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Medical & Pharmacy

Medical & Pharmacy

New Carrier

We offer the choice of four medical plans through our new 2024 carrier, Anthem. All of the medical options include coverage for prescription drugs through Anthem. To select the plan that best suits your family, you should consider the key differences between the plans, the cost of coverage (including payroll deductions), and how the plan covers services throughout the year.

Making the most of your plan

Getting the most out of your plan also depends on how well you understand it. Keep these important tips in mind when you use your plan.

  • In-network providers and pharmacies: You will always pay less if you see a provider within the medical and pharmacy network.
  • Preventive care: In-network preventive care is covered at 100% (no cost to you). Preventive care is often received during an annual physical exam and includes immunizations, lab tests, screenings and other services intended to prevent illness or detect problems before you notice any symptoms.
  • Preventive drugs: Many preventive drugs and those used to treat chronic conditions like diabetes, high blood pressure, high cholesterol and asthma are on the Preventive Condition Drug List. These prescriptions are covered at 100% (no cost to you) when you use an in-network pharmacy.
  • Mail Order Pharmacy: If you take a maintenance medication on an ongoing basis for a condition like high cholesterol or high blood pressure, you can use the Mail Order Pharmacy to save on a 90-day supply.
  • Pharmacy coverage: Medications are placed in tiers based on drug cost, safety and effectiveness. These tiers also affect your coverage.
    • Generic – A drug that offers equivalent uses, doses, strength, quality and performance as a brand-name drug, but is not trademarked.
    • Brand preferred – A drug with a patent and trademark name that is considered “preferred” because it is appropriate to use for medical purposes and is usually less expensive than other brand-name options.
    • Brand non-preferred – A drug with a patent and trademark name. This type of drug is “not preferred” and is usually more expensive than alternative generic and brand preferred drugs.
    • Specialty – A drug that requires special handling, administration or monitoring. Most can only be filled by a specialty pharmacy and have additional required approvals.
Embedded deductibles and out-of-pocket maximums
  • Under an embedded approach, each person only needs to meet the individual deductible and out-of-pocket maximum before the plan begins paying its share for that individual. (And, once two or more family members meet the family limits, the plan begins paying its share for all covered family members). This applies to all of the Anthem medical plans.

RESOURCES

250 HMO Plan - SBC
1500 PPO Plan - SBC
3200 HDHP w HSA - SBC
5000 HDHP w HSA - SBC
Anthem - Sydney Health App Flyer
Anthem Health Guide Flyer
Anthem HMO (HPN) Benefit FAQ Flyer
Anthem - Connect with Sydney Health Flyer
Anthem - Continuation of Care Flyer
Anthem - Digital ID Card User Guide Flyer
Anthem - Find Care - Cost Member Flyer
Anthem - Pharmacy
Overview Member Brochure
Anthem Pharmacies
Anthem Pharmacy Welcome Flier
Anthem Pharmacy Welcome Flier
Anthem - Carelon Sydney App Flier
Western Reserve Care Solutions -
HMO - $250 SOB
Western Reserve Care Solutions -
HSA $5,000 SOB
Western Reserve Care Solutions -
HSA $3,200 (with Copay)
Western Reserve Care Solutions -
PPO - $1,500 SOB
Syndey Overview - With Rx
Anthem HMO Plan Member Flyer
Anthem - Home Delivery Pharmacy Flyer
 

1500 PPO Plan

3200 HDHP (with HSA)
Medical Plan Provisions In-Network Out-of-Network In-Network Out-of-Network
Company contribution to HSA
(Individual/Family)		 N/A $500/$1,000** $500/$1,000**
Annual Deductible (Individual/Family) $1,500/$3,000 $5,000/$10,000 $3,200/$6,400 $7,500/$15,000
Out-of-Pocket Maximum
(Includes Deductible)		 $5,000/$10,000 $10,000/$20,000 $4,500/$9,000 $15,000/$30,000
Preventive Care Covered at 100% 50% Coinsurance Covered at 100% 50% Coinsurance
Primary Care Provider Office Visit $25 copay 50% Coinsurance $25 copay* 50% Coinsurance
Specialist Office Visit $25 copay 50% Coinsurance $50 copay* 50% Coinsurance
X-Ray and Lab Covered at 100% 50% Coinsurance 10% coinsurance 50% Coinsurance
Inpatient Hospital Services 20% coinsurance 50% Coinsurance 10% coinsurance 50% Coinsurance
Outpatient Hospital Services 20% coinsurance 50% Coinsurance 10% coinsurance 50% Coinsurance
Urgent Care $75 copay 50% Coinsurance $75 copay* 50% Coinsurance
Emergency Room $250 copay; 20% coinsurance $250 copay*; 10% coinsurance
Retail Pharmacy (up to a 30-day supply)
Generic $10 N/A $10* N/A
Brand Preferred $30 N/A $30* N/A
Brand Non-Preferred $50 N/A $50* N/A
Specialty Applicable drug tier copay applies or the max of any available manufacturerfunded copay assistance N/A Applicable drug tier copay applies N/A
Mail Order Pharmacy (90-day supply) 
Generic $25 N/A $25* N/A
Brand Preferred $75 N/A $75* N/A
Brand Non-Preferred $125 N/A $125* N/A
Specialty Applicable drug tier copay applies or the max of any available manufacturerfunded
copay assistance		 N/A Applicable drug tier copay applies N/A
 

