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Essential KeyCare®'
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Your Benefits in a nutshell |
In-Network
PPO Network of Providers. No gatekeepers or referrals. |
Deductible |
Coinsurance |
Expense Limit |
$500
$1,500
$2,500
Family deductible/out-of-pocket expense limit = 2x single deductible/out-of-pocket expense limit |
30% |
$2,500 |
Out-of-Network
Use any provider. You will be responsible for more of the cost with an out-of-network provider. No gatekeepers or referrals. |
Deductible |
Coinsurance |
Expense Limit |
$2,500 |
40% |
$5,000 |
After the Deductible, you pay a Coinsurance amount, with an annual Out-of-Pocket Expense Limit. This Expense Limit helps control your annual out-of-pocket expenses by limiting the amount you pay in Coinsurance. |
The Details - the benefits and your share of the cost
Lifetime Maximum: $2 Million regardless of providers or facilities |
Hospital Inpatient & Outpatient Care |
In-Network |
After deductible, you pay: 30% |
Out-of-Network |
After deductible, you pay: 40% |
Emergency Care |
In-Network |
After deductible, you pay 30% coinsurance, in or out-of-network3 |
Out-of-Network |
After deductible, you pay 30% coinsurance, in or out-of-network3 |
Doctor Visits |
In-Network |
First 3 yearly visits: $30 copayment. Covered before deductible.
Remaining visits: 30% Covered after deductible. |
Out-of-Network |
You pay: 40% |
Prescription Drugs |
Separate $200 yearly deductible per person.
You pay $15 or 40%, whichever is greater.
Coverage for generic drugs only
Yearly Benefit Maximum: $5,000 per person |
Routine Wellness |
In-Network |
Doctor Visits for Routine Wellness Care
One yearly visit per person. If included with first 3 yearly doctor visits, covered before deductible, and you pay $30 copayment. If after first 3 yearly doctor visits, covered after the deductible, and you pay 30%.
Routine Screenings
Covered after deductible. You pay 30%. |
Out-of-Network |
After deductible, you pay: 40%
(combined with in-network visits) |
Preventive Care and Immunizations for Children
Coverage for immunizations only. Optional coverage available. |
In-Network |
After deductible, you pay: 30% |
Out-of-Network |
After deductible, you pay: 40% |
Optional Coverage |
Benefits Available at an Additional Cost |
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3 This applies if covered services are for emergency care as defined by Anthem. Your Anthem Sales Representative has more details.
View the Important Facts You Should Know for additional information, including exclusions and limitations
This is not your policy and is intended as a brief summary of services. If there is any difference between this page and the policy, the provisions of the policy shall control. To understand the terms of the individual policy you are considering, please read the Policy Terms, including Exclusions and Limitations. This page refers to Policy Form #s 901119-CP.1 et al., Schedule of Benefits Form PVA1723, and Application Form #s AVA1537, AVA1572 or AVA1635, AVA1628-AVA1633, Optional Coverage Form #s AVA1393, 901167, and AVA1347.
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