I have no experience but I need to urgently choose work health insurance that will cover me the BEST! Pls help me I beg you!
Thank you so much for clicking. This is the first time that i will be covered.
For context, I'm in pretty bad physical shape. I havent had a period for 10 years, I need to start seeing a good psychologist/psychiatrist. Losing my eyesight (a bit near and far sighted) & some hearing too. I have pretty bad depression teeth too, my teeth and my need to see a gyno are top priority.
I dont know much about health insurance but i can choose from Im 30. In Texas. I make 1050 biweekly after taxes
Anthem classic PPO- $133.64
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2024– 12/31/2024 -X- Inc.: Classic PPO Plan Coverage for: Individual + Family | Plan Type: PPO
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan, The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information about your co
r coverage, or to get a copy of the complete terms coinsurance,
of coverage, https:/leoc.anthem.com eocdps/aso. For general definitions of common terms, such as allowed amount, balance billing, co copavment, deductible, provider, or other underined terms see the Glossary. You can view the Glossary at www.healthcare.goy/sbc-gloSsarv/ or call (844) 233-5875 to request a copy.
Important Questions Answers Why This Matters:
What is the overall S1,500/single or $4,500/ family Generally, you must pay all of the costs from providers up to the deductible amount before deductible? for Network Providers. this plan begins to pay. If you have other family members on the plan, cach family member $3,000/single or $9,000/ family must meet their own individual deductible until the total amount of deductible expenses paid
for Out-of-Network Providers. by all family members meets the overall family deductible. Are there services Yes. Preventive care and This plan covers some items and services even if you haven't yet met the deductible amount. covered before you Prescription Drugs are covered But a copayment or coinsurance may apply. For example, this plan covers certain preventive
meet your deductible? before you meet your deductible services without cost-sharing and before you meet your deductible. See a list of covered for Network Providers. preventive services at https://www.healthcare.gov/coverage/preventive-care-benefits/.
Are there other No. You don't have to meet deductibles for specific services.
deductibles for specific services?
What is the out-of pocket limit for this $6,850/single or $13,700/ family The out-ofpocket limit is the most you could pay in a year for covered services. If you have
for Network Providers. other family members in this plan, they have to meet their own out-of-pocket limits until the
plan? S13.700/single or overall family out-of-pocket limit has been met.
$27,400/ family for Out-of Network Providers.
What is not included Premiums, balance-billing Even though you pay these expenses, they don't count toward the out-of-pocket limit. in the out-of-pocket charges, and health care this limit? pan doesn't cover.
Will you pay less if Yes. See www.anthem.com o This plan uses a provider network. You will pay less if you use a provider in the plan's you use a network call (844) 233-5875 for a list of network. You will pay the most if you use an out-of-network provider, and you might receive provider? network providers. a bill from a provider for the difference between the provider's charge and what your plan
pays (balance billing). Be aware your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.
IN/L/A/ConduentIncClassicPPOPlan-PPO/NA/LGZLE/NA/01-24
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Do you need a referral No. You can see the specialist you choose without a referral. to see a specialist?
All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.
What You Will Pay Common Services You May Need Out-of-Network Limitations, Exceptions, & Other
Medical Event Network Provider Provider Important Information
(You will pay the least) (You will pay the most)
Walk in Retail Health Clinics have $20
Primary care visit to treat an copayment in-network and 40% injury or illness $35 Copayment 40% coinsurance coinsurance after deductible out-of
network; Tele-Health Services have
If you visit a $20 copayment in-network health care Chiropractic care subject to specialist provider's office Specialist visit $55 Copayment 40% coinsurance copayment/coinsurance and or clinic maximum of 20 visits per year.
You may have to pay for services that
Preventive care/screening/ aren't preventive. Ask your provider if immunization No charge 40% coinsurance the services needed are preventive.
Then check what your plan will pay
for
Diagnostic test (x-ray, blood 20% coinsurance 40% coinsurance -none
If you have a test work)
Imaging (CT/PET scans, MRIs) 20% coinsurance 40% coinsurance —–none
25% coinsurance up to $20 Out-of-network pharmacy Retail: Up to 30-day supply; Mail maximum/prescription claims are reimbursed Order: Up to 90-day supply.
If you need drugs deductible does not apply based on what the plan Prescription drugs not subject to the to treat your Tier 1 -Typically Generic (retail) and 25% would have paid if the deductible. Mandatory mnail order illness or coinsurance up to $50 prescriptions were applies. condition maximum le
/prescription purchased in-network; at Amounts you pay because you deductible does not apply the contracted rate less purchased a brand drug when a
(home delivery) applicable copavments.
For more information about limitations and exceptions, see plan or policy document at https://eoc.anthem.com/cocdps/aso.
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What You Will Pay
Common Services You May Need Out-of-Network Limitations, Exceptions, & Other Medical Event Network Provider Provider Important Information
(You will pay the least) (You will pay the most)
| More information $40/prescription or 30% generic was available will not count about prescription coinsurance, whichever is toward the out-of-pocket limit. drug coverage is greater up to $120 available at maximum /prescription
rk.com or 855-559 http://www.carcma Tier 2 -Typically Preferred / deductible does not apply
(retail) and
1385 Brand $80/prescription or 30% coinsurance, whichever is
greater up to $200
maximum /prescription deductible does not apply (home delivery) $60/prescription or 45% coinsurance, whichever is greater up to $150 maximum /prescription deductible does not apply
Tier 3 -Typically Non-Preferred coinsurption or (retail) and 45%
/ Specialty Drugs $120
whichever is greater up to $250
Anthem consumer Choice 2000/4000 $88.98
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2024- 12/31/2024 -x- Inc.: Consumer Choice 2000/4000 Deductible Coverage for: Individual + Famiy | Plan Type: CDHP
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan, The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately. This is only a summary. For more information albout your co
r coverage, or to get a copy of the complete terms
of coverage, https://eoc.anthem.comleocdps/aso. For general definitions of common terms, such as allowed amount, balance billing, coinsurance, copavment, deductible, provider, or other underined terms see the Glossary. You can view the Glossary at www.healthcare.goy/sbc-gloSsarv/ or call (844) 233-5875 to request a copy.
