Out-of-Network Benefits Summary
The following table describes out-of-network benefits in the HDHP PPO & HSA, PPO $900 Deductible, and PPO $400 Deductible plans.
HDHP PPO & HSA |
PPO $900 Deductible |
PPO $400 Deductible |
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Covered
Charges |
These include billed charges up to what ‘would have paid’ if the provider was in-network. These reimbursements are generally equivalent to what other Anthem and Blue Cross Blue Shield network providers across the U.S. accept as payment in full. |
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Balance Billing |
Out-of-Network providers may bill members for excess charges above covered charges – these member payments do not count toward deductibles and out-of-pocket maximums. |
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Out-of-Network Member Deductible |
$2,400 employee-only ($4,800 family) Separate from in-network deductibles |
$900 employee-only ($2,700 family) Separate from in-network deductibles |
$900 employee-only ($2,700 family) Separate from in-network deductibles |
Out-of-Network Member Co-pays |
40% of covered charges |
30% of covered charges |
30% of covered charges |
Preventive Services |
Preventive services received at out-of-network providers are subject to the out-of-network deductible and member co-pays. |
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Out-of-Network Member Out-of-Pocket Maximums |
$5,000 ($10,000 family) Separate from in-network maximums |
$3,000 ($9,000 family) Separate from in-network maximums |
$3,000 ($9,000 family) Separate from in-network maximums |
