Tier 1 50% coinsurance up to $250 per prescription (retail only). Tier2 - Brand Formulary Covers up to a 30 day supply (retail pharmacy) Covers up to a 90 day supply (home delivery program) Member pays the retail pharmacy copay plus 50% for out of network. Tier 2- $35 copay per prescription (retail only) and $60 copay per prescription (home. 4 Home delivery pharmacy cost shares are 2.5 times the retail copay for Tier 1 drugs and 3 times the retail copay for Tier 2 and Tier 3 drugs when the plan has retail pharmacy copays. MEDICAL PLANS FOOTNOTES 3 anthem.com Individual and Family Benefit Charts for Wisconsin. Experience the Anthem difference. Retail pharmacy tier 2: Level 1 / Level 2 $60 copay / $70 copay $55 copay / $65 copay 0% coinsurance / 0% coinsurance 0%.
- Anthem Copay List
- Anthem Tier 2 Copay Assistance
- Anthem Blue Cross Copay
- Anthem Prescription Copay
- What Is My Copay Anthem
- Va Tier Copay
The Anthem Plans are available for all U.S. employees.
| Anthem Blue Cross Exclusive | Anthem Blue Cross Preferred | Anthem Blue Cross HDHP | |||
| In-Network Only Anthem PPO Network | In-Network Anthem PPO Network | Out-of-Network | In-Network Anthem PPO Network | Out-of-Network | |
| Calendar Year Deductible | $100/Individual $300/Family | $300/Individual $900/Family | $2,000/Individual $2,800/Individual up to $4,000/Family | ||
| % Co-Insurance | 10% | 20% | 35% | 10% | 30% |
| Out-of-Pocket Maximum | $2,000/Individual $6,000/Family | $2,000/Individual $6,000/Family | $4,000/Individual $12,000/Family | $5,000/Individual $10,000/Family | $5,000/Individual $10,000/Family |
| Doctor's Office Visits | $20 copay* | $25 copay* | 35% | 10% | 30% |
| Telemedicine Visit | No charge with | No charge with | NA | $59; 0% after deductible** | NA |
| Specialist Office Visits | $30 copay* | $35 copay* | 35% | 10% | 30% |
| Urgent Care | $20 copay* | $25 copay* | 35% | 10% | 30% |
| Emergency Room Services | 10% after $100 copay (waived if admitted) | 20%* after $100 copay (waved if admitted) | 10% | ||
* Deductible does not apply
**$59 fee waived during the pandemic
NOTE: Out-of-network coverage based on Anthem Blue Cross’s maximum allowed amount.
View a comparison of all the Marvell medical plans on the 2021 At-a-Glance.
Prescription Drugs + Mail Order
When you enroll in an Anthem medical plan, you are automatically enrolled in a four-tier prescription drug plan that provides you with multiple options to save money.
Exclusive & Preferred: A separate $2,000/Individual Out-of-Pocket Maximum ($6,000/Family) applies for prescription drugs.
High Deductible Health Plan (HDHP): The Out-of-Pocket maximum is combined with the Medical Out-of-Pocket maximum. You will pay the full retail price for prescriptions until you meet the Deductible. After meeting the Deductible then the prescription copay will apply.
| Description | In-Network Pharmacy | ||
| Tier 1 | Lowest Member Cost Share: These drugs offer the greatest value compared to others that treat the same conditions. | $10 copay | |
| Tier 2 | Medium Member Cost Share: These may be preferred brand drugs, based on their effectiveness and value. Some are newer, more expensive generic drugs. | $30 copay | |
| Tier 3 | Higher Member Cost Share: These generally include non-preferred brand and generic drugs. They may cost more than drugs placed on lower tiers that are used to treat the same conditions. | $50 copay | |
| Tier 4 | Highest Member Cost Share: Many drugs on this tier are specialty drugs used to treat complex, chronic conditions and may require special handling and/or management. | $100 copay | |
Note: If you use an out-of-network pharmacy, you will pay the applicable copay + 50% of covered expenses.
Prescription Drug Mail Orders: Receive a 90-day supply for 2x the copay amount. Learn how to enroll here.
Anthem Prescription Drug List
To transfer prescriptions to Anthem:
- Prescriptions you pick up at the pharmacy: Provide the pharmacy with your Anthem ID card to update your insurance coverage.
- Mail Order Prescriptions: request a new script from your physician and submit a request for a new mail-order prescription through Anthem's pharmacy benefits manager, IngenioRX, by either:
- Logging into your account at anthem.com/ca, choose Pharmacy, and on your personal pharmacy page select View Your Prescriptions under Switch to a 90-Day Supply. For the drugs you want to switch to home delivery, choose Switch to a 90-day Supply and then Select Prescriber; you can also add your shipping address, options, and payment methods on this page
- Completing and sending in the Home Delivery Order Form.
