Medical & Prescription

Provider: Anthem and Carelon Rx
Customer Service: 844-614-3181
anthem.com | anthem.com/find-care

Which Medical Plan is Right?

You have two Anthem medical plan options: the High Deductible Health Plan (HDHP) and the PPO plan.

Review The Plans. Review both plans to better understand what features the plans have in common and what is different.

Evaluate Your Needs. Consider your prior health care usage and select plans and options that fit your lifestyle and budget.

Do you take regular prescription medications?
Are you anticipating surgery?
How many dependents (spouse/children) will you need to cover?
How do these plans compare with what you or your spouse currently has?

A little bit of planning will help you select the best plans, coverage levels, and financial programs for your unique situation.

Medical Plan Comparison

Both the PPO and HDHP:

Cover the same medical services (including in-network preventive services at no cost).
Offer prescription drug coverage.
Use the same Anthem provider network and prescription network.
Feature LiveHealth Online services for: General Medical, Mental Health, and Dermatology.

Key Differences¹

The primary differences between the plans are in what you pay out of your paycheck for coverage and how much you pay when you get care.

	HDHP	PPO
Your Deductible Amount you pay for services (doctor's office visits, prescriptions, etc.) before insurance starts to pay.	When you go to the doctor or get a prescription, you pay the full cost until you meet the plan's deductible. You can use your HSA (see below) or pay another way.	Doctor's office visits and most prescriptions are covered by a copay. For most other services, you pay the full cost until you meet the deductible. Copays don't count toward the deductible.
Coinsurance Percentage you pay for the cost of covered health care services after you meet your deductible.	Once you meet your deductible, your insurance kicks in. You pay 20% of the cost of services and the plan pays 80% until you reach the out-of-pocket maximum (see below).	For services not covered by a copay, once you meet your deductible, you pay 20% of the cost of services and the plan pays 80%, until you reach the out-of-pocket maximum (see below).
Out-of-Pocket Maximum This is a "cap" on your costs for the year. In a worst-case scenario year when you need a lot of care, your plan will pay for all your eligible health care after you hit this cap.	Higher out-of-pocket maximum in exchange for lower paycheck deductions. Your copays, deductibles, and coinsurance count toward the out-of-pocket maximum.	Lower out-of-pocket maximum in exchange for higher paycheck deductions. Your copays, deductibles, and coinsurance count toward the out-of-pocket maximum.
Company Contribution Toward Out-of-Pocket Expenses	Your company helps pay your health care expenses by contributing to your HSA. You can use this money to cover current or future expenses.	No company contribution. You cover 100% of your out-of-pocket expenses.
Your Monthly Contributions The amount you pay out of your paycheck for coverage.	You'll pay less each paycheck in exchange for a higher deductible and a higher out-of-pocket maximum.	You'll pay more each paycheck in exchange for copays for doctor's office visits and most prescription coverage, a lower deductible, and a lower out-of-pocket maximum.

¹ These assume you are using in-network providers that charge lower negotiated rates than out-of-network providers. If you use out-of-network providers, you’ll pay more for care and prescription drugs. For more information about out-of-network coverage, see the Summary of Benefits Coverage (SBC) document.

Benefit Exclusive to the HDHP Only!

There are a variety of drugs and services that are covered 100% as preventive care. This coverage extends to many conditions, including heart disease, asthma, depression, liver disease, and more. To view an inclusive list, go to roperbenefits.info/medical-prescription.

Example: If you are diabetic and require A1c testing and insulin medication, you can be covered for certain drugs and services at 100%.

Medical Care & Prescriptions

Below is a summary of the Anthem HDHP and PPO and plan in-network benefits. If you use out-of-network providers, you’ll pay more for care and prescription drugs.

What You Pay for Care	Anthem HDHP	Anthem PPO
Employer HSA Contribution Individual/Family (prorated based on pay frequency and funded each pay period.)	$700 per year / $1,200/ per year	N/A
Annual Deductible Individual/Family (amount you pay before the plan begins to pay)	$3,400 employee only $6,800* if you cover others, too	$1,250 individual $2,500 others

Professional Services
Preventive care (annual physicals)	Covered in full	Covered in full
Virtual Primary Care, Mental Health and Dermatology through LiveHealth Online	$10 copay	$10 copay
Primary Care Visit	20%	$25 copay
Specialist Visit	20%	$40 copay

Other Services
Lab & X-ray	20%	$40 copay (freestanding facilities) 20% (hospital)
Urgent care center	20%	$50 copay
Emergency room (facility only)	20%	$200 copay
Outpatient and Inpatient Hospital	20%	20%
Outpatient Mental Health	20%	20%

Prescription drugs
Generic	20%* (Certain chronic conditions prescriptions are covered in full.)**	31-day supply: $10 copay retail 90-day supply: $20 copay retail or mail service
Preferred brand	20%* (Certain chronic conditions prescriptions are covered in full.)**	31-day supply: $35 copay retail90-day supply: $70 copay retail or mail service2
Non-preferred brand	20%* (Certain chronic conditions prescriptions are covered in full.)**	31-day supply: $60 copay retail90-day supply: $120 copay retail or mail service
Specialty	20%* (Certain chronic conditions prescriptions are covered in full.)**	20% up to $300 maximum per prescription

Annual Out-of-Pocket Maximum
Includes your out-of-pocket costs for medical services, prescription drugs, copays, deductible, and coinsurance	$5,500 individual $11,000 if you cover others, too	$4,000 individual $8,000 if you cover others, too

The family deductible is embedded for 2026! Roper’s HDHP has historically been an aggregate (non-embedded) deductible, which requires the total family deductible amount to be met before the insurance pays for any services for any covered individual on the plan. With an embedded family deductible, a single person can meet their individual deductible ($3,400), and the plan will begin to pay at 80%, even if the family deductible hasn’t been met yet, offering faster coverage for high-cost individual medical needs.
**Refer to the Preventive Drug List at roperbenefits.info/medical-prescription for more information.

Search for an In-Network Provider

Based on where you reside, use the applicable guest link below to search for a provider. Once you’re enrolled in 2026, you’ll search for providers via the Sydney Mobile app or at anthem.com.

Home State	Provider Directory Name	Direct URL
DC	BlueChoice Adv Open Access (Select Network)	https://www.anthem.com/find-care/?alphaprefix=110
FL	NetworkBlue (Select Network)	https://www.anthem.com/find-care/?alphaprefix=101
GA	Blue Open Access POS (Select Network)	https://www.anthem.com/find-care/?alphaprefix=108
MO Inside Kansas City ONLY	Preferred-Care Blue (KC) (Select Network)	https://www.anthem.com/find-care/?alphaprefix=102
MO All other MO locations outside KC	Blue Access Choice (St. Louis) (Select Network)	https://www.anthem.com/find-care/?alphaprefix=103
NH	BlueChoice Open Access POS (Select Network)	https://www.anthem.com/find-care/?alphaprefix=114
NJ	Horizon Managed Care Network (Select Network)	https://www.anthem.com/find-care/?alphaprefix=104
VA	HealthKeepers POS (Select Network)	https://www.anthem.com/find-care/?alphaprefix=133
WI	Blue Preferred POS (Select Network)	https://www.anthem.com/find-care/?alphaprefix=107
All other states	National PPO (BlueCard PPO)	https://www.anthem.com/find-care/?alphaprefix=901