Deductible

Copays & Coinsurance

Out-of-Pocket Maximum

The amount you pay in full for services before the plan can pay for your costs.

Please note: All CSEBO’s PPO plans waive the deductible for primary and specialist office visits.

  • Copays are the fees you pay when you go to the doctor or fill a prescription.
  • Coinsurance is the percentage you pay for care for services beyond the scope of your copay after your deductible is met.

The plan pays the rest.

The maximum you will pay for medical or prescription expenses in a calendar year. If the maximum is reached, you will be covered at 100% for the remainder of the calendar year.

Please note: All CSEBO’s PPO plans have separate medical and prescription out-of-pocket maximums.  

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Questions regarding claims processing (i.e., benefits covered, amounts paid, explanation of benefits, denied claims, etc.) should be referred to the following:


HMO

Member Services: 1-800-227-3771

Coverage While Traveling: 1-800-810-2583

Anthem HMO Resources
       - When to Use the ER
       - 24-7 Nurse Hotline
       - Anthem Discounts
       - ConditionCare
       - Future Moms


PPO

Member Services: 1-800-759-3030

Coverage While Traveling: 1-800-810-2583

The subscriber should use this reference initially. If he/she is not satisfied with the response, then the format outlined in the "Appeal Procedure" Section should be utilized.

Anthem PPO Resources
        - When to Use the ER
        - Anthem Discounts
        - ConditionCare Diabetes
        - LiveHealth Online


HSA

Member Services: 1-866-207-9878

Coverage While Traveling: 1-800-810-2583

Anthem HSA Resources
        - When to Use the ER
        - 24/7 Nurse Hotline
        - Anthem Discounts
        - ConditionCare
        - Future Moms
        - LiveHealth Online

If the District desires an on-site visit from a Managing Account Consultant, an additional supply of physician directories or forms, or open enrollment assistance, the District Representative can contact Trever Hansen, Health Benefits Manager, at trhansen@vcoe.org