Ask our decision support tool, ALEX, for help estimating your health care expenses and choosing the medical plan that best fits your needs.
When you use in-network providers, facilities, and pharmacies, you receive the highest level of benefits.
You pay $0 for preventive care when you use an in-network provider. Preventive care includes:
Annual routine physicals and well-woman exams
Immunizations for children and adults
Health screenings like mammograms, colonoscopies, and prostate tests
Routine well-vision exams
Tip: Ask your doctor or the office manager to list the primary procedure code as a preventive health screening when they file your claim with the health plan.
For prescription drugs and other in-network services, such as labs, X-rays, surgeries, hospitalizations, and urgent care, you pay 100% of the cost until you reach the deductible. Then, Edward Jones pays 80% of covered care and prescriptions costs, and you pay 20% coinsurance. When you reach the out-of-pocket maximum, Edward Jones pays 100% of covered costs.
If you have individual coverage under both the Silver and Gold plans, once you meet the deductible, the plan will start paying 80% of the cost. When you meet the out-of-pocket maximum, the plan will pay 100%.
If you have family coverage, the deductible and out-of-pocket maximum works differently depending on the plan you choose:
In-network preventive care
Plan pays
100%
Non-preventive medical and Rx
You pay
100%
Plan pays 80%
You pay 20%
Meet OOP maximum
Plan pays
100%
Bridge the gap: Use your Health Savings Account (HSA) to help cover expenses up to your deductible and for out-of-pocket expenses.
Both plans cover the same services and prescription drugs. The only difference between the two plans is the amount you pay before the plan begins paying benefits (called the “deductible”) and the amount that comes out of your paycheck for coverage (premiums).
When choosing a plan, consider how much care you typically use so you don't pay more than you need to for coverage:
ALEX is a decision-support tool that can help you estimate your health care expenses and identify which medical plan best fits your needs.
| Silver Plan: Individual/Family |
Gold Plan: Individual/Family |
|
|---|---|---|
| In-network deductible | $4,000/$8,000 | $2,000/$4,000 |
| In-network out-of-pocket maximum | $6,000/$12,000 | $4,000/$8,000 |
| Out -of-network deductible | $6,000/$12,000 | $4,000/$8,000 |
| Out-of-network out-of-pocket maximum | $8,000/$16,000 | $7,000/$14,000 |
| Preventive care (no deductible) | Plan pays 100% | Plan pays 100% |
| Other covered care and prescriptions (before deductible) | You pay 100% | You pay 100% |
| Other covered care and prescriptions (after deductible, before OOP max) | Coinsurance: Plan pays 80%/You pay 20% |
Coinsurance: Plan pays 80%/You pay 20% |
| Other covered care and prescriptions (after OOP max) | Plan pays 100% | Plan pays 100% |
Access virtual care through LiveHealth Online. As an Anthem member, you have access to virtual doctor visits through LiveHealth Online for just $40-$50 per visit (which is typically equal to or less than an office visit). This service enables you to virtually connect with a board-certified doctor using a computer, tablet, or smart phone, and is available 24/7. Most visits take under 30 minutes, and in some cases, the treating doctor can write a prescription. Commonly treated conditions include cold and flu, sinus infections, minor sprains, strains, and wounds, ear pain, fever, and more. The tool also provides support for breastfeeding, healthy sleep, high blood pressure, smoking cessation programs, and more. Create an account.
Compare costs for quality care. Anthem's medical care shopping tool shows personalized cost estimates for local doctors, facilities, and medical services based on your medical plan and deductible. You can compare providers based on what you'll pay and get tips to reduce your medical spending. Access Anthem's medical care shopping tool. You can also access via the “Sydney Health” app or through Personal and Job Information (JAC) and click on "Anthem (Medical)."
Save with mail order pharmacy. For long-term maintenance drugs, like birth control or medications for high blood pressure and high cholesterol, use the Maintenance Through Mail program to pay the lowest possible cost. If you do not switch your maintenance medications to mail order after the third fill at a retail pharmacy, you will pay the full cost of the drug at 100% before and after your deductible is met. None of the penalty costs will be applied toward your deductible or out-of-pocket maximum. Call Express Scripts at 866-677-8637 or complete the Mail Order Form.
Estimate drug costs. Price and compare different medications on the Express Scripts member site. You'll need the name of the drug and the recommended dosage information to get the cost and savings information.
Submit a claim. If a provider billed you directly for a covered medical service, submit a claim form to Anthem.
Request continuity of care. If you need to transition care or ensure ongoing care isn’t disrupted, submit a continuity of care form to Anthem.
Note: Some prescriptions must be reviewed by Express Scripts before they're dispensed. Check the Prior Authorization List and Drug Quantity Management List to see if your prescription requires review. Keep in mind that you may be required to try a lower-cost option before a more expensive one. If the first-step drug isn't effective for you, the plan will cover the second-step drug. View the step-therapy medication list.
Tip: Always ask your provider if there's a generic version of the drug you need.
If you choose to fill a brand name drug when a generic version is available, you'll pay the difference between the generic drug and the brand name drug
You and your family members nearing Medicare age can get help understanding, navigating, and enrolling in Medicare with the no-cost Smart Connect program. It includes information, education, and one-on-one telephone support. Experienced representatives can help you make the right choice and put all the plans in place to coordinate with your Edward Jones benefits.
To connect with a SmartConnect representative and explore your options, call 833-460-4726. Representatives are available weekdays from 7:30 a.m. to 5 p.m. CST.
Our medical plans cover treatment for mental health and substance abuse.
If you're enrolled in the medical plan, take advantage of additional programs included with the plan.
Pay for qualified health care expenses with pre-tax dollars.