Traditional Plan

The Traditional Plan, administered by Anthem Blue Cross (Anthem), provides full coverage for preventive care. You pay other expenses through copays, coinsurance and your deductible. The Traditional Plan provides in- and out-of-network coverage for health care services. You’ll save money when you use in-network providers.

How the Traditional Plan Works

Getting Care

  • Preventive care services are free when you visit in-network providers. Preventive care includes annual check-ups, immunizations and age-appropriate screenings.
  • You can see any provider—but will pay less when you stay in-network. Visit to search for a network provider.

Paying for Care

  • You pay copays for routine care like prescription drugs and doctor office visits. For other services, like lab work or a hospital stay, you’ll pay your deductible and then you and the plan share in costs. You’ll always pay less for care when you see in-network providers. 
  • You’re protected against really large bills. Once your expenses total the out-of-pocket maximum, the plan pays 100% of the costs until the end of the calendar year—with the exception of:
    • Non-eligible expenses
    • Costs above the allowed amount for non-network providers
Traditional Plan Overview
Annual Deductible (medical only)
  • $600 individual/$1,500 family in-network
  • $800 individual/$2,000 family out-of-network

You pay copays for physician office visits, emergency room visits, urgent care and prescription drugs. (The deductible and coinsurance do not apply.)

Medical and prescription drug copays apply toward the out-of-pocket maximum

Coinsurance Once you meet the deductible you share costs with the plan for lab, X-rays, hospitalization, and surgery (in- or out-patient). You pay 10% for in-network and 30% for out-of-network providers.*
Out-of-Pocket Maximum (includes deductible and coinsurance)
  • $2,600 individual/$5,200 family in-network
  • $5,200 individual/$10,400 family out-of-network
Plan Benefits
Preventive Care Covered at 100% in-network
Non-Preventive Care You pay copays for office visits and share costs on lab and X-rays, hospitalization, and surgery (in- or out-patient) after you have met the annual deductible. You pay 10% for in-network providers and 30% for out-of-network providers.
Prescription Drugs
Retail 30-Day Supply
(Administered by CVS/caremark)

You pay copays for prescription drugs as follows:

  • Generic: $10
  • Brand: $25
  • Non-Preferred: $50
Prescription Drugs
Mail Order 90-Day Supply
(Administered by CVS/caremark)
  • Generic: $20
  • Brand: $50
  • Non-Preferred: $100

* In the Traditional Plan, each individual will need to meet the deductible before coinsurance applies.

See the plan details for 2018.

Out-of-pocket maximum: What it is and how it works

The out-of-pocket maximum is the most you’ll pay in a calendar year for eligible plan expenses before the plan pays 100%.

Services that are excluded and amounts above reasonable and customary (i.e., the "allowed amount") for out-of-network services do not count toward the out-of-pocket maximum.

Amounts you pay toward the deductible and coinsurance count toward the out-of-pocket maximum. Medical and prescription drug copays also count toward the out-of-pocket maximum if you’re enrolled in the Traditional Plan or Kaiser HMO.