Confidential & Management

CONFIDENTIAL & MANAGEMENT - Anthem Blue Cross PPO
2019-20 Benefit Summary

• 2019 Oct Anthem PPO 90-C 30: Rx 200Ded 10-35

• 2019 Oct Anthem PPO 80-C 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 15-50

• 2019 Oct Anthem PPO Minimum Value

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

• 2019 Oct Anthem PPO 90-C 30 Rx 200Ded 10-35 SBC

• 2019 Oct Anthem PPO 80-C 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 15-50 SBC

• 2019 Oct Anthem PPO Minimum Value SBC

Dental Benefits

• PPO Unlimited
   
• PPO Incentive

Vision Benefits

• VSP Plan C $15