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How You Pay for Care

PPO

You see the doctor

A UC Medical Center doctor

You pay the applicable copayment to your provider at the time of service.

Your provider sends a claim to Anthem.

Anthem will send you an Explanation of Benefits (EOB) showing the full amount and confirming the amount you're responsible for paying.1

An Anthem doctor

In-network preventive care is covered at 100%.

Your provider sends a claim to Anthem.

If you haven't met your deductible

You pay 100% of the cost,2 up to the deductible:

  • Self-coverage: $100
  • Family coverage: $200

Your provider might request payment at the time of service or send you a bill after your visit. This amount counts toward your individual deductible.

If you have met your deductible

Your insurance kicks in. You generally pay:

  • In-network:
    $15 copayment for office and urgent care visits and 10% of the cost2 for other services
  • Out-of-network:
    30% of the cost2

Your provider may request payment at the time of service or may send you a bill after your visit. This amount counts toward your out-of-pocket maximum.

Anthem will send you an Explanation of Benefits (EOB) showing the full amount and confirming the amount you're responsible for paying.1

You fill a prescription

You pay the applicable copayment at the pharmacy.

You're protected by the out-of-pocket maximum

Essentially, it's a year-long safety net for the worst-case scenario. Once you reach the maximum, the plan pays 100% of covered services for the rest of the benefit year.

  • At UC Medical Centers:
    Self-coverage: $1,000
    Family coverage: $2,000
  • Anthem providers:
    Self-coverage: $1,000
    Family coverage: $2,000
  • Out-of-network:
    Self-coverage: $2,000
    Family coverage: $4,000

The out-of-pocket maximum includes the deductible.

1 If the EOB shows you owe a different amount than what the provider collected at the time of service or billed you, call Anthem Health Guide.
Based on Anthem’s allowed amount for the service.