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- Sample, Jackie, Joe
| Medical & Drug Deductible $1,950 |
| Medical & Drug Out-of-Pocket Maximum $8,250 |
| Primary Care Visit $40 |
| Specialist Visit $80 |
| Urgent Care $75 |
| Inpatient Hospital 35% after ded. |
| Generic Drugs $17 |
| Preferred Brand Drugs $85 after ded. |
| Medical & Drug Deductible $3,500 |
| Medical & Drug Out-of-Pocket Maximum $8,550 |
| Primary Care Visit $30 |
| Specialist Visit $75 |
| Urgent Care $75 |
| Inpatient Hospital 50% after ded. |
| Generic Drugs $15 |
| Preferred Brand Drugs $50 |
| Medical Deductible $0 |
| Medical & Drug Out-of-Pocket Maximum $8,550 |
| Primary Care Visit $50 |
| Specialist Visit $85 |
| Urgent Care $50 |
| Inpatient Hospital $1,500 /Day (x5) |
| Generic Drugs $18 after ded. |
| Preferred Brand Drugs $70 after ded. |
| Medical & Drug Deductible $3,250 |
| Medical & Drug Out-of-Pocket Maximum $7,000 |
| Primary Care Visit 20% after ded. |
| Specialist Visit 20% after ded. |
| Urgent Care 20% after ded. |
| Inpatient Hospital 20% after ded. |
| Generic Drugs 20% after ded. |
| Preferred Brand Drugs 20% after ded. |
| Medical Deductible $2,500 |
| Medical & Drug Out-of-Pocket Maximum $8,200 |
| Primary Care Visit $45 |
| Specialist Visit $75 |
| Urgent Care $45 |
| Inpatient Hospital 35% after ded. |
| Generic Drugs $20 |
| Preferred Brand Drugs $65 after ded. |
| Medical Deductible $4,000 |
| Medical & Drug Out-of-Pocket Maximum $8,200 |
| Primary Care Visit $40 |
| Specialist Visit $80 |
| Urgent Care $40 |
| Inpatient Hospital 20% after ded. |
| Generic Drugs $16 after ded. |
| Preferred Brand Drugs $60 after ded. |
| Medical Deductible $4,000 |
| Medical & Drug Out-of-Pocket Maximum $8,200 |
| Primary Care Visit $40 |
| Specialist Visit $80 |
| Urgent Care $40 |
| Inpatient Hospital 20% after ded. |
| Generic Drugs $16 after ded. |
| Preferred Brand Drugs $60 after ded. |
| Medical Deductible $4,000 |
| Medical & Drug Out-of-Pocket Maximum $8,200 |
| Primary Care Visit $40 |
| Specialist Visit $80 |
| Urgent Care $40 |
| Inpatient Hospital 20% after ded. |
| Generic Drugs $16 after ded. |
| Preferred Brand Drugs $60 after ded. |
| Medical & Drug Deductible $1,950 |
| Medical & Drug Out-of-Pocket Maximum $8,250 |
| Primary Care Visit $40 |
| Specialist Visit $80 |
| Urgent Care $75 |
| Inpatient Hospital 35% after ded. |
| Generic Drugs $17 |
| Preferred Brand Drugs $85 after ded. |
| Medical & Drug Deductible $2,600 |
| Medical & Drug Out-of-Pocket Maximum $6,850 |
| Primary Care Visit 35% after ded. |
| Specialist Visit 35% after ded. |
| Urgent Care 35% after ded. |
| Inpatient Hospital 35% after ded. |
| Generic Drugs 35% after ded. |
| Preferred Brand Drugs 35% after ded. |
| Medical Deductible $1,950 |
| Medical & Drug Out-of-Pocket Maximum $8,200 |
| Primary Care Visit $45 |
| Specialist Visit $75 |
| Urgent Care $45 |
| Inpatient Hospital 35% after ded. |
| Generic Drugs $15 w/ded. |
| Preferred Brand Drugs $60 w/ded. |
| Medical Deductible $4,000 |
| Medical & Drug Out-of-Pocket Maximum $8,200 |
| Primary Care Visit $40 |
| Specialist Visit $80 |
| Urgent Care $40 |
| Inpatient Hospital 20% after ded. |
| Generic Drugs $16 after ded. |
| Preferred Brand Drugs $60 after ded. |
| Medical Deductible $4,000 |
| Medical & Drug Out-of-Pocket Maximum $8,200 |
| Primary Care Visit $40 |
| Specialist Visit $80 |
| Urgent Care $40 |
| Inpatient Hospital 20% after ded. |
| Generic Drugs $16 after ded. |
| Preferred Brand Drugs $60 after ded. |
| Applicant | Gender | Age | DOB | Tobacco Use |
| Sample | Male | 54 | 1/1/1967 | No |
| Jackie | Female | 20 | 1/1/2001 | No |
| Joe | Male | 41 | 1/1/1980 | No |
| Proposal ID: 45801908-7509800988027913 | Proposed Effective Date: 01/01/2021 | Email: Steveshorr@cox.net |
| Zip: 90731 | County: Los Angeles | State: CA |
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Anthem
All medical plans and rates are subject to regulatory approval. We will continue to add to our plan offerings on this site as we obtain regulatory approvals. Please keep checking back.
By state law, you are required to have coverage for all 10 essential health benefits, including Child (Pediatric) Dental. If you have selected a Medical Plan that does not include coverage for the Pediatric Dental essential health benefit, you will be required to purchase the required Pediatric Dental coverage in addition to your selected medical coverage even if you have other dental coverage. The cost of the dental coverage will be in addition to the cost of your selected medical coverage. At this time, the separate Pediatric Dental plan is not available. It will be available on this quoting site in the near future. Until then, you can create a profile and save the medical plan you selected so the application process is faster when the Pediatric Dental plans and application are available.
Catastrophic plans are only available to those under the age of 30 or those who meet the eligibility requirements set forth by the Affordable Care Act. If you don’t meet the requirements, please choose one of our many other plans.
Anthem reserves the right to request additional documentation to confirm eligibility.
Blue Shield
If you are eligible for Medicare, you are not eligible for an Individual and Family commercial plan.
