Medical Benefits Plan Comparison
Anthem PPO w/HSA
Anthem PPO
In-Network
Out-of-Network
In-Network
Out-of-Network
Annual Deductible
$3,000/$6,000
$6,000/$12,000
$1,000/$2,500
$2,000/$5,000
Annual Out-of- Pocket Maximum
$5,000/$10,000
$10,000/$20,000
$3,000/$7,500
$6,000/$15,000
20% Coinsurance after Ded.
40% Coinsurance after Ded.
$25 Copay; Ded. Does not apply
40% Coinsurance after Ded.
Primary Care Visit
Specialist Office Visit
20% Coinsurance after Ded.
40% Coinsurance after Ded.
$40 Copay; Ded. Does not apply
40% Coinsurance after Ded.
20% Coinsurance after Ded.
40% Coinsurance after Ded.
$50 Copay; Ded. Does not apply
Urgent Care Visit
Covered as In-Network
20% Coinsurance after Ded.
40% Coinsurance after Ded.
Prescription Drug
$10/$35/$70
Not covered
Emergency Room
20% Coinsurance after Ded.
$150 Copay per visit; Ded. Does not apply
20% Coinsurance after Ded.
40% Coinsurance after Ded.
10% Coinsurance after Ded.
40% Coinsurance after Ded.
Inpatient Services
20% Coinsurance after Ded.
40% Coinsurance after Ded.
10% Coinsurance after Ded.
40% Coinsurance after Ded.
Outpatient Services
Outpatient Lab and X-ray
20% Coinsurance after Ded.
40% Coinsurance after Ded.
10% Coinsurance after Ded.
40% Coinsurance after Ded.
20% Coinsurance after Ded.
40% Coinsurance after Ded.
10% Coinsurance after Ded.
40% Coinsurance after Ded.
Radiology
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