HEALTH AND WELFARE
Medical Plans
Below is a summary of the three medical plan options available beginning January 1, 202 4 . It is to your advantage to use in - network providers . If you go out - of - network, you will be responsible for any amount exceeding Anthem ’ s negotiated discounts plus any deductible and co - insurance associated with your procedure.
The in - network benefits for each plan are illustrated side - by - side below so that you can compare them. Please refer to the Anthem Benefit Summaries for out - of - network - benefits associated with each of these options and more detailed information.
Plan Designs - Administered by Anthem
Qualified High Deductible Health Plan*
Features
Base Plan
Buy - Up Plan
In-Network Deductible (per calendar year) (Individual / Family)
$3, 200 / $6, 4 00 (Embedded)
$750/$1,500
$300/$600
Deductible is Calendar Year
Out - of - Pocket Maximum (per calendar year) (includes deductibles & copays - RX copays do not apply for Base and High Plans) (Individual / Family)
$3,500/$7,000
$3,000/$6,000
$4,000/$8,000
Coinsurance (the amount the plan pays)
80%
90%
90%
Office Visits (Preventive— 100% in - network)
$30 Primary Care Physician $60 Specialist
$25 Primary Care Physician $50 Specialist
Deductible & Coinsurance
LiveHealth Online
$30 Copay
$25 Copay
$49 Copay after deductible
Inpatient Hospital
Deductible & Coinsurance
Deductible & Coinsurance
Deductible & Coinsurance
Outpatient Surgery
Deductible & Coinsurance
Deductible & Coinsurance
Deductible & Coinsurance
Lab, X - Ray and Diagnostic
Deductible & Coinsurance
Deductible & Coinsurance
Deductible & Coinsurance
Urgent Care
$50 Copay
$50 Co - Pay
Deductible & Coinsurance
Emergency Room
$300 Copay
$200 Co - Pay
Deductible & Coinsurance
Prescription Drug ( Carelon Rx) Retail Pharmacy Mail Order Pharmacy
$10 / $40 / $70 / $150 2 Copays
Deductible & Coinsurance Deductible & Coinsurance
$10 / $40 / $70 / $150 2 Copays
*If you elect to enroll in the Qualified High Deductible Health Plan (QHDHP), you are required to enroll in the Health Savings Account. The District requires $125 per month from the benefit allocation to be deposited into your Health Savings Account. The School District of Clayton offers employees the ability to choose between two network options for each medical plan .
◼ Full Network —This network includes all the hospitals and affiliated physicians in the Anthem network. This is the Anthem Blue Access Choice network.
◼ Narrow Network (No BJC) - The narrow network plans have a lower premium (approximately 6% lower), but as a trade - off, your choice of providers is limited. This network excludes all BJC hospitals and affiliated physicians. This is the Anthem Blue Preferred network.
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