The CORE plan is a high-deductible PPO that generally provides the same level of coverage, no matter which provider you see. In exchange for UC paying your entire monthly premium for coverage, you’re responsible for more up-front costs when you get care—some (or possibly all) of which you can pay using a Health Flexible Spending Account (FSA). Here’s an overview of the plan:
- No-cost in-network preventive care for you and all enrolled family members through Anthem Blue Cross PPO providers. There’s no deductible or out-of-pocket cost for screenings and lab tests recommended by Anthem based on your age and gender.
- You pay a calendar-year deductible (a separate $3,000 deductible for each covered family member) before the plan begins to share in the cost of covered services, including pharmacy and behavioral health benefits.
- Once the annual deductible is met, the plan pays 80% of the cost of most covered services, including prescription drugs, and you pay 20%. The percentage you pay is called coinsurance.
- You’re protected for the worst-case scenario. The health care protects your physical health. The out-of-pocket maximum protects your finances by limiting your financial liability for covered expenses.
- After you meet the out-of-pocket maximum amount ($6,350 for individual coverage/$12,700 for family), Anthem pays 100% for most covered services, including prescription drugs, for the remainder of the year.
- Choose from a broad range of providers—including UC doctors and facilities—in the Anthem Blue Cross Prudent Buyer (PPO) network of over 60,000 providers. You can self-refer to most specialists.
- You can lower your out-of-pocket costs if you see an Anthem Blue Cross PPO provider because these providers have agreed to charge lower, negotiated rates. You’re not responsible for any costs above the negotiated rates.
- After you meet your deductible, the plan pays a percentage of the cost for covered services, and you pay the rest.