Coverage Highlights

  • For medical and Hospital care, the Plan uses the nationwide Anthem Blue Cross Preferred Provider Organization (PPO), which includes the nationwide BlueCard PPO network.
  • For most services, once you meet your annual Deductible, you pay a percentage of the cost, called your Coinsurance. 
  • Effective January 1, 2021, the Plan’s annual Deductible combines medical and Hospital care.
  • Once you reach the Plan’s annual out-of-pocket maximum for In-Network services, the Plan pays 100% of Covered Expenses In-Network. (Effective January 1, 2021, there is no cap on Out-of-Network service expenses that you are responsible for.)
  • For outpatient care, the Plan will pay benefits based on whether you received care from an In-Network Provider or an Out-of-Network Provider. Visit a Provider that participates in Anthem’s BlueCard PPO network or TIHN and, generally, you’ll save money on your care. PPO Providers have agreed to accept lower, negotiated rates for their services.
  • For inpatient Hospital care, you must use an In-Network facility, or you will not receive coverage —except in an emergency.
  • For inpatient and alternative levels of care for mental health and substance use disorder care, you must use facilities within the Beacon Health Options network, except for emergencies.
  • Caremark, Delta Dental and VSP provide the networks for pharmacy, dental and vision care respectively.