5000 HDHP (with HSA)

HMO (CCF health system only)
Medical Plan Provisions In-Network Out-of-Network In-Network Out-of-Network
Company contribution to HSA
(Individual/Family)		 $500/$1,000** N/A
Annual Deductible (Individual/Family) $5,000/$10,000 $8,000/$16,000 $250/$500 N/A
Out-of-Pocket Maximum
(Includes Deductible)		 $6,000/$12,000 $12,000/$24,000 $2,000/$6,000 N/A
Preventive Care Covered at 100% 50% Coinsurance Covered at 100% N/A
Primary Care Provider Office Visit 25% coinsurance 50% Coinsurance $20 copay at PCP Office; Covered
100% for PCP Home		 Not covered
Specialist Office Visit 25% coinsurance 50% Coinsurance $30 copay at Specialist Office;
Covered 100% for Specialist Home		 Not covered
X-Ray and Lab 25% coinsurance 50% Coinsurance No charge after deductible Not covered
Inpatient Hospital Services 25% coinsurance 50% Coinsurance 0% coinsurance Not covered
Outpatient Hospital Services 25% coinsurance 50% Coinsurance 0% coinsurance Not covered
Urgent Care 25% coinsurance 50% Coinsurance $20 copay* Not covered
Emergency Room 25% coinsurance $125 copay
Retail Pharmacy (up to a 30-day supply)
Generic $10* N/A $15 N/A
Brand Preferred $30* N/A $30 N/A
Brand Non-Preferred $50* N/A $30 N/A
Specialty Applicable drug tier copay applies N/A $30 N/A
Mail Order Pharmacy (90-day supply) 
Generic $10* N/A $30 N/A
Brand Preferred $30* N/A $60 N/A
Brand Non-Preferred $50* N/A $60 N/A
Specialty Applicable drug tier copay applies N/A $30 N/A

MEDICAL PLAN RESOURCES

New with Anthem for 2024!

Anthem Digital ID cards

Your most up-to-date Anthem ID card is available digitally on the SydneySM Health mobile app and anthem.com. Follow the simple steps below to access ID cards for yourself and any dependents on your plan.

On Sydney Health:

  • Select ID Card in the top right corner of the homepage.
  • Your ID card will appear. If you have dependents enrolled in your plan, you will see an option to view their card(s) in the top right corner.
  • Choose whether you want to print, email, fax, or download your ID card(s).
    Note: When you download your card, you can securely access it 24/7, online or offline.

On anthem.com:

  • Select Your ID Card on the homepage once you log in.
  • D cards for you and any dependents enrolled in your plan will appear.
  • Choose whether you want to print, email, fax, mail, or download your ID card(s).

Sydney Health

Access personalized health and wellness information wherever you are.

The Sydney Health mobile app is the one place to keep track of your health and your benefits. With a few taps, you can quickly access your plan details, Member Services, virtual care, and wellness resources. Sydney Health stays one step ahead — moving your health forward by building a world of wellness around you.

Anthem Health Guide

Anthem Health Guide is a concierge service for your health and health care

Health care benefits can seem complicated or confusing at times. To make the most of your benefits, you need to understand them. That is why you have a team of concierge level customer service experts — ready to answer questions, advocate for your health and explain how to use your benefits. You can call a health guide or chat from your mobile device using our Sydney Health app.

Find Care

Choosing a doctor you trust is important — and choosing one in your plan’s network can keep your costs down. Using Find Care on the SydneySM Health mobile app and anthem.com can help you meet both needs.