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How You Pay for Care

In-Network

You see the doctor

Your provider is UC Select.

You pay the applicable copayment to your provider at the time of service.

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

Your provider sends a claim to Anthem.

Anthem will send you an Explanation of Benefits (EOB) showing the full amount and confirming the amount you're responsible for paying.1

Your provider is Anthem Preferred.

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,2 up to the $3,000 individual deductible.

  • Self-coverage: $250
  • Family coverage: $750

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:

  • In-network:
    20% of the cost2
  • Out-of-network:
    50% of the cost2

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.1

You fill a prescription

You pay the applicable copayment at the pharmacy.

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

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 the maximum, the plan pays 100% of Covered Services for the rest of the calendar year.

  • UC Select
    Self-coverage: $5,100
    Family coverage: $8,700
  • Anthem preferred
    Self-coverage: $6,350
    Family coverage: $12,700

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.