Rates

2022 Anthem Blue Cross Health Plan Rates

 

Public Agencies Region 1 Northern CA         Region 2 Central CA       Region 3 LA/ Riverside/ San Bernardino Out of State Supplemental Plan to Medicare
Employee Only $   799.00 $   775.00 $   775.00 $   899.00     $   461.00
Employee and One Dependent $1,725.00 $1,550.00 $1,475.00 $1,899.00     $   919.00
Employee and Two or more Dependents $2,219.00 $2,010.00 $1,894.00 $2,223.00     $1,471.00

 

State California              Out of State Supplemental Plan to Medicare
Employee Only $  750.00 $  899.00 $  461.00
Employee and One Dependent $1449.00 $1899.00 $ 919.00
Employee and Two or more Dependents $1,927.00 $2,223.00 $1,471.00

Maximum Out-of-Pocket Expense $2,000 per person/ $4,000 for a family.

Prescription Drugs

Retail
Generic $10.00 copay
Brand Formulary $25.00 copay
Brand Non-Formulary $45.00 copay
Mail Order
Generic $20.00 copay
Brand Formulary $40.00 copay
Brand Non-Formulary $75.00 copay

Body Scans are subject to a maximum $1,000 coverage limit every 36 months.

2021 Anthem Health Plan Rates

 

Public Agencies Region 1 Northern CA         Region 2 Central CA       Region 3 LA/ Riverside/ San Bernardino Out of State Supplemental Plan to Medicare
Employee Only $   799.00 $   749.00 $   725.00 $   899.00     $   513.00
Employee and One Dependent $1,725.00 $1,499.00 $1,450.00 $1,850.00     $1,022.00
Employee and Two or more Dependents $2,199.00 $1,960.00 $1,894.00 $2,223.00     $1,635.00

 

State California              Out of State Supplemental Plan to Medicare
Employee Only $  750.00 $  899.00 $  513.00
Employee and One Dependent $1449.00 $1850.00 $1022.00
Employee and Two or more Dependents $1,927.00 $2,223.00 $1,635.00

Maximum Out-of-Pocket Expense $2,000 per person/ $4,000 for a family.

Prescription Drugs

Retail
Generic $10.00 copay
Brand Formulary $25.00 copay
Brand Non-Formulary $45.00 copay
Mail Order
Generic $20.00 copay
Brand Formulary $40.00 copay
Brand Non-Formulary $75.00 copay

Body Scans are subject to a maximum $1,000 coverage limit every 36 months.

2020 Anthem Health Plan Rates

 

Public Agencies Region 1 Northern CA         Region 2 Central CA       Region 3 LA/ Riverside/ San Bernardino Out of State Supplemental Plan to Medicare
Employee Only $   774.00 $   749.00 $   699.00 $   899.00     $   513.00
Employee and One Dependent $1,699.00 $1,499.00 $1,399.00 $1,850.00     $1,022.00
Employee and Two or more Dependents $2,199.00 $1,960.00 $1,894.00 $2,223.00     $1,635.00

 

State California              Out of State Supplemental Plan to Medicare
Employee Only $  724.00 $  899.00 $  513.00
Employee and One Dependent $1449.00 $1850.00 $1022.00
Employee and Two or more Dependents $1,927.00 $2,223.00 $1,635.00

Maximum Out-of-Pocket Expense $2,000 per person/ $4,000 for a family.

Prescription Drugs

Retail
Generic $10.00 copay
Brand Formulary $25.00 copay
Brand Non-Formulary $45.00 copay
Mail Order
Generic $20.00 copay
Brand Formulary $40.00 copay
Brand Non-Formulary $75.00 copay

Body Scans are subject to a maximum $1,000 coverage limit every 36 months.

2019 Anthem Health Plan Rates

Basic
Employee Only $   774.00
Employee and One Dependent $1,623.00
Employee and Two or more Dependent(s) $2,076.00
Supplement to Medicare
Employee Only $  513.00
Employee and One Dependent $1022.00
Employee and Two or more Dependent(s) $1,635.00

Maximum Out-of-Pocket Expense $3,000 per person/ $6,000 for a family.

