Medical Plans

Anthem PPO

Below is a brief overview of the annual deductibles, out-of-pocket maximums, and costs for common services.

PPO network providers are doctors, hospitals, etc. that participate in the PPO network and have agreed to provide services at pre-negotiated reduced rates. You are not required to choose a primary care physician, and you can see doctors and specialists within the network without a referral.

^{1 You may be responsible for paying the difference between the maximum allowed amount and the amount the non-participating provide or other health care provider charges. This amount can be significant. Choosing a participating provider will likely result in lower out of pocket costs to you.}

^{2 Subject to calendar year deductible.}

^{3 Failure to obtain pre-authorization may result in a $350 penalty.}

^{4 Covered expense is reduced by 25% if a service or supply is provided by a non-contracting hospital.}

Prescription Drugs

When you enroll in a LAPRA medical plan, you automatically receive prescription drug coverage as shown in the table below

^{1 $0 co-pay for women’s prescription contraceptives.
2 Under the Anthem Blue Cross PPO plan, you will have to pay the co-pay for the generic drug plus the difference in cost between the prescription drug maximum allowed amount for the generic drug and the brand name drug, but not more than 50% of the average cost for the tier that the brand name drug is in.
3 Maintenance drugs are those used to treat chronic conditions and are typically taken on a regular basis. To determine if your medication qualifies as a maintenance drug, contact Anthem Blue Cross at 800-700-2541. Maintenance drugs do not include any controlled substances, smoking cessation or weight management medications.
4 20% co-pay does not apply to insulin. Regular co-pays apply.}