medical Plans
Centric currently offers three different medical plans with Anthem, including a PPO option and two High Deductible Health Plans.
Your medical plans use Anthem’s provider network: A national network with no referrals and no geographical limitations within the continental United States.
You may use in-network and out-of-network providers. However, using providers in the network will save money as they are contracted to provide services at a discounted rate. Out-of-network providers may balance bill for services rendered.
Anthem also manages the prescription drug coverage. To locate an in-network pharmacy, research covered prescriptions, get pricing for a medication or enroll in the Mail Order program, please log in to your anthem.com account or the Sydney Health app.
Medical Plan Definitions
Annual deductible: For non-preventive care there is an annual deductible that must be met. If you cover dependents (other family members) under this Plan, the “Family” amounts apply. Family deductible amounts can be satisfied by any combination of family members, but one family member would never need to satisfy more than the single deductible amount. Once the single deductible amount is met, that individual will pay coinsurance until they reach the out-of-pocket maximum.
Coinsurance: Your percentage share of the costs of a healthcare service, for example 20%. You start paying coinsurance after you’ve paid your plan’s deductible.
Copay: A fixed amount for certain services you pay in some of our plans.
Out-of-pocket maximum: The most that you will have to pay for covered services in a plan year. Once you reach this limit, the plan covers all eligible expenses for the remainder of the plan year.
In-network vs. Out-of-network: Your plan contracts with a group of providers for discounted rates. You will almost always pay less when you receive care from these in-network providers. If you choose to see an out-of-network provider, you may be balance billed, which means you will be responsible for charges above Cigna’s reimbursement amount.
PPO Medical Plan (P1)
HOW THE PLAN WORKS
Plan Type: PPO
Preventive Care: The plan pays 100% for in-network preventive care.
Annual Deductible: For non-preventive care there is an annual deductible that must be met. The annual deductible is $1,000 for Individual coverage and $2,000 for Family coverage when you use in-network providers.
Coinsurance: Once you have met the deductible, you will pay coinsurance for services received. When you use in-network providers, your coinsurance cost will be 20% for Individual and Family coverage.
Out-of-Pocket Maximum: This is the most that you will have to pay for covered services in a plan year. All medical and prescription drug deductibles, copayments and coinsurance apply toward the out-of-pocket maximum. Once you meet the out-of-pocket maximum, then the plan pays 100% of your eligible expenses, including the cost of all office visits and prescription drugs, for the remainder of the year.
View the PPO Medical Plan (P1) details
| PPO Medical Plan (P1) | In-Network | Out-of-Network |
|---|---|---|
| Annual Deductible (Individual/Family) | $1,000/$2,000 | $2,000/$4,000 |
| Coinsurance | 80% | 60% |
| Out-of-Pocket Maximum(Includes Deductible) | $3,000/$6,000 | $6,000/$12,000 |
| Preventive Care | Covered at 100%, deductible waived | Covered at 60% after deductible |
| Primary Care Visit (PCP) | $25 | Covered at 60% after deductible |
| Specialist Office Visit | $40 | Covered at 60% after deductible |
| LiveHealthOnline-PCP | $0 | Not Covered |
| Inpatient Hospital Services | Covered at 80% after deductible | Covered at 60% after deductible |
| Outpatient Hospital | Covered at 80% after deductible | Covered at 60% after deductible |
| Emergency Room | $250/20% | $250/20% |
| Urgent Care | $50 | Covered at 60% after deductible |
| Prescription Drugs | ||
| Retail (30 day supply) | ||
| Generic | $10 | Covered at 50% after deductible |
| Preferred Brand | $30 | Covered at 50% after deductible |
| Non-Preferred Brand | $60 | Covered at 50% after deductible |
| Specialty | $90 | Not Covered |
| Retail (90 day supply) | ||
| Generic | $20 | Covered at 50% after deductible |
| Preferred Brand | $75 | Covered at 50% after deductible |
| Non-Preferred Brand | $150 | Covered at 50% after deductible |
| Mail Order (90 day supply) | ||
| Generic | $30 | Not Covered |
| Preferred Brand | $90 | Not Covered |
| Non-Preferred Brand | $180 | Not Covered |
HSA Medical Plan (H1)
HOW THE PLAN WORKS
Plan Type: High Deductible Health Plan
Preventive Care: The plan pays 100% for in-network preventive care.
Annual Deductible: For non-preventive care, there is an annual deductible that must be met. The annual deductible is $3,400 for Individual coverage and $6,800 for Family coverage when you use in-network providers.
Coinsurance: Once you have met the deductible, you will pay coinsurance for services received. When you use in-network providers, your coinsurance cost will be 10% for Individual and Family coverage.
