You have options to choose the right medical plan to take care of your health based on your needs.
Broad Network of Providers
You have access to the Anthem BCBS extensive network of providers. These providers contract with Anthem to provide discounted rates to our associates. The HD Value Plan, HD Standard Plan and PPO Plan all utilize this network.
Pre-Tax Savings Accounts
If you enroll in the HD Value Plan, HD Standard Plan or the PPO Plan, you may contribute to a Flexible Spending Account. And, if you enroll in the HD Value Plan or HD Standard Plan, you also may contribute to a Health Savings Account.
Prescription Drug Coverage
When you enroll in a medical plan, you automatically receive prescription drug benefits. Preventive medications are covered according to the plan you elect and are not subject to the deductible.
Additional Anthem Programs Available
When you enroll in the HD Value, HD Standard or PPO Plan, you have access to many Anthem programs to help you and your family through your life journeys. Check out the programs.
Use the Summary of Benefits and Coverage (SBC) for each medical plan which provide detailed information about coverage and costs to help you compare plans and make informed decisions.
The HD Value Plan, HD Standard Plan and PPO Plan provide:
When choosing the plan right for you and your needs, consider the following differences:
You may consider the...
Compare here! Use the Medical Plan Cost Estimator to see your health costs under each medical plan option.
Compare and contrast your medical plan options using the chart below.
Coverage Level | HD Value Plan | HD Standard Plan | PPO Plan |
---|---|---|---|
Associate only | $50.50 | $78.50 | $115.00 |
Associate + spouse/domestic partner | $105.50 | $158.00 | $230.50 |
Associate + child(ren) | $93.50 | $142.50 | $206.50 |
Family | $145.00 | $219.00 | $319.50 |
HD Value Plan | HD Standard Plan | PPO Plan | |
---|---|---|---|
Health Savings Account (HSA) company contribution |
$400 single
$500 family
|
$400 single
$500 family
|
N/A |
Deductible |
$3,500 single
$7,000 family
|
$2,500 single
$5,000 family
|
$600 single
$1,200 family
|
Coinsurance |
Plan pays 70%
You pay 30%
|
Plan pays 80%
You pay 20%
|
Plan pays 80%
You pay 20%
|
Out-of-pocket Maximum |
$6,750 single
$13,500 family
|
$5,000 single
$10,000 family
|
$3,000 single
$6,000 family
|
PCP/Specialist Visit |
After you meet your deductible:
Plan pays 70%
You pay 30%
|
After you meet your deductible:
Plan pays 80%
You pay 20%
|
$25 copay for PCP
$50 copay for specialist
(does not apply to deductible)
|
Prescription Drug Deductible | Included in medical deductible | Included in medical deductible | Included in medical deductible |
Prescription Drug Out-of-pocket Maximum | Included in medical out-of-pocket maximum | Included in medical out-of-pocket maximum | Included in medical out-of-pocket maximum |
Retail (30-day supply) |
Plan pays 70%
You pay 30%
|
Plan pays 80%
You pay 20%
|
Generic: $10 copay
Preferred: $30 copay
Non-preferred: $60 copay
Specialty: $100 copay
|
Mail order (90-day supply) |
Plan pays 70%
You pay 30%
|
Plan pays 80%
You pay 20%
|
Generic: $20 copay
Preferred: $60 copay
Non-preferred: $120 copay
Specialty: $200 copay
|
Eligible for an FSA | You can elect and contribute to the Limited Purpose FSA and use it to pay for eligible dental and vision care | You can elect and contribute to the Limited Purpose FSA and use it to pay for eligible dental and vision care | You can elect and contribute to the Health Care FSA and use it to pay for eligible medical, dental and vision care |
True family deductible: The HD Value Plan and HD Standard Plan both have a true family deductible. This means that the combined total of your covered family members’ eligible expenses is used to reach the family deductible, before coinsurance begins.
Embedded out-of-pocket maximum: The HD Value Plan and HD Standard Plan both have an embedded out-of-pocket maximum. This means that if one covered family member reaches the single out-of-pocket maximum, eligible claims for the rest of the year for that individual will be paid by the plan in full. The feature works for every covered family member until the family out-of-pocket maximum is met. Then the plan pays 100% of eligible expenses for the entire family.
Coverage for preventive prescriptions: Certain preventive prescriptions are covered at the levels below with no deductible requirement. These drugs are on the CDH Preventive Medicine List and the formulary drug list.
Certain prescription contraceptives for women are covered at 100% with no deductible as well.
Express Scripts uses a preferred drug list, called a formulary, which includes both generic and preferred brand-name drugs. Your cost for a specific prescription drug is based on which type of medicine you and your doctor choose. We recommend that you check the formulary list before you fill any prescriptions. Keep in mind, prescription drug prices and categories can change throughout the year and will be reflected when a change occurs.
These plans comply with Affordable Care Act (ACA) requirements to cover certain preventive items and services at a zero dollar cost share to their members.
