2023 Anthem Health Plan Rates
Public Agencies
| EmployeeOnly | Employee+1 Dependent | Employee2+ Dependents | |
|---|---|---|---|
| Region 1 | $825.00 | $1,875.00 | $2,300.00 |
| Region 2 | $820.00 | $1,650.00 | $2,100.00 |
| Region 3 | $820.00 | $1,600.00 | $2,100.00 |
| Out of State | $935.00 | $1,899.00 | $2,250.00 |
| Supplemental Plan to Medicare | $465.00 | $1,030.00 | $1,395.00 |
Region 1: Northern California
Region 2: Central California
Region 3: LA, Riverside & San Bernardino
State Agencies
| Employee Only | Employee+1 Dependent | Employee2+ Dependents | |
|---|---|---|---|
| California | $775.00 | $1,525.00 | $2,000.00 |
| Out of State | $935.00 | $1,899.00 | $2,250.00 |
| Supplemental Plan to Medicare | $465.00 | $1,030.00 | $1,395.00 |
Maximum Out-of-Pocket Expense is $2,000 per person / $4,000 per 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.
2022 Anthem Health Plan Rates
Public Agencies
| Employee Only | Employee and 1 Dependent | Employee and 2 or more Dependents | |
|---|---|---|---|
| Region 1 | $799.00 | $1,725.00 | $2,219.00 |
| Region 2 | $775.00 | $1,550.00 | $2,010.00 |
| Region 3 | $775.00 | $1,475.00 | $1,894.00 |
| Out of State | $899.00 | $1,899.00 | $2,223.00 |
| Supplemental Plan to Medicare | $461.00 | $919.00 | $1,471.00 |
Region 1: Northern California
Region 2: Central California
Region 3: LA, Riverside & San Bernardino
State Agencies
| Employee Only | Employee and 1 Dependent | Employee and 2 or more Dependents | |
|---|---|---|---|
| California | $750.00 | $1,499.00 | $1,927.00 |
| Out of State | $899.00 | $1,899.00 | $2,223.00 |
| Supplemental Plan to Medicare | $461.00 | $919.00 | $1,471.00 |
Maximum Out-of-Pocket Expense is $2,000 per person / $4,000 per 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.
Anthem Blue Cross Rates older than five years are available upon written request from the IBT Chief Operations Officer.