SteelBlue Building Components - 2024 Benefits Guide - Bi-We…

Medical and Pharmacy Coverage

SteelBlue Building Components offers the following Medical plans through Anthem and offers “in and out-of-network” benefits.

Insurance Carrier:

Anthem Medical Insurance

Medical Plan:

$2,000 / 80% Buy-Up Plan

$4,000 / 80% Base Plan

In-Network: Office Visit - Primary Care

$20 Copay $50 Copay $20 Copay

$30 Copay $75 Copay $30 Copay

Office Visit - Specialist Care

Urgent Care

Emergency Room Care

$300 Copay; then coinsurance

$300 Copay; then coinsurance

Preventative Visit

$0 $0

$0 $0

Diagnostic Testing & Blood Work

Imaging

Deductible; then coinsurance

Deductible; then coinsurance

Coinsurance

80%

80%

Employee Deductible

$2,000 $4,000 $4,500 $9,000

$4,000 $8,000 $7,000 $14,000

Family Deductible

Employee Out-of-Pocket Max

Family Out-of-Pocket Max

Inpatient Hospital

Deductible; then coinsurance Deductible; then coinsurance

Deductible; then coinsurance Deductible; then coinsurance

Outpatient Hospital or Facility

Out-of-Network: Coinsurance

50%

50%

Employee Deductible

$6,000

$12,000 $24,000 $21,000 $42,000

Family Deductible

$12,000 $13,500 $27,000

Employee Out-of-Pocket Max

Family Out-of-Pocket Max

Prescription Drugs 30-day supply Tier 1 - Generic

$10 $35 $75

$10 $35 $75

Tier 2 - Preferred

Tier 3 - Non-Preferred

Tier 4 - Specialty

25% up to $350

25% up to $350

Employee Bi-Weekly Deduction Employee Only

$106.23 $224.79 $193.45 $309.45

$68.44

Employee + Spouse Employee + Child(ren)

$140.31 $120.18 $196.13

Family

4 STEELBLUE BUILDING COMPONENTS 2024 BENEFITS GUIDE

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