Anthem Blue Cross and Blue Shield of Virginia Individual KeyCare Preferred Plan Information
Plan Name:Individual KeyCare Preferred
Provider/ Facilities:In-Network:PPO Network of Providers.
No gatekeepers or referrals., Out-of-Network:Use any provider.
Requires additional coinsurance, separate deductible, and additional out-of-pocket maximum.
No gatekeepers or referrals.
Doctor Visits:In-Network:Covered before the deductible: $20 PCP / $30 Specialist, Out-of-Network:You pay 30% coinsurance after separate deductible.
Prescription Drug:In-Network:Covered before deductible. You pay $10 or 40%, whichever is greater.
$5,000 yearly benefit maximum per person. You receive maximum benefits when you choose generic drugs when available, Out-of-Network:Covered before deductible. You pay $10 or 40%, whichever is greater.
$5,000 yearly benefit maximum per person. You receive maximum benefits when you choose generic drugs when available
Hospital Inpatient & Outpatient Care Services:In-Network:You pay 20% or 0% coinsurance after deductible., Out-of-Network:You pay 30% coinsurance after separate deductible.
Routine Wellness Care:In-Network:Doctor Visits for Routine Wellness Care:
Covered before deductible. $20 PCP, $30 specialist. Two yearly visits per person.
Routine Screenings: Most covered before deductible. You pay 20% or 0%**, depending on the deductible you choose and the screening. Provides additional $150 per person per year for labs, x-rays & routine immunizations, Out-of-Network:You pay 30% coinsurance after separate deductible for doctor visit & screenings. Two yearly visits per person (combined with in-network visits).
Preventive Care and Immuniza-
tions for Children:In-Network:Covered before deductible. You pay 0% coinsurance., Out-of-Network:Covered before deductible. You pay 0% coinsurance.
Emergency Care:In-Network:You pay 20% or 0% coinsurance after deductible if covered services are for emergency care as defined by Anthem., Out-of-Network:You pay 20% or 0% coinsurance after deductible if covered services are for emergency care as defined by Anthem.
Dental:In-Network:Optional coverage available for preventive, restorative and complex services., Out-of-Network:Optional coverage available for preventive, restorative and complex services.
Term Life Insurance:In-Network:Not available., Out-of-Network:Not available.
Discounts on Alternative Medical Services:In-Network:Discounts include acupuncturists, chiropractors, massage therapists, health and wellness product discounts and fitness club discounts., Out-of-Network:Discounts include acupuncturists, chiropractors, massage therapists, health and wellness product discounts and fitness club discounts.
Lifetime Maximum Benefit:In-Network:$5 Million per person regardless of providers or facilities., Out-of-Network:$5 Million per person regardless of providers or facilities.
Other Anthem Blue Cross and Blue Shield of Virginia health insurance plans:
