Anthem Wisconsin

Plan Overviews

Starting in 2018, Anthem will reduce their ACA plans on the exchange 
Beginning on January 1, 2018, they will offer just one “off exchange” individual health plan in Menominee County only. This doesn’t impact Anthem’s employer-based, Medicare Advantage, Dental, Vision or Medicaid plans, nor does it impact individuals or families whose plans are “grandfathered” or “grandmothered” (grandfathered plans must have been purchased prior to March 23, 2010, and grandmothered plans must have been purchased by December 2013).

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Anthem Bronze Blue Priority WI 30% for HSA (2ESM) Anthem Bronze Blue Priority WI 5450 (2ETB) Anthem Bronze Blue Priority WI 40% for HSA (2ET8) Anthem Bronze Blue Priority WI 0% for HSA (2ESJ)
Network Name Blue Priority-WI Blue Priority-WI Blue Priority-WI Blue Priority – WI
Plan includes out-of-network coverage? No No No No
Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. $5,150 $5,450 $5,500 $6,550
Individual Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services $6,550 $7,150 $6,550 $6,550
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max 30% 30% 40% 0%
Preventative Care No additional cost No additional cost No additional cost No additional cost
Office Visit: PCP Deductible, then 30% coinsurance Deductible, then 30% coinsurance Deductible, then 40% coinsurance Deductible, then 0% coinsurance
Office Visit: Specialist Deductible, then 30% coinsurance Deductible, then 30% coinsurance Deductible, then 40% coinsurance Deductible, then 0% coinsurance
Outpatient diagnostic tests Deductible, then 30% coinsurance Deductible, then 30% coinsurance Deductible, then 40% coinsurance Deductible, then 0% coinsurance
Outpatient advanced diagnostic tests Deductible, then $500 copay and 50% coinsurance Deductible, then $500 copay and 50% coinsurance Deductible, then 50% coinsurance Deductible, then 0% coinsurance
Urgent Care Deductible, then $150 copay and 30% coinsurance Deductible, then $150 copay and 30% coinsurance Deductible, then $150 copay and 40% coinsurance Deductible, then 0% coinsurance
Emergency Room Deductible, then $500 copay and 30% coinsurance Deductible, then $500 copay and 30% coinsurance Deductible, then $500 copay and 40% coinsurance Deductible, then 0% coinsurance
Hospital: Inpatient Admission Deductible, then $1,000 copay and 30% coinsurance Deductible then $1,000 copay Deductible, then $1,000 copay and 50% coinsurance Deductible, then 0% coinsurance
Hosptial: Outpatient surgery hospital facility Deductible, then 30% coinsurance Deductible, then 30% coinsurance Deductible, then 40% coinsurance Deductible, then 0% coinsurance
Pharmacy deductible Level 1 / Level 2 pharmacy

