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.