MEDICAL INSURANCE
MEDICAL PLAN INFORMATION (AAUP)
ELIGIBILITY
65%+ FTE FACULTY
PLAN INFORMATION
PPO
HDHP
BLUE ACCESS PPO CARE NETWORK
IN NETWORK
OUT OF NETWORK
IN NETWORK
OUT OF NETWORK
$100 INDIVIDUAL $200 FAMILY $1,100 INDIVIDUAL $2,200 FAMILY
$400 INDIVIDUAL $800 FAMILY $1,100 INDIVIDUAL $2,200 FAMILY
$1,500 INDIVIDUAL $3,000 FAMILY $3,000 INDIVIDUAL $6,000 FAMILY
$3,000 PER PERSON $6,000 FAMILY $6,000 INDIVIDUAL $12,000 FAMILY
ANNUAL DEDUCTIBLE
ANNUAL OUT OF POCKET MAXIMUM
ANNUAL HEALTH SAVINGS ACCOUNT FUNDING (UC)
$350 – $800 EE $700 - $1,600 FAMILY
$350 – $800 EE $700 - $1,600 FAMILY
NOT APPLICABLE
NOT APPLICABLE
70% AFTER DEDUCTIBLE 70% AFTER DEDUCTIBLE
70% AFTER DEDUCTIBLE 70% AFTER DEDUCTIBLE
PREVENTIVE CARE**
COVERED 100%
COVERED 100%
90% AFTER DEDUCTIBLE
90% AFTER DEDUCTIBLE
COVERED SERVICES
TIER 1 (GREATEST VALUE): $15 TIER 2 (BRAND): $25 TIER 3 (HIGHER COST BRAND): $35 TIER 4 (SPECIALTY): 25% CO-INS, $250 MAX
90% AFTER DEDUCTIBLE IN NETWORK, 70% OUT OF NETWORK
RETAIL PHARMACY
MAIL ORDER 90 DAY SUPPLY (MANDATORY FOR MAINTENANCE MEDICATIONS)
TIER 1: $30 TIER 2: $50 TIER 3 : $70
90% AFTER DEDUCTIBLE IN NETWORK, 70% OUT OF NETWORK
EMPLOYEE CONTRIBUTION
RATES VARY BASED ON PLAN SELECTION AND TOTAL ANNUAL BASE PAY
ANTHEM
PLAN ADMINISTRATOR
FOR MORE INFORMATION: www.anthem.com
EMPLOYEES HAVE 45 DAYS TO ENROLL VIA UC Flex/ESS IF NO ELECTIONS ARE MADE WITHIN 45 DAYS, EMPLOYEES WILL BE ENROLLED IN THE PPO EMPLOYEE ONLY COVERAGE PLAN
NEXT STEPS
** AS RECOMMENDED BY THE AMERICAN MEDICAL ASSOCIATION
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