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Medical – Anthem Blue Cross, continued
High Deductible Health Plan (HDHP)
In-Network
Out-Of-Network
(Coinsurance % of UCR, PLUS anything
over UCR)
Annual Deductible
Individual
Family
$2,000
$4,000
$4,000 (combined with in-network)
$8,000 (combined with in-network)
Annual Out-of-Pocket Max
Individual
Family
$4,000
$8,000
$8,000 (combined with in-network)
$16,000 (combined with in-network)
Lifetime Max
Unlimited
Unlimited
Office Visit
Primary Provider
Plan pays 80% after deductible
Plan pays 60% after deductible
Specialist
Plan pays 80% after deductible
Plan pays 60% after deductible
Telemedicine
LiveHealth Online
Plan pays 80% after deductible
Not Covered
Preventive Services
Plan pays 100%
Plan pays 60% after deductible
Chiropractic Care
Plan pays 80% after deductible
Plan pays 60% after deductible
Lab and X-ray
Plan pays 80% after deductible
Plan pays 60% after deductible
Inpatient Hospitalization
Plan pays 80% after deductible
Plan pays 60% after deductible
Outpatient Surgery
Plan pays 80% after deductible
Plan pays 60% after deductible
Urgent Care
Plan pays 80% after deductible
Plan pays 60% after deductible
Emergency Room
Plan pays 80% after deductible
Plan pays 80% after deductible;
Non-Emergency (No Admission):
Plan pays 60% after deductible