Medical
Choosing the Best Plan
When choosing a medical plan, it is important to look at your budget, your preferences, your age and health, as well as the age and health of your covered dependents. You should consider the key differences between plan types and choose one that best suits you and your family.
The plans differ in the following areas:
- Cost of coverage, including payroll contributions
- Consider your deductible, copayments, and coinsurance
- Compare out-of-pocket maximum
- Convenience, covered services, access to providers, ease of use
What is a HMO Plan?
HMO stands for Health Maintenance Organization. With an HMO plan, you must choose a Primary Care Physician (PCP) from a network of local healthcare providers who will refer you to in-network specialists or hospitals when necessary
What is a PPO Plan?
PPO plans, or “Preferred Provider Organization” plans, are one of the most popular types of plans in the Individual and Family market. PPO plans allow you to visit whatever in-network physician or healthcare provider you wish without first requiring a referral from a primary care physician.
CDHP Plans (with Health Savings Account)
CDHP stand for Consumer Driven Health Plan. In a CDHP you must first satisfy your deductible. Once your deductible is satisfied, you will pay a percentage of the cost (your coinsurance) until your annual out-of-pocket maximum is reached. Once your annual out-of-pocket maximum is reached, the plan will pay 100% of the cost of covered services for the remainder of the calendar year. Please note you will still be responsible for costs in excess of reasonable and customary limits (applies to non-network providers only).
CDHP plan has a second component, Health Savings Account (HSA). The HSA allows you to fund a personal bank account to help offset future health care expenses and provides triple-tax savings.
Anthem Advantage CDHP PPO/HSA
A Consumer Driven Health Plan (CDHP) is a medical PPO plan. The unique part of being enrolled in a CDHP is that it allows you the opportunity to also open a Health Savings Account (HSA). This account allows you to set aside money on a pre-tax basis for eligible medical, dental and vision expenses.
The Anthem Advantage CDHP PPO/HSA plan offered by Anthem is a special type of health plan that typically does not have copays; instead, you’ll pay for all medical services and prescriptions up front until you meet your deductible. After meeting the deductible, most benefits are paid on a percentage basis rather than flat dollar copays. Preventive care is 100% covered when you use in-network providers. Many preventive prescriptions are covered at 100% not subject to deductible or copay (refer to) anthem.com/ca for a listing of included medications. Enrolling in the Anthem Advantage CDHP PPO/HSA allows you to pay for eligible health care expenses using your own tax-free medical savings account called a HSA.
The HSA allows you to fund a personal bank account to help offset current and future health care expenses and provides triple-tax savings:
- Tax-free contributions when you or Jackson Family Wines contributes to the account
- Tax-free interest on your HSA balance and investment gains
- Tax-free withdrawals for qualified expenses
- Any unused funds rollover and all funds are yours to keep
*State payroll taxes apply in some states, please check with your tax professional.
Important components of the Anthem Advantage CDHP PPO/HSA Plan
You must enroll in the Anthem Advantage CDHP PPO/HSA plan to be eligible to open a HSA. Contributions can be made to your HSA up to the limits set by the U.S. Treasury and the Internal Revenue Service (IRS). These limits include contributions from any source and the limits may be increased for inflation annually.
Jackson Family Wines will fund the following amounts to your HSA in 2023 (prorated based on date of hire):
- $500 for employee only coverage*
- $1,000 for employee plus family coverage* (enrolled with one or more family members on the medical plan)
The 2023 maximum funding (combined employee and JFW contributions):
- $3,850 for employee only coverage*
- $7,750 for employee plus family coverage (enrolled with one or more family members on the medical plan)
- $1,000 additional catch up contribution for anyone age 55+ (catch up contributions can be made any time during the year in which the HSA participant turns 55)
* Funded 50% in January 2023 and 50% in July 2023
Your traditional health coverage begins after you meet the calendar year deductible ($1,500 if you enroll yourself only, or $2,700 if you enroll one or more family members). Your calendar year deductible resets every January. Remember you can use your HSA to pay for expenses.
Your calendar year deductible, non-preventive medical services and non-preventive prescription drug costs apply to the Anthem Advantage CDHP PPO/HSA calendar year out-of-pocket maximum. Once you have reached your calendar year out-of-pocket maximum, medical and prescription drug expenses are 100% covered (for covered services). Your out-of-pocket maximum resets every January.
Preventive care for adults and children is 100% covered by the plan when you use PPO in-network providers (no charge to you). You do not need to meet any deductibles for preventive care visits as long as you use in-network providers. Additionally, there are certain maintenance/preventive drugs that are also 100% covered (no deductible). Please refer to the detailed list located on the online portal.
Due to IRS regulations, if you contribute to a HSA, you may not contribute to a Health Care FSA. However, you are eligible to contribute towards a Limited Health Care FSA (LPFSA) and Dependent Care FSA.
JFW is working with BenefitWallet to administer our HSA bank accounts. The first time you enroll in the CDHP plan, as part of the process, you will need to actively open your HSA account with BenefitWallet. If you enroll in benefits online through the portal and you elect the CDHP plan, you may click to the link on the screen to open your HSA account at that time. If you do not open your HSA account at the time of enrollment, you may go to www.mybenefitwallet.com anytime to open your account.