Tier 1, 2, 3, 4: Medical deductible applies

Level 1 / Level 2 Pharmacy

Tier 1, 2, 3, 4: Medical deductible applies

Level 1 / Level 2 Pharmacy

Tier 1, 2, 3, 4: Medical deductible applies

Level 1 / Level 2 Pharmacy

Tier 1, 2, 3, 4: Medical deductible applies

Retail pharmacy tier 1: level 1 / level 2 30% coinsurance / 40% coinsurance 30% coinsurance / 40% coinsurance 40% coinsurance / 50% coinsurance 0% coinsurance / 0% coinsurance
Retail pharmacy tier 2: level 1 / level 2 30% coinsurance / 50% coinsurance 30% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance 0% coinsurance / 0% coinsurance
Retail pharmacy tier 3: level 1 / level 2 40% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance 0% coinsurance / 0% coinsurance
Retail pharmacy tier 4: level 1 / level 2 40% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance 0% coinsurance / 0% coinsurance
Physical and occupational therapy Deductible, then 30% coinsurance Deductible, then 30% coinsurance Deductible, then 40% coinsurance Deductible, then 0% coinsurance
Speech therapy Deductible, then 30% coinsurance Deductible, then 30% coinsurance Deductible, then 40% coinsurance Deductible, then 0% coinsurance
Office Visit: chiropractic Deductible, then 30% coinsurance Deductible, then 30% coinsurance Deductible, then 40% coinsurance Deductible, then 0% coinsurance
Anthem Silver Blue Priority WI 1850 (2ETL) Anthem Silver Blue Priority WI 2500 (2ESW) Anthem Silver Blue Priority WI for HSA (2ET2) Anthem Silver Blue Priority WI 3200 (2ESA) Anthem Silver Blue Priority WI 3750 (2ESQ) Anthem Silver Blue Priority WI 4000 (2ETE) Anthem Silver Blue Priority WI 5300 (2ES4)
Network Name Blue Priority-WI Blue Priority-WI Blue Priority-WI Blue Priority – WI Blue Priority-WI Blue Priority-WI Blue Priority-WI
Plan includes out-of-network coverage? No No No No No No No
Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. $1,850 $2,500 $3,000 $3,200 $3,750 $4,000 $5,300
Individual Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services $7,150 $7,150 $5,000 $6,650 $5,500 $5,000 $6,650
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max 20% 10% 10% 50% 10% 25% 25%
Preventative Care No additional cost No additional cost No additional cost No additional cost No additional cost No additional cost No additional cost
Office Visit: PCP $40 copay per visit for the first 3 visits, then deductible and 20% coinsurance $40 copay per visit for the first 3 visits, then deductible and 10% coinsurance Deductible, then 10% coinsurance $20 copay $45 copay $20 copay $35 copay
Office Visit: Specialist Deductible, then 0% coinsurance Deductible, then 20% coinsurance Deductible, then 10% coinsurance Deductible, then 50% coinsurance Deductible, then 10% coinsurance Deductible, then 25% coinsurance Deductible, then 25% coinsurance
Outpatient diagnostic tests Deductible, then 20% coinsurance Deductible, then 10% coinsurance Deductible, then 10% coinsurance Deductible, then 50% coinsurance Deductible, then 10% coinsurance Deductible, then 25% coinsurance Deductible, then 25% coinsurance
Outpatient advanced diagnostic tests Deductible, then $500 copay and 50% coinsurance Deductible, then $500 copay and 50% coinsurance Deductible, then $500 copay and 50% coinsurance Deductible, then $500 copay and 50% coinsurance Deductible, then $500 copay and 50% coinsurance Deductible, then 50% coinsurance Deductible, then $500 copay and 50% coinsurance
Urgent Care Deductible, then $150 copay and 20% coinsurance Deductible, then $150 copay and 10% coinsurance Deductible, then $150 copay and 10% coinsurance Deductible, then $150 copay and 50% coinsurance Deductible, then $150 copay and 10% coinsurance $150 copay Deductible, then $150 copay and 25% coinsurance
Emergency Room Deductible, then $500 copay and 20% coinsurance Deductible then $500 copay and 10% coinsurance Deductible, then $500 copay and 10% coinsurance Deductible, then $500 copay and 50% coinsurance Deductible, then $500 copay and 10% coinsurance Deductible, then $500 copay and 25% coinsurance Deductible, then $500 copay and 25% coinsurance
Hospital: Inpatient Admission Deductible, then $750 copay and 50% coinsurance Deductilbe, then $750 copay and 50% coinsurance Deductible, then $750 copay and 50% coinsurance Deductible, then $750 copay and 50% coinsurance Deductible, then $750 copay and 50% coinsurance Deductible, then $750 copay and 50% coinsurance Deductible, then $750 copay and 50% coinsurance
Hosptial: Outpatient surgery hospital facility Deductible, then 20% coinsurance Deductible, then 10% coinsurance Deductible, then 10% coinsurance Deductible, then 50% coinsurance Deductible, then 10% coinsurance Deductible, then 25% coinsurance Deductible, then 25% coinsurance
Pharmacy deductible Level 1 / Level 2 pharmacy

