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Anthem Blue Cross
|
Click on the button below to obtain the appropriate forms. These are pdf files to be printed, completed, and faxed to our office.
| Employee Application Package for New Group | Add Employee to Existing Group Plan | Employee Waiver |
Other Forms:
Employee forms can be faxed to our office at (303) 721-1085. Please confirm that application was received by calling (303) 721-1145. Please call with any questions regarding eligibility or waiting periods.
The following plans are available from Anthem effective 11-1-05. For Anthem's Comparison Guide brochure, click here. Plans are offered as an employee "buffet", allowing the employer to offer plans which best meet the needs of the individual employee. Employer may pay a flat amount (minimum $125) toward each plan, and employee pays the difference. Employer may limit the selection to one plan, or offer any combination of the 12 plans.
Please note the Classic HMO Select and Premier HMO Select are only available in the 7-county Denver metro area and include only a select network of providers within that area.
| Health
Plan Name |
Office
Visit Copay |
Hospital
Copay |
Outpatient Copay |
Prescriptions |
$30 |
$500 + 20%, $3500 max |
$500 + 20%, $3500 max |
$15/$30/$50/30% |
|
| PPO $40 Copay | $40 |
$500 + 30%, $4000 max |
$500 + 30%, $4000 max |
$15/$30/$50/30% |
$35 |
$500 + 30%, $3500 max |
$500 + 30%, $3500 max |
$15 generic only |
|
| PPO $45 Copay, Gen Rx | $45 |
$750 + 40%, $4000 max |
$750 + 40%, $4000 max |
$15 generic only |
| Premier PPO $15 Copay | $15 |
$150 + 10%, $2500 max |
$150 + 10%, $2500 max |
$10/$30/$50/30% |
| Premier PPO $25 Copay | $25 |
$150 + 20%, $3000 max |
$150 + 20%, $3000 max |
$15/$30/$50/30% |
| Deductible, then 100% |
Deductible, then 100% |
Deductible, then 100% |
Deductible, then 100% |
|
| HSA PPO 3500 Deductible | 20% after deductible |
20% after deductible, max $5000 |
20% after deductible, max $5000 |
20% after deductible, $5000 max |
| Classic HMO | $20 |
$500 |
$250 |
$15/$40/$60/30% |
| Premier HMO | $15 |
$250 |
$200 |
$10/$30/$50/30% |
| Classic HMO Select | $20 |
$500 |
$250 |
$15/$40/$60/30% |
| Premier HMO Select | $15 |
$250 |
$200 |
$10/$30/$50/30% |
State Mandated Plans
| Health Plan Name |
Office Visit Copay |
Hospital Copay |
Outpatient Copay |
| Basic HMO | $30 |
$400/day, max $1600 |
$150 |
| Standard HMO | $20 | $150/day, max $600 | $50 |
| Basic PPO | $30 |
$3000 deductible + 30%, $5000 max |
$3000 deductible + 30%, $5000 max |
| Standard PPO | $30 |
$1000 deductible + 20%, $2000 max |
$1000 deductible + 20%, $2000 max |
Discontinued Plans
The following plans were discontinued by Anthem as of 10-31-05. Some plans may be renewed in 2006, other plans will have to be converted to a new plan design. Please call (303) 721-1145 for details.
BlueAdvantage HMO Plans
| Health Plan Name |
Office Visit Copay |
Hospital Copay |
Outpatient Copay |
| 15-300 | $15 | $300 | $225 |
| 15-500 | $15 | $500 | $375 |
| 20-300 | $20 | $300 | $225 |
| 20-700 | $20 | $700 | $525 |
| 30-250 | $30 | $250/day, max $1000 | $200 |
| Freedom | $150/day, max $750 | $200 |
BluePreferred PPO Plans
| Plan Name |
Office Visit Copay |
Deductible |
Coinsurance |
$20 |
$250 |
10% to $1,000 max |
|
$20 |
$500 |
20% to $2,000 max |
|
$25 |
$2000 |
20% to $3,000 max |
|
$30 |
$500 |
20% to $2,000 max |
|
$30 |
$1000 |
10% to $2,000 max |
|
$40 |
$2000 |
20% to $3,000 max |
|
$15 |
$0 |
10% to $1K + copays |
|
$25 |
$0 |
20% to $2K + copays |
|
$25 |
$0 |
20% to $2K + copays |
|
$25 |
$1000 |
20% to $3K + copays |
|
$30 |
$3000 |
30% to $7K + copays |
HSA Plans
Plan Name |
Deductible |
Coinsurance |
Max Out-of-Pocket |
| $1250/$2500 |
100/0 |
$1250/$2500 |
|
| $1250/$2500 |
100/0 |
$1250/$2500 |
|
$1250/$2500 |
90/10 |
$2000/$4000 |
|
$1250/$2500 |
90/10 |
$2000/$4000 |
|
$1500/$3000 |
100/0 |
$1500/$3000 |
|
$1500/$3000 |
100/0 |
$1500/$3000 |
|
$1500/$3000 |
90/10 |
$2500/$5000 |
|
$1500/$3000 |
90/10 |
$2500/$5000 |
|
$2000/$4000 |
100/0 |
$2000/$4000 |
|
$2000/$4000 |
100/0 |
$2000/$4000 |
|
$2000/$4000 |
90/10 |
$3000/$6000 |
|
$2000/$4000 |
90/10 |
$3000/$6000 |
|
$2500/$5000 |
100/0 |
$2500/$5000 |
|
$2500/$5000 |
100/0 |
$2500/$5000 |
|
$2500/$5000 |
90/10 |
$4000/$8000 |
|
$2500/$5000 |
90/10 |
$4000/$8000 |
|
$2500/$5000 |
80/20 |
$5000/$10,000 |
|
$2500/$5000 |
80/20 |
$5000/$10,000 |
|
$3000/$6000 |
80/20 |
$5000/$10,000 |
|
$3000/$6000 |
80/20 |
$5000/$10,000 |
Multi Option Plans
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Click
below for: Roper Individual Health Insurance Services |
 South Metro Denver Chamber of Commerce |
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