Page 8 - 2021 Master's University Benefit Brochure_Final3

Anthem Medical Select & Traditional HMO Benefits

In-Network Only

You Pay Difference Card Pays Anthem Benefits

Annual Deductible $0 $5,900 per member $5,900 per member

$0 $500 Individual $500 Individual
Annual Coinsurance Max
$0 $1,000 Family $1,000 Family
Office Visit

Primary Provider $15 copay $20 copay $35 copay
Specialist $15 copay $55 copay $70 copay

Preventive Services No charge N/A No charge

Chiropractic Care - American $10 copay
Specialty Health Network $0 $10 copay (30 visits per calendar year)

Lab and X-ray

Diagnostic No charge N/A No charge

Complex Imaging $100 copay $150 copay $250 copay

Inpatient Hospitalization Deductible & 30% coinsurance
$0
coinsurance after deductible
Outpatient Surgery $0 Deductible & 30% coinsurance
coinsurance after deductible
Urgent Care $10 copay $25 copay $35 copay

Durable Medical 50% coinsurance
$0
Equipment Deductible & coinsurance (Ded. Waived)
$100 copay $150 copay + deductible $250 copay + 30%
Emergency Room coinsurance after deductible
(copay waived if admitted) & coinsurance
(copay waived if admitted)
$500 / $1,500
Pharmacy Deductible for tiers 2-4, then
$5/$20/$50/$75/30% to $500 / $1,500 Deductible
$250 for tiers 2-4 (single / family) $5/$20/$50/$75/
30% to $250
The Select HMO has a limited network of providers. Depending on your place of residence you may need to enroll on
the Traditional HMO plan. Benefits are the same between these two plans, the network of providers is the only
variation. Please refer to your provider finder flyer for details on how to find in-network doctors.

The Master’s University & Seminary Page 7
2021 Employee Benefits Brochure