PPO Share Plans

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More benefits to cover a wider range of needs.  
Need a lot of benefits for a growing family? Our PPO Share Plans offer:  
 
  • A choice of three deductibles: $1,500, $2,500 or $5,000 with immediate benefits for doctor visits, annual physical exams and preventive care (deductible is waived for these services.)
  • Lower rates on services when you use our PPO network of more than 50,000 doctors and 400 hospitals. This means your share of medical costs will be lower, too.
  • Maternity benefits.
  • Coverage for brand-name and generic drugs. You’ll have no deductible on generics, but you will have a separate deductible for brand-name prescriptions.
  • Health and wellness programs. Learn how to improve your health with online access to health-related information, tools and product discounts.
  • Out-of-state coverage. This protects you from the high cost of unexpected emergencies when you travel.
 
For extra security, we offer dental and life insurance plans that you can add to your medical coverage.  
 
 
 
If you have questions:
 
Benefits-at-a-glance for PPO Share Plans

 

       
Plan Benefits  
 PPO Share Plans 1500/2500/5000
In-Network Out-of-Network
Annual Deductible Choices 
Individual  
$1,500/$2,500/$5,000 per member  
Family  
Once 2 members each reach the deductible, the deductible is satisfied for the entire family  
Annual Out-of-Pocket Limit1  
(in addition to deductible, if any) 
Individual  
$4,500/$5,000/$2,500 per member  
Family  
Once 2 members each reach the out-of-pocket limit, the limit is satisfied for the entire family  
Lifetime Maximum  
Plan pays up to $5 Million per member  
 
Covered Services  
The amounts shown are your share of costs after any deductible  
 In-Network Out-of-Network
Doctors’ Office Visits  
30% of negotiated fee / $35 copay / $40 copay (deductible waived) 
50% of negotiated fee plus all excess charges (deductible waived) 
Professional Services  
(x-ray, lab, anesthesia, surgeon, etc.) 
30% of negotiated fee 
50% of negotiated fee plus all excess charges 
Hospital Inpatient 
(overnight hospital stays) 
30% of negotiated fee2 
All charges except $650 per day 
Hospital Outpatient 
(if you don’t stay overnight) 
30% of negotiated fee2 
All charges except $380 per day 
Emergency Room Services 
($100 copay applies for each visit; waived if admitted as inpatient) 
30% of negotiated fee 
30% of customary and reasonable fees plus all excess charges 
Maternity 
30% of negotiated fee 
50% of negotiated fee plus all excess charges 
Preventive Care 
(tests ordered by physician are covered, including appropriate screening for breast, cervical, ovarian, and prostate cancer) 
Adult Services 
Annual Physical exam(s)3: 30% of negotiated fee (deductible waived)  
OR HealthyCheckSM Centers: $25 / $75 copay for basic/premium screening (deductible waived)  
Routine mammogram, Pap and PSA tests: 30% of negotiated fee (deductible waived)  
50% of negotiated fee plus all excess charges (deductible waived) 
Children's Services 
Well-Child (through age 6): 40% of negotiated fee (deductible waived) 
Acupuncture / Acupressure 
All charges except $25 per visit, up to 24 visits per year (deductible waived) 
Chiropractic Services 
30% of negotiated fee 
All charges except $25 per visit 
Plan covers up to 12 visits per year 
 
Prescription Drug Coverage Options 
In-Network 
Out-of-Network 
Comprehensive Prescription Drug Coverage 
Generic: 
$10 copay  
Brand-name:  
$30/$30/$35 copay after $250/$500/$750 annual brand-name deductible (2 member max)   
50% of drug limited fee schedule and all excess charges plus the copay/coinsurance as stated for in-network benefits; subject to the $250/$500/$750 annual brand-name prescription drug deductible 
Generic Prescription Drug Coverage 
Included above 
No Prescription Drug Coverage 
Not applicable 

1. Excludes non-participating charges in excess of the Anthem Blue Cross negotiated fee and non-participating charges in excess of customary and reasonable fees for emergency care. Copays/coinsurance to participating and non-participating providers apply to annual calendar year out-of-pocket limit except where specifically noted in the policy.
2. Additional $500 admission charge at participating hospitals (no additional charge for preferred participating) is for inpatient stays or outpatient surgery or infusion therapy. The charge is not required for ambulatory surgical centers or medical emergencies.
3. Maximum annual physical exam benefit is $200 for members covered more than 6 months; $100 for members covered less than 6 months.

PPO Share Plans