Medical and Pharmacy Coverage
Graves Directional Drilling offers the following Medical plans through Anthem and offers “in and out-of-network” benefits.
Insurance Carrier:
Anthem Medical Insurance
Medical Plan:
$2,500 / 10% Copay Plan $5,000 / 20% Copay Plan
$6,000 / 30% Copay Plan
In-Network: Office Visit Copay - Primary Care
$35
$35
$30
Office Visit Copay - Specialist Care
$70
$70
$70
Urgent Care Copay
$70
$75
$70
Emergency Room Care
Deductible; then $350 Copay
Deductible; then $350 Copay
Deductible; then $350 Copay
Preventative Visit Copay
$0
$0
$0
Diagnostic Testing & Blood Work
Deductible; then 10% Coinsurance
Deductible; then 20% Coinsurance
Deductible; then 30% Coinsurance
Imaging
Deductible; then 10% Coinsurance
Deductible; then 20% Coinsurance
Deductible; then 30% Coinsurance
Plan Coinsurance
90%
80%
70%
Employee Deductible
$2,500
$5,000
$6,000
Family Deductible
$5,000
$10,000
$12,000
Employee Out-of-Pocket Max
$4,500 (includes deductible)
$7,600 (includes deductible)
$8,500 (includes deductible)
Family Out-of-Pocket Max
$9,000 (includes deductible)
$15,200 (includes deductible)
$17,000 (includes deductible)
Inpatient Hospital
Deductible; then 10% Coinsurance
Deductible; then 20% Coinsurance
Deductible; then 30% Coinsurance
Outpatient Hospital or Facility
Deductible; then 10% Coinsurance
Deductible; then 20% Coinsurance
Deductible; then 30% Coinsurance
Out-of-Network: Coinsurance
50%
50%
50%
Employee Deductible
$7,500
$15,000
$18,000
Family Deductible
$22,500
$45,000
$54,000
Employee Out-of-Pocket Max
$13,500
$22,800
$25,500
Family Out-of-Pocket Max
$40,500
$68,400
$76,500
Prescription Drugs: ( 30 Day Supply) Tier 1 - Generic
$10 Copay
$10 Copay
$15 Copay
Tier 2 - Preferred
$60 Copay
$60 Copay
Deductible; then 100% Coinsurance
Tier 3 - Non-Preferred
$90 Copay
$90 Copay
Deductible; then 100% Coinsurance
Tier 4 - Specialty
20% Coinsurance up to $250
20% Coinsurance up to $250
Deductible; then 100% Coinsurance
Employee Weekly Deduction Employee Only
$33.69
$30.71
$26.25
Employee + Spouse
$107.82
$98.26
$84.00
Employee + Child(ren)
$97.71
$89.05
$76.12
Family
$171.83
$156.60
$133.87
4 GRAVES DIRECTIONAL DRILLING 2024 BENEFITS GUIDE
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