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.
Plan Descriptions
EMPLOYEE ELECT PLANS (Brochure)
Health Plan Name
Office Visit Copay
Hospital Copay

Outpatient Copay

Prescriptions

PPO $30 Copay

$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%

PPO $35 Copay
Gen Rx

$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%

Lumenos HSA 2000 Deductible

Deductible, then 100%
Deductible, then 100%
Deductible, then 100%
Deductible, then 100%
Lumenos HSA 3000 Deductible
Deductible, then 100%
Deductible, then 100%
Deductible, then 100%
Deductible, then 100%
Lumenos HSA 5000 Deductible A
Deductible, then 100%
Deductible, then 100%
Deductible, then 100%
Deductible, then 100%
Lumenos HIA Plus 2000 Deductible
Deductible, then 100%
Deductible, then 100%
Deductible, then 100%
Deductible, then 100%
Lumenos HIA Plus 3000 Deductible A
Deductible, then 100%
Deductible, then 100%
Deductible, then 100%
Deductible, then 100%
Classic HMO A
$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 QA
$15
$250
$200
$10/$30/$50/30%

BENEFITS PLANS (Brochure)

Health Plan Name
Office Visit Copay
Hospital Copay

Outpatient Copay

Prescriptions
Hospital Benefits A

Not Covered

Deductible & Coinsurance
Deductible & Coinsurance
$100 Deductible after Medical Ded & Coinsurance
Hospital Benefits Plus A
50%
Deductible & Coinsurance
Deductible & Coinsurance
$100 Deductible after Medical Ded & Coinsurance
Hospital Benefits Preferred A
50%
Deductible & Coinsurance
Deductible & Coinsurance
$100 Deductible after Medical Ded & Coinsurance

PPO $35 Copay
Gen Rx
A

$35
$500 + 30%, $3500 max
$500 + 30%, $3500 max
$15 generic only
Lumenos HSA 3000 Deductible AA
Deductible, then 100%
Deductible, then 100%
Deductible, then 100%
Deductible, then 100%
Classic HMO Select b
$20
$500
$250
$15/$40/$60/30%


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.

 

BluePreferred PPO Plans

Plan Name
Office Visit Copay
Deductible
Coinsurance
$15
$0
10% to $1K + copays
$25
$0
20% to $2K + copays
$25
$0
20% to $2K + copays

 

 

 

 

 

              

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