Telemedicine Appointments with LiveHealthOnline.com
Anthem members have access to free* online doctor visits or psychologist visits 24/7 through LiveHealthOnline.com. Download the app and sign in (linking your Anthem member ID) so you're ready the next time you need medical attention:
Services include:
- Medical: Get advice, a treatment plan, and prescriptions (if needed)
- Kids: Speak immediately with a pediatrician and receive expert advice and treatment
- Psychology: Talk with a therapist from the privacy of your home in 4 days or less
- Psychiatry: See a psychiatrist and discuss possible medication management needs
- Allergy: Consult with a doctor who knows the latest allergy treatment trends
*Members enrolled in the HDHP pay $59/visit until their annual deductible has been met but this has been waived during the pandemic.
In-Network Provider Search for the Anthem Network
If you haven't enrolled in Anthem coverage yet and want to search for in-network doctors, please use the below instructions.
- Go to: https://www.anthem.com/ca/health-insurance/providerreimagine-directory/searchcriteria?brand=ABC
- Select the 'Guest' tile. Do not click the 'change state' button. It will list California but you still be able to search providers outside of California.
- When prompted, search by plan and select the following:
- What type of care are you searching for? Medical
- What state do you want to search in? Select state
- What type of plan do you want to search with? Medical (Employer-Sponsored)
- Select a plan/network: National PPO (BlueCard PPO)
- The next page will prompt you to enter information to search for a specific provider or specialty.
- Type in your provider's information and your City, County, or Zip Code in the search bar and click Search to see results.
Traveling Outside the Country
Before you leave, visit https://www.bcbsglobalcore.com/ to know your care options while abroad.
For more resources available to Marvell employees when traveling, visit the Travel page of this website.
Medical Second Opinion with 2nd.MD
Facing a medical decision? Marvell employees and their family members (including spouses, children, parents, grandparents, and siblings) have access to 2nd.MD. With 2nd.MD, you can connect with board-certified, expert doctors for an expert second opinion via phone or video - all within a matter of days, and at no cost to you. Learn more here.
Gender-Affirming Services
Marvell's Exclusive, Preferred, and HDHP all offer coverage for gender affirming services including providing coverage for aesthetic gender-affirming services in order to better align with the WPATH standards of care. Marvell's Short-Term Disability programs will also provide coverage for aesthetic gender affirming services.
Diabetes Prevention Program
Receive a free fitness tracker and wireless scale!
Roughly 88 million Americans are living with prediabetes but 84% aren’t even aware they have it. Prediabetes often doesn’t cause symptoms, but it does increase the risk of developing type 2 diabetes, heart disease, and stroke. That’s why Anthem partnered with Lark to offer a diabetes prevention program that can help you determine if you’re at risk for prediabetes and if needed, take steps to address it.
Lark's program can help you lose weight, eat healtier, increase activity, sleep better, and manage stress. For participating, you'll receive a free wireless scale, a personal activity tracker, and a digital coach available 24/7.
To determine your risk level and whether you are eligible for Lark's proram, visit lark.com/anthemBC. Learn more from this flyer and FAQ.
Cancer Care Program
Members facing a cancer diagnosis will have acces to a concierge service through Anthem to provide guidance on treatment and diagnosis, round-the-clock health monitoring, and VIP service at best-in-class clinical trials. View this flyer for more information.
As a reminder, Marvell's standard Case Management Support for cancer is available for all members which pairs members with an Anthem case manager certified in oncology to help members with cancer navigate the health care system and understand the benefits available to them. To be connected with a Case Manager, please contact Anthem.
Autism Support Program
Anthem members have free access to the Autism Spectrum Disorders (ASD) Program, which provides support for the entire family and helps you find and manage care. View this flyer for additional information or call the ASD Program Team at 1-844-269-0538. Marvell also offers all employees free services to support families with developmental disabilities through Rethink.
All overviews summarize the Marvell Benefits Program. Full details of the benefit plan are contained in the official documents, which will govern in the case of any discrepancies.
Log into your Anthem account to monitor claims, review your Evidence of Benefits (EOBs), print out temporary ID cards, and search for in-network doctors and facilities.
ENGAGE WELL-BEING APP
Download Marvell's Well-Being app, Engage! Join the 2 annual challenges to earn gift cards as you compete with your colleauges across the U.S.
All employees and spouses can access Engage for the challenges, quarterly sweepstakes for prizes, and for personalized recommendations on Marvell benefit programs.
