Page 10 - Veritone EE Guide OOS_ 2019

Option 1 3

Anthem Blue Cross
Plan Name PPO $500
Prudent Buyer
Network Name Non-Network
PPO
Health Benefits
Anthem Blue Cross
Lifetime Maximum Benefit Unlimited
Features: Calendar Year Deductible
• Keep your ID card on your phone that can be viewed, faxed or - Individual $500 $1,000
sent via email right from your mobile device - Family $1,000 $2,000
• Find a doctor, urgent care center or hospital fast with maps and
driving directions Out-of-Pocket Maximum
• The Health Record tool keeps your records available and up to - Individual $3,500 $6,500
date - Family $7,000 $13,000
• Compare cost and quality for common procedures Coinsurance (Plan Pays) 80% 60%

Download Anthem’s free mobile app today. To log in on your Office Visit Copay
smartphone, you must be registered on Anthem’s secure member site - Preventive Care No Charge Deductible, 40%
and have a user name and password. - Primary Care Physician $20 Copay Deductible, 40%
- Specialist $40 Copay Deductible, 40%
- Urgent Care $20 Copay Deductible, 40%
- Telemedicine $10 Copay N/A
Hospitalization
- Inpatient Deductible, 20% Deductible, 40%
- Outpatient Surgery Deductible, 20% Deductible, 40%

Lab and X-Ray
- Diagnostic Deductible, 20% Deductible, 40%
- Complex Deductible, 20% Deductible, 40%

Emergency Services $100 Copay, 20%
Chiropractic $20 Copay Deductible, 40%

Max 30 Visits/Year