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How You Pay for Care

You see the doctor

In-network preventive care is covered at 100%.

Your provider sends a claim to Anthem.

If you haven't met your deductible

You pay 100% of the cost,1 up to the $3,000 individual deductible.

Your provider might request payment at the time of service or send you a bill after your visit. This amount counts toward your individual deductible.

If you have met your deductible

Your insurance kicks in. You generally pay 20% of the cost.1 (This is called coinsurance.)

Your provider may request payment at the time of service or may send you a bill after your visit. This amount counts toward your out-of-pocket maximum.

Pay this amount from your FSA (if enrolled) or out of pocket.

Anthem will send you an Explanation of Benefits (EOB) showing the full amount and confirming the amount you're responsible for paying.2

You fill a prescription

If you haven't met your deductible

You pay 100% of the cost,1 up to the deductible.

If you have met your deductible

Your insurance kicks in. You generally pay 20% of the cost.1

Pay this amount from your FSA (if enrolled) or out of pocket.

The percentage you pay is called coinsurance.

You're protected by the out-of-pocket maximum

Essentially, it's a year-long safety net for the worst-case scenario. Once you reach this amount ($6,350 individual-coverage; $12,700 family coverage), the plan pays 100% of Covered Services for the rest of the calendar year.

Out-of-pocket maximum includes the deductible.

 

Based on Anthem’s allowed amount for the service.
If the EOB shows you owe a different amount than what the provider collected at the time of service or billed you, call Anthem Health Guide.