Out-of-Pocket Maximum: This is the most that you will have to pay for covered services in a plan year. All medical and prescription drug deductibles, copayments and coinsurance apply toward the out-of-pocket maximum. Once you meet the out-of-pocket maximum, then the plan pays 100% of your eligible expenses, including the cost of all office visits and prescription drugs, for the remainder of the year.
View the HSA Medical Plan (H1) details
| HSA Medical Plan (H1) | In-Network | Out-of-Network |
|---|---|---|
| Annual Year Deductible (Individual/Family) | $3,400/$6,800 | $6,300/$12,600 |
| Coinsurance | 90% | 70% |
| Out-of-Pocket Maximum (Includes Deductible) | $5,000/$10,000 | $7,500/$15,000 |
| Preventive Care | Covered at 100%, deductible waived | Covered at 70% after deductible |
| Primary Care Visit (PCP) | Covered at 90% after deductible | Covered at 70% after deductible |
| Specialist Office Visit | Covered at 90% after deductible | Covered at 70% after deductible |
| LiveHealth Online (PCP) | Covered at 100% after deductible | Not Covered |
| Inpatient Hospital Services | Covered at 90% after deductible | Covered at 70% after deductible |
| Outpatient Hospital | Covered at 90% after deductible | Covered at 70% after deductible |
| Emergency Room | Covered at 90% after deductible | Covered at 90% after deductible |
| Urgent Care | Covered at 90% after deductible | Covered at 70% after deductible |
| Prescription Drugs | ||
| Retail (30 day supply) | ||
| Generic | Covered at 90% after deductible | Covered at 70% after deductible |
| Preferred Brand | Covered at 90% after deductible | Covered at 70% after deductible |
| Non-Preferred Brand | Covered at 90% after deductible | Covered at 70% after deductible |
| Specialty | Covered at 90% after deductible | Covered at 70% after deductible |
| Retail (90 day supply) | ||
| Generic | Covered at 90% after deductible | Covered at 70% after deductible |
| Preferred Brand | Covered at 90% after deductible | Covered at 70% after deductible |
| Non-Preferred Brand | Covered at 90% after deductible | Covered at 70% after deductible |
| Mail Order (90 day supply) | ||
| Generic | Covered at 90% after deductible | Not Covered |
| Preferred Brand | Covered at 90% after deductible | Not Covered |
| Non-Preferred Brand | Covered at 90% after deductible | Not Covered |
HSA Medical Plan (H2)
HOW THE PLAN WORKS
Plan Type: High Deductible Health Plan
Preventive Care: The plan pays 100% for in-network preventive care.
Annual Deductible: For non-preventive care there is an annual deductible that must be met. The annual deductible is $4,500 for Individual coverage and $9,000 for Family coverage when you use in-network providers.
Coinsurance: Once you have met the deductible, you will pay coinsurance for services received. When you use in-network providers, your coinsurance cost will be 20% for individual and family.
Out-of-Pocket Maximum: This is the most that you will have to pay for covered services in a plan year. All medical and prescription drug deductibles, copayments and coinsurance apply toward the out-of-pocket maximum. Once you meet the out-of-pocket maximum, then the plan pays 100% of your eligible expenses, including the cost of all office visits and prescription drugs, for the remainder of the year.
View the HSA Medical Plan (H2) details
| HSA Medical Plan (H2) | In-Network | Out-of-Network |
|---|---|---|
| Annual Year Deductible (Individual/Family) | $4,500/$9,000 | $4,500/$9,000 |
| Coinsurance | 80% | 60% |
| Out of Pocket Maximum (Includes Deductible) | $6,000/$12,000 | $9,000/$18,000 |
| Preventive Care | Covered at 100%, deductible waived | Covered at 60% after deductible |
| Primary Care Visit (PCP) | Covered at 80% after deductible | Covered at 60% after deductible |
| Specialist Office Visit | Covered at 80% after deductible | Covered at 60% after deductible |
| LiveHealth Online (PCP) | Covered at 100% after deductible | Not Covered |
| Inpatient Hospital Services | Covered at 80% after deductible | Covered at 60% after deductible |
| Outpatient Hospital | Covered at 80% after deductible | Covered at 60% after deductible |
| Emergency Room | Covered at 80% after deductible | Covered at 80% after deductible |
| Urgent Care | Covered at 80% after deductible | Covered at 60% after deductible |
| Prescription Drugs | ||
| Retail (30 day supply) | ||
| Generic | Covered at 80% after deductible | Covered at 60% after deductible |
| Preferred Brand | Covered at 80% after deductible | Covered at 60% after deductible |
| Non-Preferred Brand | Covered at 80% after deductible | Covered at 60% after deductible |
| Specialty | Covered at 80% after deductible | Covered at 60% after deductible |
| Retail (90 day supply) | ||
| Generic | Covered at 80% after deductible | Covered at 60% after deductible |
| Preferred Brand | Covered at 80% after deductible | Covered at 60% after deductible |
