Individual KeyCare Flexible Choice SM

In-Network

PPO Network of Providers. No gatekeepers or referrals

Deductible  

Coinsurance  

Expense Limit  

$500
$1,500
$2,500
$5,000 

20%

0% 

$2,500
$3,500
$2,500
$5,000 

Family deductible/out-of-pocket expense limit = 2x single deductible/out-of-pocket expense limit  

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.

Deductible  

Coinsurance  

Expense Limit  

$500
$1,500
$2,500
$5,000 

30% 

$5,000
$7,000
$5,000
$10,000 

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  

Hospital Inpatient & Outpatient Care

In-Network 

After deductible, you pay 20% or 0% 

Out-of-Network 

After deductible, you pay 30% 

Emergency Care

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

In-Network 

Covered before deductible
$500 & $1,500 deductibles: $30 PCP/ $40 specialist
$2,500 & $5,000 deductibles: $20 PCP/ $30 specialist 

Out-of-Network 

After deductible, you pay 30%

Prescription Drugs

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

. 
With KeyCare Flexible Choice, prescription drug benefits are divided
into two categories, or tiers: Non-specialty, or Tier 1 drug benefits,
and Specialty, or Tier 2 drug benefits. Your Benefit Comparison
Chart gives more details.

What is a Specialty drug?
Specialty drugs are high cost, scientifically engineered drugs.
They are usually injected or infused and require special storage
and handling that make them difficult for a typical pharmacy
to dispense. Certain Specialty drugs are only available through
Anthem’s Specialty Pharmacy Network. If you enroll in KeyCare
Flexible Choice, you’ll receive more information in your member kit.

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

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. 

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.  

In-Network 

Covered before deductible, you pay 20% 

Out-of-Network 

After deductible, you pay 30% 

Optional Coverage