Page 4 - OptimaTax Journey All

Benjamin’s Journey
Benjamin is currently enrolled in the High PPO plan. He has
medical conditions and wants to make sure he is covered.
What should he consider?

Benjamin has stayed on the High PPO plan because he always wants to make sure he is covered and
has the flexibility to see any providers in or out‐of‐network due to his medical conditions.

What can Benjamin expect with the new medical plan offerings for 2020?

New Basic PPO New Standard EPO New Premier PPO

 He can see contracted
 He can see any provider  He can see any provider
providers only
 Doctor Visits range from  Doctor Visits range from  Doctor Visits range from

$5 ‐ $30 $5 ‐ $30 $5 ‐ $20
 $1,500 Deductible for  $250 Deductible for
Hospitals & Labs/X‐rays  No Deductible to satisfy Hospitals & Labs/X‐rays
 Maximum Out‐of‐Pocket  Maximum Out‐of‐Pocket  Maximum Out‐of‐Pocket
due to catastrophic year is due to catastrophic year is due to catastrophic year is
$6,000 in‐network $6,000 in‐network $3,750 in‐network
 Does NOT covers non‐  Does NOT covers non‐  Covers non‐formulary

formulary pharmacy drugs formulary pharmacy drugs pharmacy drugs
 He will be paying about  He will be paying about  He will be paying about
$1,325 in total annual $1,746 in total annual $4,755 in total annual
premium premium premium

Benjamin has several things to consider before enrolling. Given his medical conditions, he may want
to review and determine what would be his best option for 2020.

 Are my current providers contracted with Anthem?
 Are my pharmacy drugs on the Anthem’s formulary list?
 If I anticipate a lot to happen in 2020, what will be the most I pay out‐of‐pocket for my
benefits and employee premiums altogether annually?
1)

Questions
Please contact the Optima Tax Relief Human Resources Department.