Individual KeyCare Preferred
Lower your costs by visiting doctors and hospitals within the Anthem Blue Cross and Blue Shield PPO network - ( includes 85% of doctors in Virginia¹).
Doctor visits, copay $20 ; specialist copay $30.
No deductible to pay for prescription drugs and most routine wellness care in network - including routine dental care at a network dentist.
In fact, when you visit a network dentist, there's no charge to you for checkups and twice-a-year cleanings.
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Individual KeyCare Preferred ®
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The Basics of Your Coverage |
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In-Network
PPO Network of Providers. No gatekeepers or referrals |
Deductible |
Coinsurance |
Expense Limit |
$300
$750
$1,500
$2,500
$5,000
Family deductible/out-of-pocket expense limit = 2x single deductible/out-of-pocket expense limit |
20%
0% |
$1,500
$0 |
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 |
$300
$750
$1,500
$2,500
$5,000 |
30% |
$3,000 |
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: $5 Million regardless of providers or facilities |
Hospital Inpatient & Outpatient Care |
In-Network |
You pay: 20% or 0% |
Out-of-Network |
You pay: 30% |
Emergency Care |
In-Network |
You pay 20% or 0% coinsurance, in or out-of-network 3 |
Out-of-Network |
You pay 20% or 0% coinsurance, in or out-of-network 3 |
Doctor Visits |
In-Network |
Covered before deductible
$20 PCP / $30 Specialist |
Out-of-Network |
You pay 30% |
Prescription Drugs |
Covered before deductible.
You pay $10 or 40%, whichever is greater.
Yearly Benefit Maximum: $5,000 per person |
Routine Wellness Care |
In-Network |
Doctor Visits for Routine Wellness Care
Covered before deductible. $20 PCP, $30 Specialist. Two yearly visits per person.
Routine Screenings
Most screenings covered before deductible. You pay 20% or 0%, depending on the deductible you choose and the screening. See your brochure for more details. Provides additional $150 per person per year for routine immunizations, labs & x-rays. |
Out-of-Network |
You pay: 30% for doctor visit & screenings. Two yearly visits per person (combined with in-network visits). |
Preventive Care and Immunizations for Children |
In-Network |
Covered before deductible, you pay 0% |
Out-of-Network |
Same as in-network |
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 brochure and the policy, the provisions of the policy shall control. This brochure is only one part of your entire fulfillment kit. This brochure refers to Policy Form #s 901119-CP.1 et al., Schedule of Benefits Form#s 901152 or PVA2326, and Application Form #s AVA1309 - AVA1311, AVA1528-AVA1536, AVA1313 or AVA1537, AVA1359 or AVA1572. |
