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.