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Benefits Anthem Blue Access Core PPO Plan

 Coverage - 2014 Rates - Forms/Documents

For Open Enrollment 2015 information, forms and rates, please visit the Open Enrollment Page.

Coverage

Anthem Core PPO Plan Highlights

  • 100% Preventive Care Coverage
  • Deductible
    • Network - $600 individual and $1,200 family
    • Non-network - $1,200 individual and $2,400 family
  • Out-of-pocket maximum
    • Network - $4,000 individual and $8,000 family
    • Non-network - $8,000 individual and $16,000 family
  • Co-Insurance
    • Network - 80%/20%
    • Non-network - 60%/40%
  • Prescription Co-Payments
    • Retail Pharmacies (30-day supply)
      • $10 Tier 1; $40 Tier 2; $60 Tier 3; $80 Tier 4
    • Mail Order (90-day supply)
      • $20 Tier 1; $80 Tier 2; $120 Tier 3

Anthem Core 2014 Summary of Benefit Coverage (SBC)

Anthem Core 2014 Plan Certificates

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Anthem Core PPO Rates for Plan Year 2014

Blue Cross/Blue Shield Blue Access Core PPO Plan - Salary $38,000 and above ($3,166.67 monthly, $19.49 hourly)

2014 Rates Employee's Bi-weekly Premium Employee's Monthly Premium
Single Plan $64.23 $128.46
Employee + Child(ren) $106.59 $213.18
Employee + Spouse $141.50 $283.00
Family Plan $176.25 $352.50

Blue Cross/Blue Shield Blue Access Core PPO Plan - Salary below $38,000($3,166.67 monthly, $19.49 hourly)

2014 Rates Employee's Bi-weekly Premium Employee's Monthly Premium
Single Plan $54.60 $109.20
Employee + Child(ren) $90.60 $181.20
Employee + Spouse $120.28 $240.56
Family Plan $149.82 $299.64

For Retiree and COBRA Rates, contact a Benefits Representative.

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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.

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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. 

2014/2015 Dates

  • Tuesday, Dec 9
  • Thursday, Dec 11
  • Tuesday, Jan 27
  • Wednesday, Feb 25
  • Thursday, Feb 26
  • Tuesday, Mar 24
  • Wednesday, Apr 22
  • Thursday, Apr 23
  • Tuesday, May 19
  • Wednesday, June 24
  • Thursday, June 25
  • Tuesday, July 21
  • Wednesday, Aug 19
  • Thursday, Aug 20
  • Tuesday, Sep 8
  • Wednesday, Oct 21
  • Thursday, Oct 22
  • Tuesday, Nov 17
  • Wednesday, Dec 9
  • Thursday, Dec 10