Medical and prescription drug

Need help choosing a medical plan?

Use the Medical Plan Comparison Tool to estimate your health care expenses to help identify which medical plan best fits your needs.

Stay in-network and save!

When you use in-network providers, facilities, and pharmacies, you receive the highest level of benefits.

What you pay when you need care

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:

Know Your Deductible:

  • Premium Plan: $3,850 per person; $7,750 maximum per family
  • Platinum Plan: $4,850 per person; $9,750 maximum per family

Bridge the gap:

Use your Health Savings Account (HSA) to help cover expenses up to your deductible.

Which plan is right for you

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). Consider how much care you typically use when choosing a plan so you don't pay more than you need to for coverage.

The Premium Plan has a lower deductible and higher premiums.

This plan might be right for you if …

  • You tend to have more health care expenses.
  • You like to have more predictable costs, even if it means you might pay more than you need to.
  • You don't have savings built up in your HSA to help cover unexpected expenses.

The Platinum Plan has a higher deductible and lower premiums.

This plan might be right for you if …

  • You are generally healthy and tend to have low health care expenses.
  • You'd rather pay less per pay period, even if it means you pay more out-of-pocket if you need more care than you expected
  • You have savings built up in your HSA to help cover any unexpected expenses.

Need help deciding? Use the Medical Plan Comparison Tool to estimate your health care expenses to help identify which medical plan best fits your needs.

Get the most out of your coverage

Compare costs for quality care. Anthem's medical care shopping tool shows personalized cost estimates for local doctors, facilities, and medical services based 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 Jones Associate Connection and click on "Anthem (Medical)" (must be on Edward Jones network).

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 (you'll pay more at a retail pharmacy after three fills). 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.

1 Financial advisor reference incorporates financial advisor, service partner, and joint venture service partner roles.

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

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