Marvell Anthem members using Engage can search for in-network doctors and review where you've spent your healthcare dollars.
Jump to:
Anthem MediBlue Plus (HMO) H3447-021 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Anthem HealthKeepers available to residents in Indiana. This plan includes additional Medicare prescription drug (Part-D) coverage. The Anthem MediBlue Plus (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $4,400 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,400 out of pocket. This can be a extremely nice safety net.
Anthem MediBlue Plus (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.
Anthem HealthKeepers works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Anthem MediBlue Plus (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Anthem HealthKeepers and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Anthem HealthKeepers except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
Ready to Enroll?
Or Call
1-855-778-4180
Mon-Fri 8am-9pm EST
Sat 9am-9pm EST
2021 Anthem HealthKeepers Medicare Advantage Plan Costs
| Name: | |
|---|---|
| Plan ID: | H3447-021 |
| Provider: | Anthem HealthKeepers |
| Year: | 2021 |
| Type: | Local HMO |
| Monthly Premium C+D: | $0 |
| Part C Premium: | $0 |
| MOOP: | $4,400 |
| Part D (Drug) Premium: | $0 |
| Part D Supplemental Premium | $0 |
| Total Part D Premium: | $0 |
| Drug Deductible: | $0 |
| Tiers with No Deductible: | 0 |
| Gap Coverage: | Yes |
| Benchmark: | not below the regional benchmark |
| Type of Medicare Health: | Enhanced Alternative |
| Drug Benefit Type: | Enhanced |
| Similar Plan: | H3447-022 |
Anthem MediBlue Plus (HMO) Part-C Premium
Anthem HealthKeepers plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
H3447-021 Part-D Deductible and Premium
Anthem MediBlue Plus (HMO) has a monthly drug premium of $0 and a $0 drug deductible. This Anthem HealthKeepers plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Anthem HealthKeepers above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Anthem HealthKeepers Gap Coverage
In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Anthem HealthKeepers plan does offer additional coverage through the gap.
H3447-021 Formulary or Drug Coverage
Anthem MediBlue Plus (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.
2021 Anthem MediBlue Plus (HMO) Summary of Benefits
Additional Benefits
| No |
|---|
Comprehensive Dental
| Diagnostic services | Not covered |
|---|---|
| Endodontics | Not covered |
| Extractions | Not covered |
| Non-routine services | Not covered |
| Periodontics | Not covered |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered |
| Restorative services | Not covered |
Deductible
| $0 |
|---|
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | $140-225 copay |
|---|---|
| Diagnostic tests and procedures | $0-160 copay |
| Lab services | $0-10 copay |
| Outpatient x-rays | $50-120 copay |
Doctor Visits
| Primary | $5 copay per visit |
|---|---|
| Specialist | $40 copay per visit |
Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
|---|---|
| Urgent care | $35 copay per visit (always covered) |
Foot Care (podiatry services)
| Foot exams and treatment | $0-40 copay |
|---|---|
| Routine foot care | $0 copay |
Ground Ambulance
| $295 copay |
|---|
Hearing
| Fitting/evaluation | $0 copay |
|---|---|
| Hearing aids | $0 copay |
| Hearing exam | $40 copay |
Inpatient Hospital Coverage
| $295 per day for days 1 through 7 $0 per day for days 8 through 90 |
|---|
Medical Equipment/Supplies
| Diabetes supplies | $0 copay |
|---|---|
| Durable medical equipment (e.g., wheelchairs, oxygen) | 0-20% coinsurance per item |
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
Medicare Part B Drugs
| Chemotherapy | 20% coinsurance |
|---|---|
| Other Part B drugs | 20% coinsurance |
Mental Health Services
| Inpatient hospital - psychiatric | $210 per day for days 1 through 8 $0 per day for days 9 through 90 |
|---|---|
| Outpatient group therapy visit | $40 copay |
| Outpatient group therapy visit with a psychiatrist | $40 copay |
| Outpatient individual therapy visit | $40 copay |
| Outpatient individual therapy visit with a psychiatrist | $40 copay |
MOOP
| $4,400 In-network |
|---|
Option
| No |
|---|
Optional supplemental benefits
| Yes |
|---|
Outpatient Hospital Coverage
