Page 11 - Veritone EE Guide 07-19_FINAL.pub
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MEDICAL PLAN HIGHLIGHTS - PPO
Option 5 Anthem Blue Cross HSA PPO Prudent Buyer Non-Network or National Unlimited $5,000 $2,700 $10,000 $5,400 $10,000 $5,500 $20,000 $11,000 60% 80% Deductible, 40% Deductible, 20% Deductible, 40% Deductible, 20% Deductible, 40% Deductible, 20% Deductible, 40% Deductible, 20% N/A Deductible, 20% Deductible, 40% Deductible, 20% Deductible, 40% Deductible, 20% Deductible, 40%
Anthem Blue Cross PPO $1,500 Prudent Buyer or National $1,500 $3,000 $11,000 70% No Charge $30 Copay $50 Copay $30 Copay $10 Copay Deductible, 30% Deductible, 30% Deductible, 30% Deductible, 30% $100 Copay, 30% $30 Copay
Option 4 Non-Network Unlimited $5,000 $10,000 $10,000 $20,000 50% Deductible, 50% Deductible, 50% Deductible, 50% Deductible, 50% N/A $500/Admit, 50% Deductible, 50% Deductible, 50% Deductible, 50% Deductible, 50% Max 30 Visits/Year
3 $5,500
Option 3 Anthem Blue Cross PPO $500 Prudent Buyer Non-Network PPO Unlimited $1,000 $500 $2,000 $1,000 $6,500 $3,500 $13,000 $7,000 60% 80% Deductible, 40% No Charge Deductible, 40% $20 Copay Deductible, 40% $40 Copay Deductible, 40% $20 Copay N/A $10 Copay Deductible, 40% Deductible, 20% Deductible, 40% Deductible, 20% Deductible, 40% Deductible, 20% Deductible, 40% Deduct
Plan Name Network Name Health Benefits Lifetime Maximum Benefit Calendar Year Deductible - Individual - Family Out-of-Pocket Maximum - Individual - Family Coinsurance (Plan Pays) Office Visit Copay - Preventive Care - Primary Care Physician - Specialist - Urgent Care - Telemedicine Hospitalization - Inpatient - Outpatient Surgery Lab and X-Ray - Diagnostic - Complex Emergency Services Chiroprac
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