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Benefits Anthem Blue Access Core PPO Plan

 Coverage - 2014 Rates - Forms/Documents

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 Dates

  • Wednesday, Jan 22
  • Tuesday, Feb 18
  • Thursday, Feb 20
  • Wednesday, Mar 19
  • Tuesday, Apr 15
  • Thursday, Apr 17
  • Wednesday, May 14
  • Tuesday, June 17
  • Thursday, June 19
  • Wednesday, July 23
  • Tuesday, Aug 19
  • Thursday, Aug 21
  • Wednesday, Sep 24
  • Tuesday, Oct 21
  • Thursday, Oct 23
  • Wednesday, Nov 19
  • Tuesday, Dec 9
  • Thursday, Dec 11