Behavior Frontiers offers five choices of medical insurance plans, two HMO plans, two PPO plans, and one High Deductible Health Plan (HDHP). Each of our medical insurance plans offer different levels of deductibles, copayments, and out-of-pocket maximums. MEDICAL
Anthem HDHP Plan A High Deductible Health Plan (H.D.H.P.) is a PPO which allow the same freedom as the other PPOs. You do not need to elect a PCP or obtain PCP-authorized referrals to specialists. You can seek medical care from both in and out-of-network providers. The difference is your overall annual contributions will be lower on the High Deductible Health Plan (HDHP) plan, you must meet the deductible before the copays and co-insurance start kicking in, which means you should expect to pay out of pocket for your prescriptions and doctor visits at the beginning of the year. The exception to this is your preventative services, which the plan will cover at 100% as long as you go to an in-network provider. The High Deductible Health Plan (H.D.H.P.) is a medical plan which allows you to open a Health Savings account
Solution HDHP (H.S.A.) Plan
Out-of-Network 1
In-Network
$3,000 single $6,000 family
$9,000 single $18,000 family $15,000 single $30,000 family
Calendar Year Deductible
$5,000 single $10,000 family
Calendar Year Out-of-Pocket Maximum
Physician Office Visit
0% after deductible
30% after deductible
Specialist Office Visit
0% after deductible
30% after deductible
LiveHealth Online
No charge
30% after deductible
Preventive Care
No Charge
30% after deductible
Urgent Care
0% after deductible
30% after deductible
Diagnostic X-Ray/Lab
0% after deductible
30% after deductible
30% after deductible
Outpatient Surgery
0% after deductible
30% after deductible $1,000 copay if no preauthorization
Inpatient Hospital
0% after deductible
Emergency Room (Waived if Admitted)
0% after deductible
Prescription Deductible
Combined with Medical Deductible $5/$15
Combined with Medical Deductible All tiers: 30% up to $250
Generic (Tier 1a/1b) Preferred (Tier 2) Non-Preferred (Tier 3) Specialty (Tier 4)
$40 $60 30% up to $250 max
Copays and coinsurance percentages shown in the above plan descriptions represent the amount paid by the member. 1. Members are responsible for all charges above Anthem’s allowable amounts when using non -network providers. 2.Additional $500 copay required if you do not receive preauthorization from Anthem for non-emergency visit
Behavior Frontiers Benefits Guide | 6
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