Eskaton team members have access to the Anthem PPO network of providers and facilities. Personify Health formerly known as HealthComp is the Third Party Administrator (TPA) and will house your eligibility and pay your claims. When you use an Anthem PPO in-network provider, you will receive a higher level of benefit coverage. When you use a provider outside of the Anthem network, you will pay more out-of-pocket.
You can access your account through Personify Health at: personifyhealth or download the app, HCOnline for your smartphone. You can view benefits, enrollment, claims history, your Explanation of Benefits (EOB), inquire about claims and request an ID card and more.
Understanding Your Options:
PPO stands for Preferred Provider Organization. A PPO plan allows you to seek care in and outside of the Anthem Blue Cross provider network. You do not need a referral and are not required to select a Primary Care Provider (PCP). You or your covered dependents will pay less out of your pocket by obtaining care in the Anthem Blue Cross provider network. You have access to Telehealth providers through LiveHealth Online, so you can access care when, where, and how you need it.
Before you review your medical plan options, you should understand how they work. Start with these terms:
Coinsurance: A set percentage you pay of the cost of the care you receive, for example 20%.
Copay: A set dollar amount you pay when you receive health care, for example $40 when you see a specialist.
Deductible: A set amount you must pay out of your pocket before the plan starts paying part of the cost unless a copay applies.
Out-of-pocket maximum: The most you will pay in a calendar year for provider visits, prescriptions, etc., for covered expenses and includes your deductible, copays, and coinsurance. This “safety net” provides peace of mind for those who have a serious condition or illness
What do I need to think about?
- Deductions are taken biweekly
- Insurance deductions are deducted pre-tax.
Plan Coverage Details | Team Member Monthly Cost | Team Member Biweekly Cost |
|---|---|---|
| Medical PPO Full-Time Associates | ||
| Team Member Only | $145 | $72.50 |
| Team Member + One Dependent | $515 | $257.50 |
| Team Member & Family | $810 | $405 |
| Medical PPO Part-Time Associates | ||
| Team Member Only | $153 | $76.50 |
| Team Member + One Dependent | $540 | $270 |
| Team Member & Family | $850 | $425 |
Coverage | In-Network Anthem Blue Cross | Out-of-Network Anthem Blue Cross |
|---|---|---|
| Plan Provisions | In Network | Out of Network |
| Annual Deductible (Individual / Family) | $250 Individual / $750 Family | $1,000 Individual / $3,000 Family |
| Out-of-Pocket Maximums (Individual / Family) | $2,000 Individual / $6,000 Family | $4,000 Individual / $8,000 Family |
| Preventive Care * | Covered at 100% | Not covered |
| Primary (Telemedicine)/Specialist Office Visit | $20 / $40 copay* | 40% after deductible |
| Chiropractic / Acupuncture (up to 20 visits/year) | $15 copay* | 40% coinsurance after deductible |
| Diagnostic Lab & X-ray | $20 copay* | 40% coinsurance after deductible |
| Urgent Care | $50 copay* | $50 copay + 40% after deductible |
| Inpatient Hospital Stays | $100 copay + 20% after deductible | 40% after deductible |
| Outpatient Surgery | 20% after deductible | 40% after deductible |
| Emergency Room (waived if admitted) | $100 copay | $100 copay + 40% after deductible |
| Generic | $15 copay | $30 copay |
| Formulary/Brand | $30 copay | $60 copay |
| Generic | $30 copay | Not covered |
| Formulary/Brand | $60 copay | Not covered |
| CanaRx*** | $0 copay | Not covered |
*Deductible waived
**Preventive Services include annual physicals for adults and children, routine mammograms, pap smears, and routine prostate exams and tests. See Summary Plan Descrip(on (SPD) for details
*** Prescription on drug copays does not accrue towards the calendar year out-of-pocket maximum.
****Only applicable to certain drugs. Members who qualify for CanaRx will receive notification by mail.
Prescriptions
Did you know you have 3 options for prescription drug benefits?
1. Retail Pharmacy: Provide a 30-day supply for a $15 (generic) or $30 (formulary/brand) co-payment
2. Mail order with ProAct OR Retail Pharmacy: 100-day supply. Take advantage of the savings of getting more than 3 months of medication for the price of 2! Visit www.proactrx.com or scan the QR code below for more information about mail order services.
3. Cana Rx: For certain medications, Cana Rx will notify you of your eligibility to receive your medication a NO COST to you!
Visit www.proactrx.com or scan the QR code below for more information about mail order services.