Important Questions Answers Why This Matters:
What is the overall $2,000/single or $4,000/ family Generally, you must pay all of the costs from providers up to the deductible amount before deductible? for Network Providers. this plan begins to pay. If you have other family members on the policy, the overall family
$6,000/single or $12,000/ family deductible must be met before the plan begins to pay.
for Out-of-Network Providers. Employer HSA contributions for active employees: $500 single/$1,000 family
Are there services Yes. Preventive care services for This plan covers some items and services even if you haven't yet met the deductible amount. covered before you Network Providers. But a copayment or coinsurance may apply. For example, this plan covers certain preventive meet your deductible? services without cost-sharing and before you meet your deductible. See a list of covered
preventive services at https://www.healthcare.gOv/coverage/preventive-care-benefits/.
Are there other No. You don't have to meet deductibles for specific services. deductibles for specific services? What
tis the out-of $6,250/single or $12,500/family The out-of-pocket Iimit is the most you could pay in a year for covered services. If you have pocket limit for this for Network Providers. other family members in this plan, they have to meet their own out-of-pocket limits until the plan? $12,500/single or overall family out-ofpocket limit has been met.
$25,000/family for Out-of Network Providers.
What is not included charges, and health care this Premiums, balance-biling Even though you pay these expenses, they don't count toward the out-of-pocket limit.
in the out-of-pocket limit? plan doesn't cover.
Will you pay less if Yes. See www.anthem.com or This plan uses a provider network. You will pay less if you use a provider in the plan's you use a network call (844) 233-5875 for a list of network. You will pay the most if you use an out-of-network provider, and you might receive provider? network providers. a bill from a provider for the difference between the provider's charge and what your plan
pays (balance billing). Be aware your network provider might use an out-of-network provider
IN/L/AConduentinc.ConsumerChoice2000/4000-CDHP/NA/67MS8/NA/01-24
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for some services (such as lab work). Check with your provider before you get services.
Do you need a referral No. You can see the specialist you choose without a referral. to see a specialist?
All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.
What You Will Pay
Common Services You May Need Out-of-Network Limitations, Exceptions, & Other Medical Event Network Provider Provider Important Information
(You will pay the least) You will pay the most)
Chiropractic care maximum of 20 visits; Walk in Retail Health Clinics
Primary care visit to treat an have 20% coinsurance after deductible injury or illness 20% coinsurance 40% coinsurance in-network and 40%o coinsurance after
If you visit a deductible out-of-network; Tele health care Health Services have 20% coinsurance provider's office after deductible in-network or clinic Specialist visit 20% coinsurance 40% coinsurance –none
You may have to pay for services that
Preventive care/screening/ aren't preventive. Ask your provider if immunization No charge 40% consurance the services needed are preventive. Then check what your pan will pay
for
Diagnostic test (x-ray, blood 20% coinsurance 40% coinsurance –none
If you have a test work)
Imaging (CT/PET scans, MRIs) 20% coinsurance 40% coinsurance -none If you need drugs $4/prescription or 25% Out-of-network pharmacy Retail: Up to 30-day supply; Mail to treat your cOinsurance, whichever is claims are reimbursed Order: Up to 90-day supply. Certain illness or greater up to S20 based on what the plan preventive drugs not subject to the orescription
condition More maximum /pe would have paid if the deductible. Mandatory mail order information about Tier 1 -Typically Generic (retail) and prescriptions were applies. prescription drug $10/prescription or 25% purchased in-network; at
coinsurance, whichever is the contracted rate less Amounts you pay because you
coverage is greater up to $50 purchased a brand drug when a available at maximum /prescription applicable copayments generic was available will not count htto://www.carema (home delivery) toward the out-of-pocket limit.
For more information about limitations and exceptions, see plan or policy document at https://eoc.anthem.com/cocdps/aso.
2 of 8
What You Will Pay Common Services You May Need Out-of-Network Limitations, Exceptions, & Other
Medical Event Network Provider Provider Important Information
(You will pay the least) (You will pay the most)
rk.com or 855-559 $25/prescription or 25% 1385 coinsurance, whichever is
greater up to S60 maximum /prescription
Tier 2 -Typically Preferred / (retail) and Brand $60/prescription or 25% coinsurance, whichever is
greater up to $150 maximum /prescription (home delivery) $40/prescription or 25% coinsurance, whichever is greater up to S90 maximum /prescription
Tier 3 – Typically Non-Preferred (retail) and
/ Specialty Drugs $100/prescription or 25% cOinsurance, whichever is
greater up to $225 maximum /prescription (home delivery)
Tier 4-Tunically Specialry Same as retail copayment
I don't know if all this info what needed so I apologize if I added too much.
submitted by /u/iam_Elizabethkat
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