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Benefits Anthem Blue Access Core PPO Plan

 Coverage - 2015 Rates - Forms/Documents

Coverage

Anthem Core PPO Plan Highlights

  • 100% Preventive Care Coverage
  • Deductible
    • Network - $750 individual and $1,500 family
    • Non-network - $1,500 individual and $3,000 family
  • Out-of-pocket maximum
    • Network - $4,500 individual and $9,000 family
    • Non-network - $9,000 individual and $18,000 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; $150 Tier 4
    • Mail Order (90-day supply)
      • $20 Tier 1; $80 Tier 2; $120 Tier 3

Anthem Core 2015 Summary of Benefit Coverage (SBC)

Anthem Core 2014 Plan Certificates

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Anthem Core PPO Rates for Plan Year 2015

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

2015 Rates Employee's Bi-weekly Premium Employee's Monthly Premium
Single Plan $68.28 $136.56
Employee + Child(ren) $113.30 $226.60
Employee + Spouse $150.42 $300.84
Family Plan $187.35 $374.70

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

2015 Rates Employee's Bi-weekly Premium Employee's Monthly Premium
Single Plan $58.04 $116.08
Employee + Child(ren) $96.30 $192.60
Employee + Spouse $127.85 $255.70
Family Plan $159.25 $318.50

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. 

2015 Dates

  • 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