| Non-Preferred Brand | Covered at 80% after deductible | Covered at 60% after deductible |
| Mail Order (90 day supply) | ||
| Generic | Covered at 80% after deductible | Not Covered |
| Preferred Brand | Covered at 80% after deductible | Not Covered |
| Non-Preferred Brand | Covered at 80% after deductible | Not Covered |
Important Resources
Pharmacy Directory
Building Healthy Families
ConditionCare Flyer
Cost Comparison Tool
Cost Relief Drug List
Find a Doctor
Lark Weight Loss Support
LiveHealth Online Virtual Visit Flyer
Preventive Care Benefits
Special Offers and Discounts
Sydney Health Mobile App
Mental Health Support
Virtual Care Options
Where to Go for Care Flyer
Anthem H1 HSA $3,400 Medical SBC
Anthem H2 HSA $4,500 Medical SBC
Anthem PPO $1,000 Medical SBC
Anthem’s Customer Service Team can assist you in understanding your coverage, verify covered providers and help with any changes or disruption that may occur to your medical care coverage or pharmacy needs. Call
833-952-2042 to talk with a customer service representative today, download the Sydney Health app or register at anthem.com. The following programs are also available:
Sydney Health App
With Sydney Health, you can find everything you need to know about your medical and pharmacy benefits all in one place. Download the Sydney Health app today!
Key features include:
- Find care and check costs
- See all benefits
- View claims
- View and use digital ID cards
- Use the interactive chat feature to get answers quickly
- Sync your favorite fitness tracker
Weight Loss – Lark
Lark’s Weight Management Program is designed to help you lose weight and keep it off at no extra cost to you. No matter where you are in your weight loss journey, Lark has a program for you with:
- 24/7 personalized digital coaching from your smartphone or tablet
- Weight loss medications
- Personalized plans with a wellness coach
See if you qualify for the Lark program today; visit Lark.com/AnthemWMP.
Cost Comparison
Anthem’s Cost Comparison tool is an internet-based self-service tool that contains personalized out-of-pocket cost information for many covered healthcare items and services. This tool enables members to compare the amount of cost they would be responsible for with respect to a specific item or service. You can access the Cost Comparison tool via the Sydney Health mobile app.
Virtual Care
All your virtual care will be provided through our Sydney Health app.
You can seek virtual care for:
- Urgent care: cough, cold, rash, sprains, pink eye, etc.
- Primary Care: annual preventive care visit
- Mental Health: anxiety, depression
- Dermatology
- Symptom Checker
- Prescriptions: new and refills
When it’s time for your virtual appointment, use your smartphone, tablet or computer with a camera to meet securely through our SydneySM Health app or at anthem.com. You can also call 24/7 NurseLine anytime, day or night at 800-337-4770 at no additional cost for health questions and guidance on where to go for care, if needed.
Find Care
Having access to the right doctor can have a positive impact on your health and well-being. Choosing one in your plan’s network also saves you money.
Our online Find Care resource includes a search function to locate medical doctors, hospitals, labs and other healthcare professionals in your plan’s network.
If you use a healthcare professional or facility outside your plan’s network, your part of the cost will be higher, and your care may not be covered.
Healthy Families
Whether trying to conceive, expecting a child or in the thick of raising young children, Building Healthy Families offers personalized, digital support to help each family navigate their unique journey. You can find Building Healthy Families in your plan’s mobile health app to do things like:
- Track baby’s feedings, diaper changes and developmental milestones.
- Monitor prenatal health risks and receive updates on your pregnancy progress.
- Explore a library with thousands of educational articles and videos.
- Connect with one-on-one pregnancy support.
ConditionCare
Managing chronic conditions, such as asthma, diabetes, chronic obstructive pulmonary disease (COPD) or heart disease requires extra care and attention. To help you be at your best, the ConditionCare program offers free resources, including:
- 24/7 phone access to nurses who can address your health concerns
- Support from healthcare professionals to help you reach your health goals
- Educational guides and useful tools to help you learn more about certain conditions
Connect with the support you need with ConditionCare: 866-962-1071
| Biweekly Rates | |||
|---|---|---|---|
| FTE Rates | |||
| PPO | HDHP1 | HDHP2 | |
| Employee | |||
| Emloyee + Spouse | |||
| Employee + Child(ren) | Family | ||
| W2T Rates | |||
| PPO | HDHP1 | HDHP2 | |
| Employee | |||
| Employee + Spouse | |||
| Employee + Child(ren) | Family | ||