Confidential & Management

CONFIDENTIAL & MANAGEMENT - 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 90-C $20 PPO RX 10-35 200-500 DED.pdf
   

• 2021 Oct Blue Cross PPO 80-C $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 15-50 200-500 DED.pdf

• 2021 Oct Blue Cross Anthem Minimum Value PPO RX 9-35 MVP.pdf

Dental Benefits

• PPO Unlimited
   
• PPO Premier (2000)

Vision Benefits

• VSP Plan C $15