Embedded deductible and out-of-pocket maximum: The PPO Plan has an embedded deductible and out-of-pocket maximum. This means that if one covered family member reaches the single deductible, coinsurance will begin for that individual. This feature works for every covered family member until the family deductible is met. The out-of-pocket maximum works the same way – when one of your covered family members reaches the single out-of-pocket maximum, eligible claims for the rest of the year for that individual will be paid by the plan in full. The feature works for every covered family member until the family out-of-pocket maximum is met. Then the plan pays 100% of eligible expenses for the entire family.
Formulary: A formulary is a preferred drug list that includes generic and preferred brand-name drugs. If you enroll in the HD Value Plan, HD Standard Plan or PPO Plan and receive your prescription coverage through Express Scripts, your cost for a specific prescription drug is based on the type of medicine you and your doctor choose. It’s important that you discuss your medication needs and options with your doctor to ensure you’re getting what you need at the lowest cost.
H&R Block recommends that you check the formulary list before you fill any prescriptions. Prescription drug prices and categories can change throughout the year and will be reflected as such when a change occurs.
Long-term maintenance medications: You can choose how you want to fill your long-term maintenance medications. You can either have a 90-day supply of your medication sent to your home through mail order, or you can pick up a 30-day supply of your medication at your retail pharmacy.
If you choose home delivery for 90-day refills, you’ll pay the lowest price for your medication through deeper discounts. On average, you save about 25% on costs when you fill long-term prescriptions through mail order versus a retail pharmacy. You will not be able to fill a 90-day prescription at a retail pharmacy; only 30-day supplies can be purchased at a retail pharmacy.
You can fill a 30-day prescription for a long-term maintenance drug twice at a retail pharmacy, covered by the plan with the standard coinsurance or co-pay. After two retail pharmacy fills, if you don’t switch to home delivery, you will pay full price.
Generic medications: You are encouraged to use generic medications as an effective cost-saving step. If a generic equivalent medication is available and you choose a brand-name drug instead, you will pay the cost for the brand-name drug, but only the cost for the generic equivalent will apply toward your deductible. This penalty will not apply if your physician requests a brand-name drug and writes “dispense as written” on your prescription.
Prior authorization: Certain medications may require approval from Express Scripts to be covered by your medical plan. Your doctor will make a recommendation that will have to be approved by Express Scripts. The list of medications subject to prior authorization is reviewed and updated each year. Learn more here.
Step therapy: Step therapy is a process by which a lower-priced medication that is effective to meet your care and financial needs is recommended before stepping up to one that costs more. Here’s an example of step therapy. Let’s say you have allergies. You should first try using an over-the-counter medication. If that doesn’t help you, you’re encouraged to try a tier 1 medication, which is less expensive than tier 2 or tier 3 medication. If that doesn’t work, we’ll review if you met the step therapy requirements before your plan will help pay for a tier 2 or tier 3 medication. Review the list of medical conditions that require step therapy. Learn more here.
If you are an associate living in Hawaii, you may only enroll in the Kaiser Permanente HMO. Learn more about the Kaiser Permanente HMO Plan.
If you select the Kaiser HMO in Hawaii, you and your covered dependents will automatically receive prescription drug coverage administered by Kaiser. Prescription drugs are covered as part of your medical plan when filled at a Kaiser Permanente Pharmacy (located in most Kaiser Permanente clinics), at a pharmacy your plan designates, or through the Kaiser Permanente Mail-Order Pharmacy (for long-term maintenance medication). If you fill a prescription from a non-Kaiser Permanente pharmacy, you will be responsible for 100% of the charges.
This plan complies with the ACA requirements to cover certain preventive items and services at zero dollar cost share to its members.
More information about the Kaiser Permanente prescription drug program is available on the Kaiser website or by calling 808-643-7979.
Formulary: A formulary is a preferred drug list that includes generic and preferred brand-name drugs. If you enroll in the Kaiser HMO and receive your prescription coverage through Kaiser Permanente, your cost for a specific prescription drug is based on the type of medicine you and your doctor choose.
H&R Block recommends that you check the formulary list before you fill any prescriptions. Even though nonformulary drugs are generally not covered under your prescription drug plan, your Kaiser Permanente physician can sometimes request a nonformulary drug for you, specifically when formulary alternatives have failed or use of nonformulary drug is medically necessary, provided the drug is not excluded by your plan.
H&R Block recommends that you check the formulary list before you fill any prescriptions. Prescription drug prices and categories can change throughout the year and will be reflected as such when a change occurs.
Generic medications: You are encouraged to use generic medications as an effective cost-saving step. If you want a brand-name or specialty drug for which there is a generic equivalent, or if you request a nonformulary drug, you will pay 100% of the charges since they are not covered.
Well Rx Program: The Well Rx Program is a program that provides members who meet specific eligibility criteria with certain chronic disease drugs or diabetes supplies without charge.
Find more details about the Kaiser HMO in the Summary of Benefits and Coverage.