Classified

CLASSIFIED - Anthem Blue Cross PPO
2019-20 Benefit Summary

• 2019 Oct Anthem PPO 90-A 20: Rx 200Ded 10-35

• 2019 Oct Anthem PPO 90-C 30: Rx 9-35

• 2019 Oct Anthem PPO 80-E 20: Rx 200Ded 10-35

• 2019 Oct Anthem PPO 80-G 30 Select: 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 90-A 20 Rx 200Ded 10-35 SBC

• 2019 Oct Anthem PPO 90-C 30 Rx 9-35 SBC

• 2019 Oct Anthem PPO 80-E 20 Rx 200Ded 10-35 SBC

• 2019 Oct Anthem PPO 80-G 30 Rx 200/10-35 SBC

• 2019 Oct Anthem PPO Minimum Value SBC

Dental Benefits

• PPO Incentive ($1,200/$1,000)
   
• PPO $1,500

Vision Benefits

• VSP Plan A $15