
Covered in full!
*Retail copays for medications on the BASIC plan will be higher at Walgreens, Meijer, Rite- Aid, Sam’s Club & Costco
Medical Administration by Anthem: Anthem has negotiated discounts with a large national network of doctors and hospitals named Blue Access PPO. You will enjoy the highest level of benefits and the greatest value if you choose to receive care through the Blue Access PPO Network of providers. While it is not required that you utilize the network, the services you obtain outside of the network will be billed at a greater cost to you. You may log on to www.Anthem.com for a listing of participating providers. Please visit myCREAbenefits.com for further details
Page 3 | CREA, LLC | Plan Year 2024
This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations , and exclusions set forth in each insurance carrier or provider’s contract.
Made with FlippingBook interactive PDF creator