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Benefits Anthem Blue Access Buy-Up PPO Plan -
Available to Current Participants Only

Introduction - Coverage - 2014 Rates - Forms/Documents

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

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 - $300 individual and $600 family
    • Non-network - $600 individual and $1,200 family
  • Out-of-pocket maximum
    • Network - $2,000 individual and $4,000 family
    • Non-network - $4,000 individual and $8,000 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; $70 Tier 4
    • Mail Order (90-day supply)
      • $20 Tier 1; $48 Tier 2; $80 Tier 3

Anthem Buy-Up 2014 Summary of Benefit Coverage (SBC)

Anthem Buy-Up 2014 Plan Certificate

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Anthem Buy-Up PPO Rates for Plan Year 2014

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

2014 Rates Employee's Bi-weekly Premium Employee's Monthly Premium
Single Plan $111.70 $223.40
Employee + Child(ren) $185.20 $370.40
Employee + Spouse $245.81 $491.62
Family Plan $306.15 $612.30

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