Health & Welfare Plan
Health and Welfare Benefit Summaries
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Covered Features
Anthem HMO is one of the three medical plans available to eligible participants in certain areas of California. -
Choice of Providers
Must use only Anthem HMO Health Plan Providers -
Plan Maximums
No plan maximum -
Out-of-Pocket Maximums
$1,500/individual
$3,000/for 2 family members
$4,500/for 3+ family members -
Doctor Visits or Hospital
Your co-payment is:
$25 per visit
No Charge -
In-Patient Hospital Co-Pay
Your co-payment is $250 per confinement.
No charges for surgeon or assistant surgeon. -
Anesthesia
$35 co-pay per occurrence -
Emergency Room Co-Pay
Your co-pay is $100 for bona fide emergencies. Waived if admitted. -
Ambulance Services
$50 co-pay per trip. -
Outpatient Lab and X-Ray
No charge -
Preventive Health Care
(Routine check-ups, well baby care, immunizations, preventive screenings, etc.)100% preventive care coverage is available in accordance with the Affordable Care Act. Click here for more information. -
Prescriptions
Co-Payment for Generic Co-Payment for Name Brand Retail Pharmacy on Recommended Drug List $10 per 30-day supply $30 per 90-day supply Mail Service Pharmacy on Recommended Drug List $20 per 90-day supply $60 per 90-day supply Retail Pharmacy not on Recommended Drug List $30 per 30-day supply 50% per 90-day supply Mail Service Pharmacy not on Recommended Drug List $60 per 30-day supply 50% per 90-day supply -
Mental Health and Substance Abuse Treatment Benefits
$250 co-pay per admission.
Detoxification covered for Substance Abuse. -
Contact Information
Website: www.anthem.com
Phone: (800) 522-0088