Unlike the PPO 5000, this is a copay plan. This means that you’ll usually pay a fixed amount when you see in-network providers, and the plan will pay for the rest. You can see both in-network and out-of-network doctors without  a referral, but keep in mind staying in-network for care will almost always be cheaper.

2020 COPAY 5000
Provider network Extensive national network of contracted providers. Benefits are higher when you use Anthem Blue Cross PPO providers.
Primary Care Physician (PCP) to manage care Not required
Referrals needed to see a specialist Not required
Calendar Year Deductible
In-network: $5,000 per individual1/$10,000 per family1,2
Health Savings Account (HSA) No
Coinsurance (You Pay) After Meeting Deductible In-network: 20%
Calendar Year Out-of-Pocket Maximum
In-network: $7,000 per individual3/$14,000 per family3
Preventive Care
In-network: Covered in full (calendar year deductible waived)
Office Visit (You Pay) PCP: $45 copay. Specialist: $75 copay
Hospitalization
In-network: 20%4
Pharmacy Retail
(30-day supply)
Network pharmacy: specified preventive drugs—100% covered; generic—$10 copay4; brand formulary—$25 copay4; brand non-formulary—$40 copay4
Pharmacy Mail Services
(up to 90-day supply)
Network pharmacy: specified preventive drugs—100% covered; generic—$20 copay4; brand formulary—$50 copay4; brand non-formulary—$80 copay4
  1. In-network calendar year deductible is separate from out-of-network calendar year deductible and does not cross accumulate. Refer to the Copay 5000 Summary of Benefits and Coverage (SBC) for information on out-of-network deductible amounts.
  2. The family deductible must be met before any person receives benefits.
  3. In-network calendar year out-of-pocket maximum is separate from out-of-network calendar year out-of-pocket maximum and does not cross accumulate. Refer to the Copay 5000 Summary of Benefits and Coverage (SBC) for information on out-of-network out-of-pocket maximum amounts.
  4. After calendar year deductible.