Medical and prescription drug

Need help choosing a medical plan?

Ask our decision support tool, ALEX, for help estimating your health care expenses and choosing the medical plan that 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.

Deductible and coinsurance

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:

  • Silver: Once one person meets the individual deductible, the plan begins sharing the cost of that person’s care.
  • Gold: If you choose family coverage in the Gold plan, there is no individual deductible or out-of-pocket maximum. One person or a combination of family members must meet the full family deductible before the plan pays 80% of the cost, and they must meet the full out-of-pocket maximum before the plan pays 100%.

In-network preventive care

Plan pays

Non-preventive medical and Rx


You pay


Plan pays 80%

You pay 20%

Meet OOP maximum

Plan pays

Learn more about how your medical plans work

Watch: Your medical plan choices

Watch: How deductibles work

Watch: How coinsurance works

Bridge the gap: Use your Health Savings Account (HSA) to help cover expenses up to your deductible and for out-of-pocket expenses.

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).

When choosing a plan, consider how much care you typically use so you don't pay more than you need to for coverage:

  • The Silver Plan has a higher deductible and lower premiums. This plan may be right for you if you tend to have low health care costs, or if you have savings built up in your HSA to cover unexpected expenses.
  • The Gold Plan has a lower deductible and higher premiums. This plan may be right for you if you tend to have more health care costs, or if you don’t have savings built up in your HSA to help cover unexpected expenses. 

Need help picking a plan?

ALEX is a decision-support tool that can help you estimate your health care expenses and identify which medical plan best fits your needs.

Talk to ALEX.

Review the plans side by side

Silver Plan:
Gold Plan:
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%
Plan pays 80%/You pay 20%
Other covered care and prescriptions (after OOP max) Plan pays 100% Plan pays 100%

Get the most out of your coverage

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)."

Improve your surgical experience and save. SurgeryPlus 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 SurgeryPlus 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 you medical plan deductible, any coinsurance cost for the surgery is waived. Review this FAQ for more details. You can also visit or contact a Care Advocate at 888-726-1354. They’re available from 6 a.m. to 10 p.m. CST.

Note: SurgeryPlus is available to U.S. mainland associates and dependents enrolled in the Anthem Silver or Gold medical plan. SurgeryPlus is not available to associates and dependents in Hawaii or Canada.

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

Help with Medicare

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. 

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