Anthem $5,000 PPO HSA Compatible

In-Network Deductible

(Individual/Family)

$5,000/$10,000

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In-Network Out-of-Pocket Maximum

(Individual/Family)

$7,500/$15,000

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Office Visits (PCP/Specialist)

20% after deductible

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Prescription Drugs - Medical d Deductible Applies

Tier 1/Generic: $5-$15 after deductible

Tier 2/Brand:  $40 after deductible

Tier 3/Non-Preferred:  $60 after deductible

Tier 4/Specialty:  30% to $250 after deductible