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California Health Insurance: Anthem Blue Cross Platinum 90 EPO

California Health Insurance: Anthem Blue Cross Platinum 90 EPO

Anthem Platinum 90 EPO

In-Network

Cost Share Information 
Individual Deductible  $0
Family Deductible  $0
Out of Pocket Limit-Individual  $4,000
Out of Pocket Limit-Family  $8,000
Co-Insurance  10%
Lifetime Maximum  Unlimited
Office Visits 
Primary Care  $15
Specialist  $40
Adult Preventive Care  No Charge
Child Preventive Care  No Charge
Maternity Prenatal/Postnatal Care  Pre-No charge; Post $15
Rehabilitation Services  $15
Chiropractic Care  Refer to carrier
Inpatient Services 

Inpatient Hospital

10%

Maternity Delivery/Inpatient 

10%

Outpatient Services 
Outpatient Facility  10% 
Mental Health Outpatient  $15
Lab/X-Ray  $20/$40
Emergency Care 
Emergency Room  $150 (waived if admitted)
Urgent Care  $15  
Ambulance  $150 
Prescription Drugs 
Rx Deductible  N/A
Rx Generic  $5
Rx Preferred  $15
Rx Non-Preferred  $25
Recovery/ Special Needs 

Home Health Care

10%; 100 visits per year

Durable Medical Equipment  10%
 
Optional Benefits  None 
 
If you you have questions about the Anthem Blue Cross Platinum 90 EPO plan or any other plans from Anthem Blue Cross of California please call The Lynn Company at (800)-326-5966 for more information on California Health Insurance Plans
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