Medical
Medical coverage offers healthcare protection for you and your family. You may visit any medical provider you choose, but in-network providers offer the highest level of benefits and lower out-of-pocket costs. Network providers charge members reduced, contracted fees instead of their typical fees. Providers outside the plan’s network set their own rates, so you may be responsible for the difference if a provider’s fees are above the Reasonable and Customary (R&C) limits.
Preventive Care – like physical exams, flu shots, and screenings – is always covered 100% when you use in-network providers. The key difference between the plans is the amount of money you’ll pay each pay period and when you need care.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums– the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Anthem Platinum PPO
Plan Information
Plan Name: Anthem Platinum PPO
Policy Number: J12024
Effective Date: 01/01/2025
Provider Network: Anthem
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Family)
$250/$750
Out-of-Pocket Max (Individual/Family)
$3,700/$7,400
Preventive Care
$o copay
Primary Care Visit
$15 copay
Specialist Visit
$3o copay
Urgent Care
$15 copay
Emergency Room
$225 copay + 10% after deductible
Retail RX (Up to 30-Day Supply)
Tier 1
$5 copay
Tier 2
$30 copay
Tier 3
$50 copay
Mail-Order RX (Up to 90-Day Supply)
Tier 1
$10 copay
Tier 2
$75 copay
Tier 3
$125 copay
Out-of-Network
Deductible (Individual/Family)
$2,000/$4,000
Out-of-Pocket Max (Individual/Family)
$7,400/$14,800
Preventive Care
50% after deductible
Primary Care Visit
50% after deductible
Specialist Visit
50% after deductible
Urgent Care
50% after deductible
Emergency Room
$225 + 10% after deductible
Retail RX (Up to 30-Day Supply)
Tier 1
Not Covered
Tier 2
Not Covered
Tier 3
Not Covered
Mail-Order RX (Up to 90-Day Supply)
Tier 1
Not Covered
Tier 2
Not Covered
Tier 3
Not Covered
Plan Documents
Contact Information
Anthem Silver HDHP PPO
Plan Information
Plan Name: Anthem Silver HDHP PPO
Policy Number: J12024
Effective Date: 01/01/2025
Provider Network: Anthem
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Member/Family)
$2,600/$3,300/$5,200
Out-of-Pocket Max (Individual/Family)
$7,050/$14,100
Preventive Care
$0 copay
Primary Care Visit
35% after deductible
Specialist Visit
35% after deductible
Urgent Care
35% after deductible
Emergency Room
35% after deductible
Retail RX (Up to 30-Day Supply)
Tier 1
Preferred Network: $15 copay after deductible
In-Network: $20 copay after deductible
Tier 2
Preferred Network: $70 copay after deductible
In-Network: $80 copay after deductible
Tier 3
Preferred Network: $110 copay after deductible
In-Network: $120 copay after deductible
Tier 4
Preferred Network: 30% up to $250 copay after deductible
In-Network: 40% up to $250 copay after deductible
Mail-Order RX (Up to 90-Day Supply)
Tier 1
$30 copay after deductible
Tier 2
$175 copay after deductible
Tier 3
$275 copay after deductible
Tier 4
30% up to $250 copay after deductible
Out-of-Network
Deductible (Individual/Member/Family)
$5,200/$6,600/$10,400
Out-of-Pocket Max (Individual/Family)
$14,100/$28,200
Preventive Care
50% after deductible
Primary Care Visit
50% after deductible
Specialist Visit
50% after deductible
Urgent Care
50% after deductible
Emergency Room
50% after deductible
Retail RX (Up to 30-Day Supply)
Tier 1
Not Covered
Tier 2
Not Covered
Tier 3
Not Covered
Tier 4
Not Covered
Mail-Order RX (Up to 90-Day Supply)
Tier 1
Not Covered
Tier 2
Not Covered
Tier 3
Not Covered
Tier 4
Not Covered
Plan Documents
Contact Information
Anthem Gold PPO
Plan Information
Plan Name: Anthem Gold PPO
Policy Number: J12024
Effective Date: 01/01/2025
Provider Network: Anthem
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Family)
$500/$1,500
Out-of-Pocket Max (Individual/Family)
$7,900/$15,800
Preventive Care
$0 copay
Primary Care Visit
$30 copay
Specialist Visit
$60 copay
Urgent Care
$30 copay
Emergency Room
$250 copay + 20% after deductible
Retail RX (Up to 30-Day Supply)
Tier 1
$10 copay
Tier 2
$50 copay
Tier 3
$90 copay
Mail-Order RX (Up to 90-Day Supply)
Tier 1
$20 copay
Tier 2
$125 copay
Tier 3
$225 copay
Out-of-Network
Deductible (Individual/Family)
$2,000/$4,000
Out-of-Pocket Max (Individual/Family)
$15,800/$31,600
Preventive Care
50% after deductible
Primary Care Visit
50% after deductible
Specialist Visit
50% after deductible
Urgent Care
50% after deductible
Emergency Room
$250 copay + 20% after deductible
Retail RX (Up to 30-Day Supply)
Tier 1
Not Covered
Tier 2
Not Covered
Tier 3
Not Covered
Mail-Order RX (Up to 90-Day Supply)
Tier 1
Not Covered
Tier 2
Not Covered
Tier 3
Not Covered
Plan Documents
Contact Information
Kaiser Platinum HMO
Plan Information
Plan Name: Kaiser Platinum PPO
Policy Number: 345433
Effective Date: 01/01/2024
Provider Network: Kaiser
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
$0 copay
Primary Care Visit
$10 copay
Specialist Visit
$20 copay
Urgent Care
$10 copay
Emergency Room
$200 copay
Retail RX (Up to 30-Day Supply)
Tier 1
$5 copay
Tier 2
$15 copay
Mental Health (Up to 100-Day Supply)
Tier 1
$10 copay
Tier 2
$30 copay