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Individual KeyCare Flexible Choice SM -  |
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| The Basics – how your coverage works |
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| In-Network PPO Network of Providers. No gatekeepers or referrals |
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| Deductible | Coinsurance | Expense Limit | |||
| $500 $1,500 $2,500 $5,000 Family deductible/out-of-pocket expense limit = 2x single deductible/out-of-pocket expense limit |
20% 0% |
$2,500 $3,500 $2,500 $5,000 |
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| Out-of-Network Use any provider. You will be responsible for more of the cost with an out-of-network provider. No gatekeepers or referrals. |
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| Deductible | Coinsurance | Expense Limit | |||
| $500 $1,500 $2,500 $5,000 |
30% | $5,000 $7,000 $5,000 $10,000 |
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| After the Deductible, you pay a Coinsurance amount, up to an annual Out-of-Pocket Expense Limit. This Expense Limit helps control most of your annual out-of-pocket expenses for covered services, including deductible, copayments, and coinsurance amounts. Prescription drug expenses do not accumulate towards the out-of-pocket expense limit. | |||||
| The Details – the benefits and your share of the cost Lifetime Maximum: $5 Million regardless of providers or facilities |
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| Hospital Inpatient & Outpatient Care |
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| In-Network | After deductible, you pay 20% or 0% | ||||
| Out-of-Network | After deductible, you pay 30% | ||||
| Emergency Care |
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| In-Network | After deductible, you pay 20% or 0% coinsurance, in or out-of-network 3 | ||||
| Out-of-Network | After deductible, you pay 20% or 0% coinsurance, in or out-of-network 3 | ||||
| Doctor Visits |
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| In-Network | Covered before deductible $500 & $1,500 deductibles: $30 PCP/ $40 specialist $2,500 & $5,000 deductibles: $20 PCP/ $30 specialist |
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| Out-of-Network | After deductible, you pay 30% |
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| Prescription Drugs |
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| In-Network | Before deductible. Non-specialty (Tier 1 drugs), you pay $15 copayment or 40% coinsurance, whichever is greater. Yearly Benefit Maximum is $5,000 per person for non-specialty drugs. Specialty (Tier 2) drugs covered through Anthem's Specialty Pharmacy Network, you pay 40% coinsurance up to $500 expense limit per prescription; $10,000 annual expense limit per person. | ||||
| Out-of-Network | Before deductible. Non-specialty (Tier 1) drugs, you pay $15 copayment or 40% coinsurance, whichever is greater. Yearly Benefit Maximum is $5,000 per person combined with in-network for non-specialty drugs. You are responsible for the amounts above the allowable charge. Specialty (Tier 2) drugs not covered. | ||||
| Routine Wellness Care |
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| In-Network Doctor Visits for Routine Wellness Care Routine Screenings | Covered before deductible. Two yearly visits per person. $500 & $1,500 deductibles: $30 PCP/ $40 Specialist $2,500 & $5,000 deductibles: $20 PCP/ $30 Specialist Covered before deductible. You pay 20%. See your brochure for more details. Provides additional $150 yearly per person for routine immunizations, labs & x-rays. |
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| Out-of-Network | After deductible, you pay 30% for doctor visit & screenings. Two yearly visits per person (combined with in-network visits). | ||||
| Preventive Care and Immunizations for Children Coverage for immunizations only. Optional coverage available. |
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| In-Network | Covered before deductible, you pay 20% | ||||
| Out-of-Network | After deductible, you pay 30% | ||||
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| GET INSTANT QUOTES and APPLY ONLINE | |||||