Anthem Blue Cross Prudent Buyer (PPO)

The PPO plan allows you to use any provider you want.

Doctors/Health Care Providers: You can choose any doctor you want, and you can go to any hospital or pharmacy. However, you’ll pay less when you use a provider or facility that participates in the Anthem PPO network.

Preventive Care: Preventive care is 100% covered when you use in-network providers.

Annual  Deductible: You generally pay an annual deductible before the plan begins to pay for a portion of covered medical services. The only services that don’t require you to pay a deductible first are preventive care, office visits, and prescription drugs. Deductibles for In-Network care range from $300 to $600.

Paying for Care: When you receive medical care, there are two ways you pay for services:

•  Copays: When you go to an in-network doctor for an office visit, go to the emergency room, or pick up a prescription, you pay a set dollar amount called a copay. (You may need to pay the annual deductible first before the copay applies.) Copays are $20 for primary care and $40 for specialist visits.

•  Coinsurance: When you receive any other medical services, you pay a percentage of the cost of the service, and the plan pays the remaining percentage. This is called coinsurance. (You will need to pay the annual deductible first before coinsurance  applies.)

Annual Out-of-Pocket Maximum:  The PPO includes an out-of-pocket maximum. This is the maximum amount you must pay out of your own pocket (under the applicable coinsurance percentage) after meeting the deductible. Once you reach the out-of-pocket maximum, the plan pays 100% of in-network charges for the remainder of the plan year. Please note that your out-of-pocket maximum will be lower when you use in-network providers.


Per Pay Period Cost






Employee                 Employee                    Employee          

    Only                         Plus 1                        Plus 2 more


Anthem Blue Cross PPO


  $589.17 $1,178.32