Certificated

CERTIFICATED - Anthem Blue Cross PPO

2022-23 Benefits

Plan Summary Comparisons

Current Cost Information

New Plan Election Form

2021-22 Benefit Summary

• 2021 Oct Blue Cross PPO 100-A $10 PPO RX 9-35.pdf
   

• 2021 Oct Blue Cross PPO 100-D $20 PPO RX 10-35 200-500 DED.pdf

• 2021 Oct Blue Cross PPO 80-G $30 PPO RX 10-35 200-500 DED.pdf

• 2021 Oct Blue Cross PPO 80-L $30 PPO RX 10-35 200-500 DED.pdf
   
• 2021 Oct Blue Cross Anthem Minimum Value PPO RX 9-35 MVP.pdf 

2021-22 What this Plan Covers & What it Costs
SBC - Summary of Benefits and Coverage:

• 2021 Oct Blue Cross PPO 100-A $10 Rx 9-35.pdf
   
• 2021 Oct Blue Cross PPO 100-D $20 Rx 10-35 200-500 DED.pdf
   

• 2021 Oct Blue Cross PPO 80-G $30 Rx 10-35 200-500 DED.pdf

• 2021 Oct Blue Cross PPO 80-L $30 Rx 10-35 200-500 DED.pdf

• 2021 Oct Blue Cross Minimum Value PPO Rx MVP.pdf

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Dental Benefits

• PPO Unlimited
   
• PPO Premier (2000)

Vision Benefits

• VSP Plan C $15