Rates

2020 Anthem Health Plan Rates

 

Public AgenciesRegion 1 Northern CA        Region 2 Central CA      Region 3 LA/ Riverside/ San BernardinoOut of StateSupplemental 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

 

StateCalifornia             Out of StateSupplemental 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 Manager.