Prescription Drugs

Retail
Generic $10.00 copay
Brand Formulary $25.00 copay
Brand Non-Formulary $45.00 copay
Mail Order
Generic $20.00 copay
Brand Formulary $40.00 copay
Brand Non-Formulary $75.00 copay

Body Scans are subject to a maximum $1,000 coverage limit every 36 months.

2018 Anthem Blue Cross Rates

Basic
Employee Only $734.00
Employee and One Dependent $1,540.00
Employee and Two or more Dependent(s) $1,970.00
Supplement to Medicare
Employee Only $487.00
Employee and One Dependent $970.00
Employee and Two or more Dependent(s) $1,551.00

Maximum Out-of-Pocket Expense $3,000 per person/ $6,000 for a family.

Prescription Drugs

Retail
Generic $10.00 copay
Brand Formulary $25.00 copay
Brand Non-Formulary $45.00 copay
Mail Order
Generic $20.00 copay
Brand Formulary $40.00 copay
Brand Non-Formulary $75.00

Benefit Changes effective 2015: Body Scans will be subject to a maximum $1,000 coverage limit every 36 months.

2017 Anthem Blue Cross Rates

Basic
Employee Only $699.00
Employee and One Dependent $1,467.00
Employee and Two or more Dependent(s) $1,876.00
Supplement to Medicare
Employee Only $464.00
Employee and One Dependent $924.00
Employee and Two or more Dependent(s) $1,477.00

Maximum Out-of-Pocket Expense $4,500 per person/ $9,000 for a family.

Prescription Drugs

Retail
Generic $10.00 copay
Brand Formulary $25.00 copay
Brand Non-Formulary $45.00 copay
Mail Order
Generic $20.00 copay
Brand Formulary $40.00 copay
Brand Non-Formulary $75.00

Benefit Changes effective 2015: Body Scans will be subject to a maximum $1,000 coverage limit every 36 months.

2016 Anthem Blue Cross Rates

Basic
Employee Only $699.00
Employee and One Dependent $1,399.00
Employee and Two or more Dependent(s) $1,789.00
Supplement to Medicare
Employee Only $442.00
Employee and One Dependent $881.00
Employee and Two or more Dependent(s) $1,408.00

Maximum Out-of-Pocket Expense $4,500 per person/ $9,000 for a family.

Prescription Drugs

Retail
Generic $10.00 copay
Brand Formulary $25.00 copay
Brand Non-Formulary $45.00 copay
Mail Order
Generic $20.00 copay
Brand Formulary $40.00 copay
Brand Non-Formulary $75.00

Benefit Changes effective 2015: Body Scans will be subject to a maximum $1,000 coverage limit every 36 months.

2015 Anthem Blue Cross Rates

Basic
Single $675.00
Two Party $1,292.00
Family $1,642.00
Supplement to Medicare
Single $402.00
Two Party $802.00
Family $1,281.00

2014 Anthem Blue Cross Rates

Basic
Single $643.00
Two Party $1,186.00
Family $1,507.00
Supplement to Medicare
Single $397.00
Two Party $791.00
Family $1,264.00

2013 Anthem Blue Cross Rates

Basic
Single $581.00
Two Party $1,088.00
Family $1,382.00
Supplement to Medicare
Single $418.00
Two Party $833.00
Family $1,331.00

2012 Anthem Blue Cross Rates

Basic
Single $556.00
Two Party $1,041.00
Family $1,323.00
Supplement to Medicare
Single $418.00
Two Party $833.00
Family $1,331.00

2011 Anthem Blue Cross Rates

Basic
Single $527.00
Two Party $987.00
Family $1,254.00
Supplement to Medicare
Single $418.00
Two Party $833.00
Family $1,331.00

2010 Anthem Blue Cross Rates

Basic
Single $484.00
Two Party $906.00
Family $1,151.00
Supplement to Medicare
Single $363.00
Two Party $723.00
Family $1,157.00

Anthem Blue Cross Rates older than five years are available upon written request from the IBT Chief Operations Officer.