Medical
Your Medical Plan Choices
Active employees have two medical plan choices:
PPO Plan (Anthem Blue Cross Blue Shield Network)
This plan is a preferred provider organization (PPO). It gives you the flexibility to see any medical provider. However, you save money when you use in-network providers. See the summary plan description for details. This plan is self-funded, which means the Fund—not Anthem or Zenith American Solutions—pays the claims.
HMO Plan (Health Plan of Nevada)
This plan is a health maintenance organization (HMO). You must always see Health Plan of Nevada providers in order to receive coverage, except for life-threatening emergencies. See the Health Plan of Nevada folder in your enrollment packet for details. This plan is fully insured, which means Health Plan of Nevada pays the claims.
Medical Plan Comparison Chart
|
Swipe to see full table. |
PPO Plan (Anthem Blue Cross Blue Shield Network) In-Network Coverage |
HMO Plan (Health Plan of Nevada) In-Network Required |
|---|---|---|
| Calendar-year deductible | Single: $500 Family: $1,500 |
None |
| Out-of-pocket maximum The most you pay for covered expenses in a plan year (includes in-network copayments, coinsurance, and deductibles) before the plan begins to pay 100% |
Medical: Single: $5,600 Family: $11,200 Prescription drugs: Single: $1,000 Family: $2,000 |
Single: $6,250 Family: $12,500 Includes prescription drugs |
| Preventive care services | No cost to you | No cost to you |
| Physician services | PCP: $10 copay Specialist: $15 copay |
PCP: $35 copay Physician Extender/Asst.:$25 copay Specialist: $70 copay |
| Hospital inpatient services | $100 copay plus 10% coinsurance up to $5,000 | $500 per day up to $1,500 per admission |
| Hospital outpatient services | $50 copay | $400 per admission |
| Routine diagnostic services | X-ray: $15 per visit Lab: $5 per service |
X-ray: $25 per service Lab: $15 per service |
| Urgent care services | $15 copay | $40 copay |
| Emergency services* | $50 copay if life-threatening emergency | $400 per visit (waived if admitted) |
| Prescription drugs | Generic: $5 copay Preferred brand: $20 copay or 20% coinsurance Non-preferred: $45 copay or 45% coinsurance Specialty: $50 copay Mail order available for all tiers |
Low cost: $25 copay Midrange cost: $50 copay Highest cost: $75 copay Mail order available for all tiers |
* If your emergency isn’t life-threatening, the PPO plan pays only $75 of emergency room charges and you pay the balance, which could be as much as $3,000 per visit, and the HMO plan pays nothing.
Save Money on Medical Costs
Get Preventive Care
Teamsters Local 14 encourages all members to get preventive care services, which are covered by both plans at 100%. Spending a relatively small amount of time now can save you a lot of time, money, and discomfort in the future. Early detection is often key to treatment of many diseases and conditions that cause serious illness or even death.For a list of covered preventive care services for the PPO plan, see the Anthem preventive care flyer. For the HMO plan, visit the Preventive Services page at healthplanofnevada.com.
- Visit a Family Wellness Center for no-cost medical care. You’ll have access to an experienced medical team, including a full-time PCP. Your covered dependents can visit for free too!
- Be sure to use your Anthem ID card properly.
- Obtain precertification when needed. If you need surgery or other high-cost medical services, contact Innovative Care Management (ICM) at 800-862-3338 for precertification.
- Save up to 65% on lifestyle medications for acne, weight loss, dietary supplements, and more through the Personal Savings Program. Just show your EnvisionRx prescription card at the pharmacy counter. No forms to fill out or claims to send in!
- Register at anthem.com, then check out discounts on a variety of fitness and nutrition services. Just select “Fitness and Health,” then “Discounts.”
You can visit a Family Wellness Center for no-cost medical care. You’ll have access to an experienced medical team, including a full-time PCP.
Visit healthplanofnevada.com. to learn about Health Plan of Nevada’s programs and resources:
- HPN symptom checker
- 24/7 telephone advice nurse service
- NowClinic® 24/7 online care
- Health education and wellness programs and classes
- Online health education resources
- Health management program for chronic conditions
