Medical and Pharmacy Coverage
USRN Partners offers the following plans through Anthem and offers “in and out-of-network” benefits.
Insurance Carrier:
Anthem Medical Insurance
Medical Plan:
Plan 2
Plan 3 - HSA
Plan 1
In-Network: Office Visit Copay - Primary Care
$10 - $30 Copay
$20 - $40 Copay
$0 Copay
Office Visit Copay - Specialist Care
$30 - $50 Copay
$40 - $70 Copay
$0 Copay
Urgent Care Copay
$100 Copay
$100 Copay
$100 Copay
Emergency Room Care
$350 Copay
$350 Copay
60% Coinsurance
Preventative Visit Copay
$0
$0
$0
Diagnostic Testing & Blood Work
$0
$0
60% Coinsurance after deductible
Imaging
90% - 100% after deductible is met
80% - 90%
60% Coinsurance after deductible
Coinsurance
90% - 100% after deductible is met
80% - 90%
60%
Employee Deductible
$750 - $1,000
$1,000 - $1,500
$3,000
Family Deductible
2x the amount of employee
2x the amount of employee
$6,000
Employee Out-of-Pocket Max
2x the amount of employee
2x the amount of employee
$3,000
Family Out-of-Pocket Max
2x the amount of employee
2x the amount of employee
$6,000
Inpatient Hospital
90% - 100% after deductible is met
80% - 90%
60% Coinsurance after deductible
Outpatient Hospital or Facility
90% - 100% after deductible is met
80% - 90%
60% Coinsurance after deductible
Out-of-Network: Coinsurance
90% - 100% after deductible is met
80% - 90%
60%
Employee Deductible
$750 - $1,000
$1,000 - $1,500
$3,000
Family Deductible
2x the amount of employee
2x the amount of employee
$6,000
Employee Out-of-Pocket Max
$750 - $1,000
$1,000 - $1,500
$3,000
Family Out-of-Pocket Max
2x the amount of employee
2x the amount of employee
$6,000
Prescription Drugs: ( 30 Day Supply) Tier 1 - Generic
$10 Copay
$10 Copay
$10 Copay
Tier 2 - Preferred
$45 Copay
$45 Copay
$40 Copay
Tier 3 - Non-Preferred
$90 Copay
$90 Copay
$70 Copay
Tier 4 - Specialty
25% Coinsurance
25% Coinsurance
25% Coinsurance
Per Pay Period
Employee Only
$57.90 $171.21 $154.21 $267.52
$54.26 $160.29 $144.39 $250.43
$43.82 $128.98 $116.21 $201.37
Employee + Spouse Employee + Child(ren)
Family
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USRN PARTNERS 2022 BENEFITS GUIDE
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