Medical coverage is one of the most important benefits we provide to you and your family.
We understand that our Benesch family has different health care needs and preferences, so we give you a choice of two types of medical plans. With both plans, you have access to Anthem’s vast network of providers and receive prescription coverage as part of Express Scripts.
Please note: If you enroll in coverage, it is effective on the first of the month following hire date.
Health Care Savings Medical Plan
- Higher deductible in exchange for lower premium
- Opportunity to save pre-tax dollars in a Health Savings Account (HSA) for qualified medical expenses
Preferred Provider Organization Plan (PPO)
- Lower deductible in exchange for higher premium
- Predictability of costs—you know before you go because there are set copays for services
Discover the best medical plan for you and your family with our new online medical cost calculator! This easy to-use tool will help you find the right fit for your unique healthcare needs.
Health Care Savings Medical Plan
This medical plan has higher deductibles but lower premiums. Once you reach your annual deductible, copays will apply. You have access to the same network of providers and high level of care. Note: in-network preventive care is paid at 100% and the deductible does not apply.
Important Note: Prescriptions are applied to the deductible first. Once you meet your deductible, a copay will apply.
By enrolling in this medical plan, you are eligible to enroll in a Health Savings Account (HSA) which provides a triple-tax advantage. The funds you contribute to your HSA is yours to keep and can be used not only for medical expenses, but for retirement expenses as well.
You are also eligible to contribute to a Limited Purpose Flexible Spending Account, (LFSA), which can be used to cover dental and vision expenses. It also provides an additional level of tax-advantage.
| In-Network | Out-of-Network | |
|---|---|---|
| Plan Design | ||
| Deductible | $3,200 individual / $6,400 family | $4,000 individual / $8,000 family |
| Maximum Out-of-Pocket | $4,000 individual / $8,000 family | $8,000 individual / $16,000 family |
| Primary Care and Mental Health and Substance Abuse Disorder Services Visits |
$25 copay after deductible | 50% after deductible |
| Preventive Care | No Charge | 50% after deductible |
| Specialist Visits | $35 copay after deductible | 50% after deductible |
| Emergency Room | $250 copay and 20% after deductible | $250 copay and 20% after deductible |
| Urgent Care | $75 copay after deductible | 50% after deductible |
| Rx Retail Copays | ||
| Generic | $10 copay after deductible | 50% coinsurance after deductible |
| Preferred Formulary | $30 copay after deductible | |
| Non-Preferred Formulary/Specialty | $50 copay after deductible | |
| Maintenance Rx 90 Day Supply through Smart 90 Pharmacies | ||
| Generic | $25 copay after deductible | Not covered |
| Preferred Formulary | $75 copay after deductible | |
| Non-Preferred Formulary/Specialty | $125 copay after deductible | |
| Express Scripts Rx Home Delivery | ||
| Generic | $20 copay after deductible | Not covered |
| Preferred Formulary | $60 copay after deductible | |
| Non-Preferred Formulary/Specialty | $100 copay after deductible | |
Plan Monthly Rates
| Coverage | Tier 1 Medical Plan Monthly Rates Base Salary < $100,000 |
Tier 2 Medical Plan Monthly Rates Base Salary = > $100,000 |
Tier 3 Medical Plan Monthly Rates Equity Partner |
|---|---|---|---|
| Employee | $142.00 | $236.68 | $826.03 |
| Employee + Spouse | $312.41 | $520.70 | $1,817.27 |
| Employee + Child(ren) | $269.81 | $449.69 | $1,569.46 |
| Employee + Family | $454.41 | $757.38 | $2,643.30 |
PPO Medical Plan
This medical plan allows you to visit any physician or healthcare provider you wish without first requiring a referral from a primary care physician. No matter which healthcare provider you choose, in-network healthcare services will be covered at a higher benefit level than out-of-network services. It's important to check if your provider accepts your health plan so you receive the highest level of benefit coverage. For a list of in-network doctors, click here.
For most services, a deductible will apply. Once you've met your deductible, a copay will apply thereafter.
Prescriptions are covered at a copay. In-network pharmacies will be covered at a higher level of benefit than out-of-network pharmacies.
You are also eligible to contribute to the Medical Flexible Spending Account (FSA) that provides tax advantages and can be used to cover the costs of your deductible and copays.
| In-Network | Out-of-Network | |
|---|---|---|
| Plan Design | ||
| Deductible | $500 individual / $1,000 family | $2,500 individual / $5,000 family |
| Maximum Out-of-Pocket | $2,000 individual / $4,000 family | $5,000 individual / $10,000 family |
| Primary Care and Mental Health and Substance Abuse Disorder Services Visits |
$25 copay | 50% after deductible |
| Preventive Care | No copay | 50% after deductible |
| Specialist Visits | $35 copay | 50% after deductible |
| Emergency Room | $250 copay | $250 copay |
| Urgent Care | $75 copay | 50% after deductible |
| Rx Retail Copays | ||
| Generic | $10 copay | 50% coinsurance |
| Preferred Formulary | $30 copay | |
| Non-Preferred Formulary/Specialty | $50 copay | |
| Maintenance Rx 90 Day Supply through Smart 90 Pharmacies | ||
| Generic | $25 copay | Not covered |
| Preferred Formulary | $75 copay | |
| Non-Preferred Formulary/Specialty | $125 copay | |
| Express Scripts Rx Home Delivery | ||
| Generic | $20 copay | Not covered |
| Preferred Formulary | $60 copay | |
| Non-Preferred Formulary/Specialty | $100 copay | |
Plan Monthly Rates
| Coverage | Tier 1 Medical Plan Monthly Rates Base Salary < $100,000 |
Tier 2 Medical Plan Monthly Rates Base Salary = > $100,000 |
Tier 3 Medical Plan Monthly Rates Equity Partner |
|---|---|---|---|
| Employee | $299.48 | $424.26 | $972.94 |
| Employee + Spouse | $658.85 | $933.37 | $2,140.47 |
| Employee + Child(ren) | $569.01 | $806.09 | $1,848.59 |
| Employee + Family | $958.33 | $1,357.62 | $3,113.41 |
My Health Dashboard
Download the Sydney Health App and use your Anthem login to find everything you need to know about your medical and wellness benefits all in one place.
In addition to being able to find a doctor matched to your preferences and manage your medical/pharmacy care, you have access to My Health Dashboard under the Menu on the app: your hub for personalized health and wellness. You can sync your devices and find resources and programs that interest you including:
- WebMD Health Risk Assessment – to help build an action plan based on your personalized needs
- Action Plans – reduce stress, sleep better, increase energy, get active, eat healthy, or achieve a healthy weight in digitally curated action plans with five easy steps
- Well-being Coach – digital and phone coaching programs to transform your health
- Emotional Wellbeing Resources – digital tools and programs to improve emotional well-being
- Weight Management Center – digital playbook to lose weight
- ConditionCare – programs specifically for cancer, diabetes, asthma and heart disease