1. 100% In-network Preventive Care Coverage
   Important preventive care services such as exams, immunizations and screenings are covered 100% with in-network providers. You don't need to use your HRA, and expenses are not subject to the deductible. Exams, screenings and tests used to determine or treat a diagnosis are not considered preventive care.
2. Health Reimbursement Account (HRA)
   UC provides the HRA that automatically pays first for 100% of eligible medical and pharmacy expenses. Your HRA helps you meet your annual deductible. Any balance left on the account at the end of the plan year will roll over to the next year.
   

   Your HRA
   Employee	$1,000
   Employee + Adult	$1,500
   Employee + Child(ren)	$1,500
   Family	$2,000

3. Out-of-pocket amount
   If you use up your Health Reimbursement Account, you are responsible for meeting the balance of your deductible. Your out-of-pocket amount will be reduced by any balance on the HRA that is rolled over from the previous plan year.
   

   Your out-of-pocket amount
   Employee	$700
   Employee + Adult	$1,050
   Employee + Child(ren)	$1,050
   Family	$1,400

   
   
4. PPO Health Coverage
   Once you meet your deductible, PPO Health Coverage takes effect. You and the plan share the cost of eligible expenses according to the percentages noted below. Your share is called coinsurance: you pay 20% for in-network services and 40% for out-of-network services.
5. Out-of-Pocket Maximum
   For your protection, there are in- and out-of-network maximums to the amount you pay out of pocket each year. If you reach this amount, then your medical and prescription drugs are covered 100% for the rest of the plan year.
   

   Out of Pocket Maximum
   	In-Network	Out-of-Network
   Employee	$5,000	$10,000
   Employee + Adult	$7,500	$15,000
   Employee + Child(ren)	$7,500	$15,000
   Family	$10,000	$20,000

   
   

Here's how the plan works for a non-preventive care doctor visit:

1. After a member sees a doctor, the doctor sends a claim to Anthem for the visit and any tests or other expenses.
2. If there are dollars in the member's HRA, the bill is paid from that account.
3. If the HRA has been used but the deductible has not been met, then the member is billed for the full amount, which is discounted if the member sees an in-network doctor.
4. If the member has met the deductible, Anthem Lumenos and the member share the costs of covered services, (80/20 for in-network services; 60/40 for out-of-network services), up to the annual out-of-pocket maximum.

Anthem Blue Cross is the trade name of Blue Cross of California . Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is registered trademark of Anthem Insurance Companies, Inc. The Blue Cross names and symbols are registered marks of the Blue Cross Association.

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