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 are covering yourself and one or more dependents, 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 at no cost. 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 Gateway and click on "Anthem (Medical)."
Improve your surgical experience and save. Lantern connects you with board-certified surgeons delivering high-quality care and better outcomes at a lower cost. Its Care Advocates provide concierge-level services to assist you through your surgical journey. You and your family members can access Lantern for non-emergency, planned surgeries if you’re covered under the Anthem Silver or Gold medical plan. You could see significant savings, because after you meet your medical plan deductible, any coinsurance cost for the surgery is waived. Review this FAQ for more details. You can also visit my.surgeryplus.com or contact a Care Advocate at 888-726-1354. They’re available from 6 a.m. to 10 p.m. CST.
Starting in 2026, bariatric surgeries are covered only if you work through Lantern.
Note: Lantern is available to U.S. mainland associates and dependents enrolled in the Anthem Silver or Gold medical plan. Lantern is not available to associates and dependents in Hawaii.
For long-term maintenance drugs, you may receive the first 30-day supply and up to one additional 30-day refill of the same maintenance medication at a participating retail pharmacy. On your third refill, you must fill a 90-day supply of your maintenance medication at a participating maintenance network retail pharmacy or use the CarelonRx home delivery pharmacy. The maintenance retail pharmacy network includes approximately 25,000 national pharmacies, including CVS, Walmart, Kroger, and other independent pharmacies. To find a pharmacy, visit the Edward Jones Anthem site.
Estimate drug costs. Use the Price a Medication tool in the Sydney app, visit Anthem and CarelonRx or call your Family Advocate at 800-359-0640 7 a.m. to 7 p.m. CST Monday – Friday. You'll need the name of the drug and the recommended dosage information to get the cost and savings information.
Submit a claim or request continuity of care. Find the forms online by logging in to your Anthem account, using the Sydney app, or calling your Family Advocate at 800-359-0640.
Note: Some prescriptions must be reviewed by CarelonRx before they're dispensed. Please review the Prescription FAQs for additional information.
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 SmartConnect 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.