| $0-275 copay per visit |
|---|
Package #1
| Deductible | |
|---|---|
| Monthly Premium | $15.00 |
Package #2
| Deductible | |
|---|---|
| Monthly Premium | $26.00 |
Package #3
| Deductible | |
|---|---|
| Monthly Premium | $51.00 |
Preventive Care
| $0 copay |
|---|
Preventive Dental
| Cleaning | $0 copay |
|---|---|
| Dental x-ray(s) | $0 copay |
| Fluoride treatment | $0 copay |
| Oral exam | $0 copay |
Rehabilitation Services
| Occupational therapy visit | $35 copay |
|---|---|
| Physical therapy and speech and language therapy visit | $35 copay |
Skilled Nursing Facility
| $0 per day for days 1 through 20 $184 per day for days 21 through 100 |
|---|
Transportation
| $0 copay |
|---|
Vision
| Contact lenses | $0 copay |
|---|---|
| Eyeglass frames | $0 copay |
| Eyeglass lenses | $0 copay |
| Eyeglasses (frames and lenses) | $0 copay |
| Other | Not covered |
| Routine eye exam | $0 copay |
| Upgrades | Not covered |
Wellness Programs (e.g. fitness nursing hotline)
| Covered |
|---|
Reviews for Anthem MediBlue Plus (HMO) H3447
| 2019 Overall Rating |
|---|
| Part C Summary Rating |
| Part D Summary Rating |
| Staying Healthy: Screenings, Tests, Vaccines |
| Managing Chronic (Long Term) Conditions |
| Member Experience with Health Plan |
| Complaints and Changes in Plans Performance |
| Health Plan Customer Service |
| Drug Plan Customer Service |
| Complaints and Changes in the Drug Plan |
| Member Experience with the Drug Plan |
| Drug Safety and Accuracy of Drug Pricing |
Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating |
|---|
| Breast Cancer Screening |
| Colorectal Cancer Screening |
| Annual Flu Vaccine |
| Improving Physical |
| Improving Mental Health |
| Monitoring Physical Activity |
| Adult BMI Assessment |
Managing Chronic And Long Term Care for Older Adults
| Total Rating |
|---|
| SNP Care Management |
| Medication Review |
| Functional Status Assessment |
| Pain Screening |
| Osteoporosis Management |
| Diabetes Care - Eye Exam |
| Diabetes Care - Kidney Disease |
| Diabetes Care - Blood Sugar |
| Rheumatoid Arthritis |
| Reducing Risk of Falling |
| Improving Bladder Control |
| Medication Reconciliation |
| Statin Therapy |
Member Experience with Health Plan
| Total Experience Rating |
|---|
| Getting Needed Care |
| Customer Service |
| Health Care Quality |
| Rating of Health Plan |
| Care Coordination |
Anthem Copay List
Member Complaints and Changes in Anthem MediBlue Plus (HMO) Plans Performance
| Total Rating |
|---|
| Complaints about Health Plan |
| Members Leaving the Plan |
| Health Plan Quality Improvement |
| Timely Decisions About Appeals |
Health Plan Customer Service Rating for Anthem MediBlue Plus (HMO)
| Total Customer Service Rating |
|---|
| Reviewing Appeals Decisions |
| Call Center, TTY, Foreign Language |
Anthem MediBlue Plus (HMO) Drug Plan Customer Service Ratings
| Total Rating |
|---|
| Call Center, TTY, Foreign Language |
| Appeals Auto |
| Appeals Upheld |
Ratings For Member Complaints and Changes in the Drug Plans Performance
Anthem Tier 2 Copay Assistance
| Total Rating |
|---|
| Complaints about the Drug Plan |
| Members Choosing to Leave the Plan |
| Drug Plan Quality Improvement |
Member Experience with the Drug Plan
| Total Rating |
|---|
| Rating of Drug Plan |
| Getting Needed Prescription Drugs |
Drug Safety and Accuracy of Drug Pricing
| Total Rating |
|---|
| MPF Price Accuracy |
| Drug Adherence for Diabetes Medications |
| Drug Adherence for Hypertension (RAS antagonists) |
| Drug Adherence for Cholesterol (Statins) |
| MTM Program Completion Rate for CMR |
| Statin with Diabetes |
Anthem Blue Cross Copay
Ready to Enroll?
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for Anthem MediBlue Plus (HMO)
Anthem Prescription Copay
(Click county to compare all available Advantage plans)
| State: | Indiana |
|---|---|
| County: | Adams,Allen,Carroll,Cass,Clay, Clinton,Crawford,Daviess,De Kalb, Dearborn,Delaware,Dubois,Fayette, Franklin,Gibson,Grant,Greene, Howard,Huntington,Knox,Lawrence, Martin,Miami,Monroe,Noble, Ohio,Orange,Owen,Parke, Pike,Posey,Ripley,Spencer, Steuben,Sullivan,Tipton,Union, Vanderburgh,Vermillion,Vigo,Wabash, Warrick,Wayne,Wells,Whitley, |
Go to topWhat Is My Copay Anthem
Va Tier Copay
Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.