Medical and Pharmacy Coverage
USRN Partners offers the following plans through Anthem and offers “in and out-of-network” benefits. **Please see age banded rate sheets on Page 18-19. Insurance Carrier:
Anthem Medical Insurance
Anthem Platinum Pathway $2,500 / 20%
Anthem Gold Pathway $2,000 / 20% / $5,000
Medical Plan:
In-Network: Office Visit Copay - Primary Care
$25 Copay
$20 Copay
Office Visit Copay - Specialist Care
$60 Copay
$45 Copay
Urgent Care Copay
$100 Copay
$100 Copay
Emergency Room Care
20% Coinsurance; after deductible is met
$350 Copay
Preventative Visit Copay
$0
$0
Diagnostic Testing & Blood Work
$25 Copay
$45 Copay
Imaging
$25 Copay
$45 Copay
Coinsurance
80%
100%
Employee Deductible
$2,000
$0
Family Deductible
$4,000
$0
Employee Out-of-Pocket Max
$5,000
$2,500
Family Out-of-Pocket Max
$10,000
$5,000
Inpatient Hospital
20% Coinsurance; after deductible is met
$500 Copay
Outpatient Hospital or Facility
20% Coinsurance; after deductible is met
$500 Copay
Out-of-Network: Coinsurance
50%
50%
Employee Deductible
$6,000
$2,000
Family Deductible
$12,000
$4,000
Employee Out-of-Pocket Max
$15,000
$7,500
Family Out-of-Pocket Max
$30,000
$15,000
Prescription Drugs: ( 30 Day Supply) Tier 1 - Generic
$10 Copay
$10 Copay
Tier 2 - Preferred
$60 Copay
$60 Copay
Tier 3 - Non-Preferred
30% Coinsurance up to $500
30% Coinsurance up to $500
Tier 4 - Specialty
30% Coinsurance up to $1,000
30% Coinsurance up to $1,000
Per Pay Period
**USRN will be paying 90% of your employee only medical premium based off of the Gold Plan pricing. If you decide to elect the Platinum Plan you will be responsible for the difference.
Employee Only
Employee + Spouse Employee + Child(ren) Family
**If you choose to add a spouse or dependent, USRN will pay 70% of that total premium based off the Gold Plan pricing.
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USRN PARTNERS 2023 BENEFITS GUIDE
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