Tier 1, 2: No deductible

Tier 3, 4: Medical deductible applies

Level 1 / Level 2 pharmacy

Tier 1, 2: No deductible

Tier 3, 4: Medical deductible applies

Level 1 / Level 2 Pharmacy

Tier 1, 2, 3, 4: Medical deductible applies

Level 1 / Level 2 pharmacy

Tier 1, 2: No deductible

Tier 3, 4: Medical deductible applies

Level 1 / Level 2 pharmacy

Tier 1, 2: No deductible

Tier 3, 4: Medical deductible applies

Level 1 / Level 2 pharmacy

Tier 1: No deductible

Tier 2, 3, 4: $1,000 Combined pharmacy deductible

Level 1 / Level 2 pharmacy

Tier 1, 2: No deductible

Tier 3, 4: Medical deductible applies

Retail pharmacy tier 1: level 1 / level 2 $10 copay/$20 copay $10 copay/$20 copay 10% coinsurance / 20% coinsurance $10 copay/$20 copay $10 copay/$20 copay $10 copay/$20 copay $10 copay/$20 copay
Retail pharmacy tier 2: level 1 / level 2 $50 copay/$60 copay $40 copay/$50 copay 10% coinsurance / 30% coinsurance $40 copay/$50 copay $40 copay/$60 copay $40 copay/$50 copay $40 copay/$50 copay
Retail pharmacy tier 3: level 1 / level 2 40% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance 50% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance
Retail pharmacy tier 4: level 1 / level 2 40% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance 50% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance 40% coinsurance / 50% coinsurance
Physical and occupational therapy Deductible, then 20% coinsurance Deductible, then 10% coinsurance Deductible, then 10% coinsurance Deductible, then 50% coinsurance Deductible, then 10% coinsurance Deductible, then 25% coinsurance Deductible, then 25% coinsurance
Speech therapy Deductible, then 20% coinsurance Deductible, then 10% coinsurance Deductible, then 10% coinsurance Deductible, then 50% coinsurance Deductible, then 10% coinsurance Deductible, then 25% coinsurance Deductible, then 25% coinsurance
Office Visit: chiropractic $40 copay per visit for the first 3 visits, then deductible and 20% coinsurance $40 copay per visit for the first 3 visits, then deductible and 10% coinsurance Deductible, then 10% coinsurance $20 copay $45 copay $20 copay $35 copay
Anthem Catastrophic Blue Priority WI 7150 (2ESG)
Network Name Blue Priority-WI
Plan includes out-of-network coverage? No
Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. $7,150
Individual Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services $7,150
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max 0%
Preventative Care No additional cost
Office Visit: PCP $40 copay per visit for the first 3 visits, then deductible and 0% coinsurance
Office Visit: Specialist Deductible, then 0% coinsurance
Outpatient diagnostic tests Deductible, then 0% coinsurance
Outpatient advanced diagnostic tests Deductible, then 0% coinsurance
Urgent Care Deductible, then 0% coinsurance
Emergency Room Deductible, then 0% coinsurance
Hospital: Inpatient Admission Deductible, then 0% coinsurance
Hosptial: Outpatient surgery hospital facility Deductible, then 0% coinsurance
Pharmacy deductible Level 1 / Level 2 pharmacy

Tier 1, 2, 3, 4: Medical deductible applies

Retail pharmacy tier 1: level 1 / level 2 0% coinsurance / 0% coinsurance
Retail pharmacy tier 2: level 1 / level 2 0% coinsurance / 0% coinsurance
Retail pharmacy tier 3: level 1 / level 2 0% coinsurance / 0% coinsurance
Retail pharmacy tier 4: level 1 / level 2 0% coinsurance / 0% coinsurance
Physical and occupational therapy Deductible, then 0% coinsurance
Speech therapy Deductible, then 0% coinsurance
Office Visit: chiropractic $40 copay per visit for the first 3 visits, then deductible and 0% coinsurance

When you begin shopping for a Marketplace health plan, you’ll see plan options with different metal tiers such as Gold, Silver and Bronze plans. But the only difference between these plans is how much premium you’ll pay each month and how much you’ll pay for certain medical services. A Bronze plan typically gives you lower monthly premium payments, but potentially higher out-of-pocket costs – if you end up needing a lot of care. And a Gold plan may have higher monthly premiums, but that helps you limit your out-of-pocket costs later. If you’re looking for a balance on your monthly premium payments and your out-of-pocket costs, Silver plans provide just that. And, Silver plans are the only plans with additional out-of-pocket payment reductions (cost sharing reductions)! This helps lower the costs of your copays, deductibles and coinsurance. So, if you are eligible for a subsidy and cost sharing, Silver plans offer the highest value.

Dental Plans
Benefit Frequency Cost Share
Eye Exam Once every 12 months $20 copay
Standard plastic (CR39) lenses Once every 24 months
Single Vision $20 copay
Bifocal $20 copay
Trifocal $20 copay
Contact lenses: Once every 24 months
Elective (conventional and disposable) $80 allowance
Non-elective Covered in full
Frames Once every 24 months $130 allowance
FAQ
Q: I have an Anthem individual ACA health plan — when do I have to find new coverage?
A: Nothing is changing with your Anthem ACA health plan in 2017. Later this year, you’ll have to shop for a new plan for 2018. You’ll do this during the open enrollment period starting November 1. Affected members will receive an official notice that their plan is ending, along with information on options for next year. We’ll help you connect with the right people to find a new plan.
Q: I didn’t switch to an ACA plan, my individual health plan is grandfathered/grandmothered. Does this affect me?
A: No, this change affects Anthem’s ACA individual health plans only.
Q: Is Anthem also discontinuing individual dental and vision plans in Wisconsin?
A: No, this change affects Anthem’s individual ACA health plans only. We’ll continue to offer dental and vision plans in Wisconsin.
Q: I get health benefits from my employer. Does this affect me?
A: No, this change affects Anthem’s individual ACA health plans only. Plans sponsored by employers are not impacted.
Q: I have an Anthem Medicare plan. Does this affect me?
A: No, this change affects Anthem’s individual ACA health plans only. Anthem’s Medicare plans are not impacted.

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Contact Us

New Enrollments:

Phone: (312) 726-6565
Email: [email protected]