Certificated

CERTIFICATED - Anthem Blue Cross PPO
2019-20 Benefit Summary

• 2019 Oct Anthem PPO 100-A 10: Rx 9-35
   
• 2019 Oct Anthem PPO 100-D 20: Rx 200Ded 10-35
   
• 2019 Oct Anthem PPO 80-G 30 Select: Rx 200Ded 10-35
   
• 2019 Oct Anthem PPO 80-L 30: Rx: 200Ded 10-35
   
• 2019 Oct Anthem PPO Minimum Value

2019-20  What this Plan Covers & What it Costs
SBC - Summary of Benefits and Coverage:

• 2019 Oct Anthem PPO 100-A 10 Rx 9-35 SBC
   
• 2019 Oct Anthem PPO 100-D 20 Rx 200Ded 10-35 SBC
   
• 2019 Oct Anthem PPO 80-G 30 Rx 200/10-35 SBC
   
• 2019 Oct Anthem PPO 80-L 30 Rx 200Ded 10-35 SBC
   
• 2019 Oct Anthem PPO Minimum Value SBC

Dental Benefits

• PPO Unlimited
   
• PPO Incentive

Vision Benefits

• VSP Plan C $15