Campus Photo Campus Photo Campus Photo Campus Photo Campus Photo
Employment OpportunitiesEmployeeBenefitsCompensationResourcesPoliciesContact
Benefits Anthem Blue Access Buy-Up PPO Plan -
Available to Current Participants Only

Introduction - Coverage - 2015 Rates - Forms/Documents

Effective with the 1/1/2014 enrollment, this plan is no longer available for new enrollees, however, it remains available to everyone currently enrolled in this plan.

Coverage

Anthem Buy-Up PPO Plan Highlights

  • 100% Preventive Care Coverage
  • Deductible
    • Network - $500 individual and $1,000 family
    • Non-network - $1,000 individual and $2,000 family
  • Out-of-pocket maximum
    • Network - $2,500 individual and $5,000 family
    • Non-network - $5,000 individual and $10,000 family
  • Co-Insurance
    • Network - 80%/20%
    • Non-network - 60%/40%
  • Prescription Co-Payments - Prescription Formulary - Specialty Pharmacy
    • Retail Pharmacies (30-day supply)
      • $10 Tier 1; $24 Tier 2; $40 Tier 3; $150 Tier 4
    • Mail Order (90-day supply)
      • $20 Tier 1; $48 Tier 2; $80 Tier 3

Anthem Buy-Up 2015 Summary of Benefit Coverage (SBC)

Anthem Buy-Up 2015 Plan Certificate

Vaccine Shots 2014-2015

(top of page)

Anthem Buy-Up PPO Rates for Plan Year 2015

Blue Cross/Blue Shield Blue Access Buy-Up PPO Plan - The premium is inclusive of medical and prescription drug coverage.

2015 Rates Employee's Bi-weekly Premium Employee's Monthly Premium
Single Plan $118.74 $237.48
Employee + Child(ren) $196.86 $393.72
Employee + Spouse $261.29 $522.58
Family Plan $325.43 $650.86

For Retiree and COBRA Rates, contact a Benefits Representative.

(top of page)


Forms and Documents

Anthem Medical Enrollment Application

Anthem Employee Change Form

Anthem Tiered Drug List

Anthem Specialty Drug List

 

To learn more about the Anthem plans, visit Anthem.com.



(top of page)



Open Enrollment Dates

TIAA-CREF Representative

Lori Matthews of TIAA-CREF will hold individual appointments in the HR Training Room on the below dates. To schedule an appointment, contact 800/732-8353. 

2015-2016 Dates

  • Dec 9
  • Dec 10
  • Jan 13 & 14
  • Feb 23
  • Mar 23 & 24
  • April 19
  • May 25 & 26
  • June 21
  • Jul 20 & 21
  • Aug 23
  • Sept 21 & 22
  • Oct 18
  • Nov 16 & 17
  • Dec 6