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How You Pay for Care

PPO HMO

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.

HMO

You see the doctor

A UC Medical Center or Anthem HMO 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.