You may change your HSA contributions anytime through the Benefitsolver system. Select Change my benefits > life event > “HSA change”.
PPO Medical Plan Comparison
ANTHEM ADVANTAGE CDHP PPO/HSA | ANTHEM VALUE PPO | |||
---|---|---|---|---|
In-Network | Out-of-Network | In-Network | Out-of-Network |
|
DEDUCTIBLE (CALENDAR YEAR) | $1,500 per individual member $3,200 per family ($3,000 embedded)* | $1,500 per individual member $3,000 per family ($2,700 embedded)* | $1,000 per member Max of 3 separate deductibles per family | $2,000 per member Max of 3 separate deductibles per family |
OUT-OF-POCKET MAXIMUM (CALENDAR YEAR) | $4,000 per individual member $8,000 per family ($4,000 embedded)* | $10,000 per individual member $20,000 per family | $4,000 per member $8,000 per family | $10,000 per member $20,000 per family |
OFFICE VISIT | 20% after deductible | 50% after deductible | $30 per visit Primary Care (deductible waived) $50 per visit Specialist (deductible waived) | 50% after deductible |
PREVENTIVE CARE | No copay (deductible waived) | 50% after deductible | No copay (deductible waived) | 50% after deductible |
X-RAY AND LABORATORY | 20% after deductible | 50% after deductible | 20% after deductible | 50% after deductible |
CHIROPRACTIC | 20% after deductible (limited to 24 visits per calendar year, combined with physical therapy) | 50% after deductible (limited to 24 visits per calendar year, combined with physical therapy) | 20% after deductible (limited to 24 visits per calendar year, combined with physical therapy) | 50% after deductible (limited to 24 visits per calendar year, combined with physical therapy) |
ACUPUNCTURE | 20% after deductible (limited to 12 visits per calendar year) | 50% after deductible (limited to 12 visits per calendar year) | 20% after deductible (limited to 12 visits per calendar year) | 50% after deductible (limited to 12 visits per calendar year) |
DURABLE MEDICAL EQUIPMENT | 20% after deductible | 50% after deductible | 20% after deductible | 50% after deductible |
EMERGENCY ROOM | 20% after deductible | 20% after deductible | 20% after $150 deductible (deductible waived if admitted inpatient) | 20% after $150 deductible (deductible waived if admitted inpatient) |
HOSPITAL (INPATIENT) | 20% after deductible | 50% after deductible | 20% after deductible | $250 deductible per admission + 50% after deductible |
HOSPITAL (OUTPATIENT) | 20% after deductible | 50% after deductible | 20% after deductible | 50% after deductible |
PRESCRIPTION DRUGS (30-DAY SUPPLY) | After plan deductible: $15/$50/$70/30% (max copay $200 per fill) | After plan deductible: 50% of the Rx drug max allowed amount + costs in excess of the Rx drug max allowed amount | $15/$50/$70/30% (max copay $250 per fill) | Copay + 50% of remaining Rx drug max allowed amount + costs in excess of the Rx drug max allowed amount |
MAIL ORDER (90-DAY SUPPLY) | After plan deductible: $37.50/$150/$210/30% (max copay $500 per fill) | Not covered | $37.50/$150/$210/30% (max copay $500 per fill) | Not covered |
*If enrolling any dependents in the Anthem Advantage CDHP PPO/HSA, there are embedded individual deductible and out-of-pocket maximums within the family limits. A single member of a family does not have to meet the full family deductible in order for after-deductible benefits to kick in.
HMO Medical Plan Comparison
ANTHEM VALUE HMO | KAISER HMO | |
---|---|---|
In-Network | In-Network Only (CA & OR Only) |
|
DEDUCTIBLE (CALENDAR YEAR) | None | None |
OUT-OF-POCKET MAXIMUM (CALENDAR YEAR) | $3,500 per member $7,000 per family | $3,000 per individual $6,000 per family |
OFFICE VISIT | $30 per visit Primary Care $50 per visit Specialist | $30 copay per visit |
PREVENTIVE CARE | No charge | No charge |
X-RAY AND LABORATORY | No charge | $100 per test for Advance Imaging $10 copay per encounter |
CHIROPRACTIC | $30 per visit | $15 copay per visit (limited to 30 visits per year) |
ACUPUNCTURE | $30 per visit | $30 copay per visit; physician referred |
DURABLE MEDICAL EQUIPMENT | 20% per item | 50% per item |
EMERGENCY ROOM | $150 per visit (waived if admitted inpatient) | $150 per visit (waived if admitted inpatient) |
HOSPITAL (INPATIENT) | $750 per day, 3 day max | $500 per admission |
HOSPITAL (OUTPATIENT) | $400 per admission | $250 per procedure |
PRESCRIPTION DRUGS (30-DAY SUPPLY) | $15/$50/$70/30% (max copay $250 per fill) | Generic: $10 copay Brand: $30 copay |
MAIL ORDER (90-DAY SUPPLY) | $37.50/$150/$210/30% (max copay $500 per fill) | Generic: $20 copay Brand: $60 copay 100 day supply |