Your medical coverage is provided through Anthem BlueCross BlueShield. We offer two Preferred Provider Organization (PPO) plans for our employees. Your network is determined by where you live. All plans cover in-network preventive care at no cost.
| In-Network Care | Pink Plan | Yellow Plan |
|---|---|---|
| Deductible (Individual) | $500 | $2,000 |
| Deductible (Family) | $1,000 | $4,000 |
| Out-of-Pocket Max (Individual) | $3,500 | $5,500 |
| Out-of-Pocket Max (Family) | $7,000 | $11,000 |
| Coinsurance (Plan Pays) | 80% | 80% |
| Preventive Care | Plan pays 100% | Plan pays 100% |
| Primary Care Visit | $0 copay | $0 copay |
| Urgent Care | $35 copay | $50 copay |
| Emergency Room | $250 after deductible | Plan pays 80% after deductible |
| Inpatient Hospital | $250/day (max $1,250/admission) | Plan pays 80% after deductible |
| Outpatient Surgery | $200 after deductible | Plan pays 80% after deductible |
Choosing the right level of care can save you time and money. Your network is determined by where you live:
BlueChoice Advantage Open Access: if you reside East of Route 123 in VA, MD, or DC.
HealthKeepers OA POS: if you reside West of Route 123 in VA.
National BlueCard PPO: if you reside outside of MD, VA, or DC.
If you have HealthKeepers or BlueChoice, what counts as In-Network depends on where you're getting care.
Outside your plan's service area: Use providers in the National BlueCard PPO network to be In-Network.
Inside your plan's service area: You must use a local participating provider (HealthKeepers/BlueChoice) to be In-Network.
Important exception: If you're inside the HealthKeepers/BlueChoice service area and you see a National BlueCard PPO provider, that care will be treated as Out-of-Network.
PPO and non-network deductibles do not cross-accumulate. Three members must satisfy the family deductible. If you use a non-network provider, you're responsible for any difference between the covered expense and the actual charge, in addition to copayments, coinsurance, and/or deductible amounts.
Deductible: The amount you pay out-of-pocket each year before your plan starts paying. Once you meet your deductible, the plan begins covering a share of costs.
Copay: A fixed dollar amount you pay for a covered service, like $20 for an office visit. Copays usually don't count toward your deductible.
Coinsurance: The percentage of costs you share with the plan after meeting your deductible. For example, 80/20 means the plan pays 80% and you pay 20%.
Out-of-Pocket Maximum: The most you'll pay in a year for covered services. After you reach this amount, the plan covers 100% of eligible expenses.
In-Network: Providers who have contracted with your insurance carrier to offer services at negotiated rates. You pay less when you use in-network providers.
Preventive Care: Routine services like annual physicals, screenings, and immunizations that are covered at no cost when you use in-network providers.
