Page 18 - Skechers 2022 Benefits Guide

ANTHEM BLUE CROSS MEDICAL PLAN COMPARISON CHART*
Four different Anthem plans. You can choose either an EPO, PPO Silver, PPO Gold, or HSA PPO.
Medical Plan Contributions**
Employee
Employee + Spouse/Domestic Partner
Employee + Child(ren)
Employee + Family
Annual Deductible:
Your Cost Share Shown Below
Per Individual
Overall Family
(Employee + one or more dependent)
ANTHEM EPO
$65
$158
$146
$246
In-Network Only
None
ANTHEM PPO SILVER
$25
$96
$79
$160
Out-of-Network
ANTHEM PPO GOLD
ANTHEM HSA PPO
(HSA Eligible)
$55
$152.50
$131.50
$238.50
In-Network
$1,000
$2,000
In-Network
$85
$209
$184
$317
Out-of-Network
$600
$1,800
In-Network
$1,400*
$2,800**
In-Network
$2,000
$4,000
Out-of-Network
$2,800*
$5,600**
Out-of-Network
$4,000
$8,000
$2,000 $300
$6,000 $900
* Applies if no dependents are enrolled
** When enrolling one or more dependents, the full family deductible must be satisfied before insurance pays anything (except for preventive care).
Out-of-Pocket Maximum
Your Cost Share Shown Below
Per Individual
Overall Family
(Employee + one or more dependent)
In-Network Only
$1,500
$3,000
In-Network
$3,000
$6,000
Out-of-Network
$10,000
$20,000
In-Network
$3,000
$6,000
Out-of-Network
$6,000
$12,000
*Available in all US states and Puerto Rico, excluding Hawaii.
**Your cost per paycheck (pre-tax). When you become eligible for the Plan, your benefits become effective on the 31st day of employment and you will be responsible for all per paycheck costs in the pay period in which your 31st day falls. If you become ineligible for the plan, your benefits terminate on the last day of the month in which you become ineligible, and you will be responsible for all per paycheck costs for the month. Benefits costs are NOT prorated.
NOTE: Annual IRS 1095-C tax forms, reporting health plan coverage for the year, are available on skechersbenefits.com and will also be provided by email to those who have completed the electronic consent form and by mail to those who have not.
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