
EPO/PPO Overview

How the EPO Plan Works
- Provides both in-network and out-of-network coverage. However, you’ll pay less out of pocket when you use Anthem network providers.
- For in-network care, no deductible applies, and you’ll pay a $10 copay for most office visits and other services ($20 copay for specialists).
- For most out-of-network care, you must first satisfy a deductible before benefits begin. After you meet the deductible, you pay 50% coinsurance for care.
How the PPO Plan Works
- Provides both in-network and out-of-network coverage. However, you’ll pay less out of pocket when you use Anthem network providers.
- You pay copays for office visits and urgent care when you stay in network. For other types of in-network care, you must first meet a deductible and then you pay 10% coinsurance.
- For most out-of-network services, you must first satisfy a deductible before benefits begin. After you meet the deductible, you pay 30% coinsurance for care.
Use Your EPO or PPO Plan Wisely
Here are ways to make the most of your Anthem EPO or PPO all year long.
- Track your stats. Log in to Anthem’s website to see how much of your deductible you’ve met, review claims, use helpful tools, and more.
- Pair it with a Healthcare Flexible Spending Account. During a separate enrollment in November, you may choose to enroll in the Healthcare Flexible Spending Account, which allows you to set aside before-tax dollars to help pay for your eligible medical, prescription, dental, and vision expenses. Keep in mind, you can only carry over up to $550 of unused money in your FSA to the next calendar year; amounts over $550 will be forfeited.
- Be cost-conscious. Visit Anthem’s website, where you can search for in-network providers and use cost estimating tools to figure out what you may have to pay for care before you go to your doctor.

Plan Comparison
Plan Details | Anthem EPO Plan | Anthem PPO Plan | ||
In-Network | Out-of-Network* | In-Network | Out-of-Network* | |
Annual Deductible (Individual/Family) |
$100/$200 | $3,000/$6,000 | $300/$900 combined in- and out-of-network | $300/$900 combined in- and out-of-network |
Out-of-Pocket Maximum (Individual/Family) |
$2,000/$6,000 | $9,000/$18,000 | $2,500/$5,000 | $6,000/$12,000 |
PCP Required | No | No | No | No |
Preventive Care | Covered in full | 50% after deductible | Covered in full | 30% after deductible |
Office Visits/ Primary Care/Specialist |
$10 copay/ $20 copay |
50% after deductible | $10 copay/ $20 copay |
30% after deductible |
Urgent Care | $10 copay | 50% after deductible | $10 copay | 30% after deductible |
Emergency Room | $100 copay | $100 copay | $100 + 10% after deductible | $100 + 10% after deductible |
Maternity Care (Inpatient) | $200 copay | 50% after deductible | $100 + 10% after deductible | 30% after deductible |
Inpatient Hospital | $200 copay | 50% after deductible | $100 + 10% after deductible | 30% after deductible |
Outpatient Surgery | $100 copay | 50% after deductible | $100 + 10% after deductible | 30% after deductible |
*Out-of-network coverage is based on the negotiated rate. If your provider’s rate is higher, you will be responsible for paying the difference.