Confidential & Management

CONFIDENTIAL & MANAGEMENT - Anthem Blue Cross PPO
2020 - 21 Benefit Summary

• 2020 Oct Blue Cross PPO 90-C $20 RX 10-35 200-500 DED.pdf

• 2020 Oct Blue Cross PPO 80-C $20 RX 10-35 200-500 DED.pdf 

• 2020 Oct Blue Cross PPO 80-G $30 RX 10-35 200-500 DED.pdf 

• 2020 Oct Blue Cross PPO 80-L $30 RX 15-50 200-500 DED.pdf 

• 2020 Oct Blue Cross Anthem Minimum Value PPO RX MVP.pdf 

 

2020-21 What this Plan Covers & What it Costs
SBC - Summary Benefits & Coverage

• 2020 Oct Blue Cross PPO 90-C $20 Rx 10-35 200-500 DED.pdf

• 2020 Oct Blue Cross PPO 80-C $20 Rx 10-35 200-500 DED.pdf

• 2020 Oct Blue Cross PPO 80-G $30 Rx 10-35 200-500 DED.pdf

• 2020 Oct Blue Cross PPO 80-L $30 Rx 15-50 200-500 DED.pdf

• 2020 Oct Blue Cross Minimum Value PPO Rx MVP.pdf

 

Dental Benefits

• PPO Unlimited
   
• PPO Incentive

Vision Benefits

• VSP Plan C $15