Plan overview: All care is managed by you (for a list of Anthem providers, please refer to www.healthcomp.com or the Human Resources Department for assistance). Medical Plan is an 80/20 plan as long as you stay within the Blue Cross Network. In-Network/Out-of-Network the deductible is $1,500/member with a maximum of three separate deductibles per family. Anthem Network Providers office visit copay, $15. $350 co-payment for emergency care; waived if admitted. $50 Urgent Care copay/visit. Physician fees are billed separate. Annual out-of-pocket maximums: $4,000/member—maximum 3 separate maximums/family up to $10,000. Non-Network provider $10,000/member—maximum of 3 separate maximums/family. Prescription Drugs—OptumRX At $10 co-payment for generic and $25 for brand drugs, if the generic equivalent is available for a brand drug, there is a $250 deductible that will apply, and $40 for nonformulary (a list of prescription drugs can be found at the Express Scripts web site at optumrx.com). Save money by using the mail order service. Chiropractic Care $25 co-payment per visit in network, limited to 24 visits per calendar year. Acupuncture 20% for most services, limited to 12 visits per calendar year. Mental Health and Substance Abuse Services Facility-based care (preauthorization required; waived for emergency admissions), $250 per admit then 80% covered. Please refer to the summary of benefits for any exclusions.