Health Plans

Plan Comparisons

For a detailed description of each plan, please review the following documents:

KeyCare 30, KeyCare 20,  and Lumenos HDHP + HSA 

  KeyCare 20 KeyCare 30
Deductible (INN) $0 individual/
$0 family
$2,000 individual/
$4,000 family
Out of Pocket Max (INN) $5,000 individual/
$10,000 family
$5,000 individual/
$10,000 family
Deductible (ONN) $500 individual/
$1,000 family
$3,000 individual/
$6,000 family
Out of Pocket Max (ONN) $6,500 individual/
$13,000 family
$7,250 individual/
$14,500 family
Prescription Drugs $15/$40/$75 retail
$38/$100/$188 mail
$15/$40/$75 retail
$38/$100/$188 mail
Preventive Care 100% 100%
PCP Office Visit Specialist Office Visit $30 copay
$50 copay
$30 copay
$50 copay
Diagnostic Lab & X-ray 20% coinsurance 20% coinsurance
Mental Health & Substance Abuse Office Visit: $30 copay
Outpatient Facility: 20% coinsurance
Office Visit: $30 copay
Outpatient Facility: 20% coinsurance
Physical Therapy $50 copay
Plus 20% coinsurance
20% coinsurance
Spinal Manipulation/ Chiro $30 PCP/
$50 Specialist
$25 copay

Lumenos with HSA Plan

  Lumenos with HSA Plan
Preventive Care 100% (no deductible)
Deductible (INN) $3,000 individual/
$6,000 family (embedded)
Covered Medical Services 100% after deductible
Prescription Drugs
(after deductible)
$10/$30/$50 or 20% retail;
$10/$60/$150 or 20% mail order*
Out of Pocket Max (INN) $4,000 individual/
$8,000 family
Out of Pocket Max (OON) $6,000 individual/
$12,000 family

* For tier 3 drugs, copay or coinsurance whichever is greater up to $200 per script retail and $400 per script mail.

Blue View Vision Network

Your Vision Benefits and Discounts

Your Anthem Blue Cross Blue Shield plan comes with valuable benefits and discounts to help you take care of your eyes. You can access your benefits two ways – by using either in-network or out-of-network vision care professionals.

In-Network

Here’s what your in-network eye care plan includes:

Vision Care Services Member Pays
Exam
Exam $15 Copay
Dilation $0
Eye Exam Refraction $0
Lens
Single Vision $50 Copay
Bi-focal $70 Copay
Tri-focal $105 Copay
Standard Progressive Lens $135 Copay
Premium Progressive Lens 80% of Charge
Other Lens Types 80% of Charge
Premium Progressive Avp 80% of Charge
Frame
Frame 65% of Charge
Lens Options
Standard Polycarbonate $40 Copay
Standard Plastic Scratch Coating $15 Copay
Tint $15 Copay
UV Treatment $15 Copay
Standard Anti-reflective (A/R) Coating $45 Copay
Other Coatings 80% of Charge
Oversized Lenses - Single Vision 80% of Charge
Oversized Lenses - Multi-focal 80% of Charge
Prism 80% of Charge
Other Lens Options 80% of Charge
Contacts
Contact Lens - Conventional 85% of Charge
Contact Lens - Disposable 100% of Charge
Non-Scheduled Items
Non-scheduled Item - Retail 80% of Charge
Retinal Imaging $39 Copay

Out –of-Network

Should you choose to receive your eye care from a non-participating vision care professional, your vision benefits still offer a $30 allowance toward the cost of the eye exam . You pay the non-participating provider for the exam at the time you receive the service, and then submit a claim to receive your allowance. (Anthem Blue Cross Blue Shield Member Services can provide you with a copy of this claim form and filing instructions.) One eye exam per member per calendar year is eligible for coverage, in-network and out-of-network combined.

Benefits through the Blue View Vision Network for your calendar year eye exam are for routine services only. If you need medical treatment for your eyes, select a participating eye care physician specialist from your medical network. Your out-of-pocket expenses related to the vision benefits do not count toward your annual out-of-pocket limit and are never waived, even if your annual out-of-pocket limit is reached. These vision services are not subject to an out-of-plan deductible.

Anthem Health Insurance

Anthem, Inc. is an Indiana-domiciled, publicly traded company that, through its subsidiary companies, provides health care benefits to millions of people. Anthem is the fifth largest publicly traded health benefits company in the United States and an independent licensee of the Blue Cross and Blue Shield Association. Anthem is the Blue Cross and Blue Shield licensee for Indiana, Kentucky, Ohio, Connecticut, New Hampshire, Colorado, Nevada, Maine and Virginia, excluding the Northern Virginia suburbs of Washington, D.C.  Anthem Blue Cross and Blue Shield Anthem Blue Cross and Blue Shield offers residents of Indiana, Kentucky, Ohio, Connecticut, New Hampshire, Colorado, Nevada, Maine and Virginia quality health plans. As a Blue Cross and Blue Shield licensee, we offer the security of being part of an organization that has provided dependable coverage since the 1930s. Today, the Blue Cross and Blue Shield symbols are among the nation's most familiar and trusted trademarks. 1 Mission and Philosophy Our mission is to improve the health of the people we serve. At Anthem, we believe the best health care coverage can actually help people stay healthy. That's why we go beyond simply providing coverage. We help encourage members' wellness by:  

  • Offering large networks of some of the region's best physicians, specialists and hospitals.
  • Reminding members to have important preventive screenings.
  • Providing programs and information to help manage chronic health conditions.
  • Offering related services including dental coverage, life insurance and pharmacy benefits management.

We work with physicians, hospitals and other providers to help ensure that care is accessible, coordinated, timely and provided in a manner and setting that promotes positive patient-provider relationships. 

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Premium Conversion Waiver

EMPLOYEES WHO DO NOT WISH TO HAVE THEIR HEALTH AND DENTAL INSURANCE PREMIUMS DEDUCTED ON A PRE-TAX BASIS MUST COMPLETE THE PREMIUM CONVERSION WAIVER FORM.

What is Premium Conversion?  A premium conversion plan is a way of providing you with valuable benefits and significant tax savings by converting your insurance premium deductions from after-tax to pre-tax payments.  These premium payments are considered salary reductions and, as a result, you own no tax on the premium amounts.  You take home additional dollars in your paycheck!  All participants enrolled in the City’s health benefit plan are automatically enrolled in Premium Conversion.

 PREMIUM CONVERSION WAIVER FORM