MEDICAL

Resources

LHP/LER will continue to offer medical coverage through Anthem. The chart below provides a brief outline of what is offered. The Annual Deductible limits for In-Network Benefits under the HSA plan have increased. Please refer to the summary plan description for complete plan details.

Note: In the PPO Plan, copays are not applied towards the deductible.

PPO

	Semi-Monthly Rate
Employee	$116.23
Employee & Spouse	$284.31
Employee & Child(ren)	$241.30
Employee & Family	$448.97

HDHP/HSA

	Semi-Monthly Rate
Employee	$60.74
Employee & Spouse	$162.41
Employee & Child(ren)	$145.59
Employee & Family	$259.03

PPO Plan

Anthem Blue Access

	In-Network	Out-of-Network
Deductible (Individual/Family)	$1,000/$3,000	$3,000/$6,000
Maximum Out-of-Pocket (Individual/Family)	$3,000/$6,000	$6,000/$12,000
Primary Care Visits	$30	50% after Ded
Preventive Care	$0	50% after Ded
Specialist Visits	$50	50% after Ded
Emergency Room	$350 and 20% of balance	$350 and 20% of balance
Urgent Care	$75	$75
Retail Pharmacy (30 Day Supply)
Generic (Tier 1)	$15	50%
Preferred (Tier 2)	$40	50%
Non-Preferred (Tier 3)	$60	50%
Preferred Specialty (Tier 4)	–	–
Mail Order Pharmacy (90 Day Supply)
Generic (Tier 1)	$30	N/A
Preferred (Tier 2)	$100	N/A
Non-Preferred (Tier 3)	$150	N/A
Preferred Specialty (Tier 4)	–	N/A

HDHP/HSA Plan

Anthem Blue Access

	In-Network	Out-of-Network
Deductible (Individual/Family)	$3,200/$6,400	$6,000/$12,000
Maximum Out-of-Pocket (Individual/Family)	$3,200/$6,400	$6,000/$12,000
Primary Care Visits	$0 after Ded	10% after Ded
Preventive Care	$0	10% after Ded
Specialist Visits	$0 after Ded	10% after Ded
Emergency Room	$0 after Ded	$0 after Ded
Urgent Care	$0 after Ded	$0 after Ded
Retail Pharmacy (30 Day Supply)
Generic (Tier 1)	$0 after Ded	10% after Ded
Preferred (Tier 2)	$0 after Ded	10% after Ded
Non-Preferred (Tier 3)	$0 after Ded	10% after Ded
Preferred Specialty (Tier 4)	$0 after Ded	10% after Ded
Mail Order Pharmacy (90 Day Supply)
Generic (Tier 1)	$0 after Ded	n/a
Preferred (Tier 2)	$0 after Ded	n/a
Non-Preferred (Tier 3)	$0 after Ded	n/a
Preferred Specialty (Tier 4)	$0 after Ded	n/a