Medical & Prescription
Mercy Housing empowers you to customize your health care with flexible options that fit your lifestyle. We’ve partnered with Anthem to provide you with three PPO medical plan options. PPO plans provide access to a broad network of providers and allow you to see specialists without referrals, including out-of-network care for greater choice and convenience. These benefits are a valuable part of your compensation—take time to understand your options so you can confidently choose the plan that works best for you and your family.
Medical & Prescription
Mercy Housing empowers you to customize your health care with flexible options that fit your lifestyle. We’ve partnered with Anthem to provide you with three PPO medical plan options.
PPO plans provide access to a broad network of providers and allow you to see specialists without referrals, including out-of-network care for greater choice and convenience. These benefits are a valuable part of your compensation—take time to understand your options so you can confidently choose the plan that works best for you and your family.
Medical & Prescription
Mercy Housing empowers you to customize your health care with flexible options that fit your lifestyle. We’ve partnered with Anthem to provide you with three PPO medical plan options.
PPO plans provide access to a broad network of providers and allow you to see specialists without referrals, including out-of-network care for greater choice and convenience. These benefits are a valuable part of your compensation—take time to understand your options so you can confidently choose the plan that works best for you and your family.
Watch this video to learn more about Choosing a Health Plan
Medical Highlights
The Anthem PPO 1500 and Anthem PPO 500 plans allow you the freedom to seek care in or outside of the plan’s network. Keep in mind that you will typically pay a higher fee and receive a reduced benefit if you visit an out-of-network doctor or hospital. The Anthem PPO In-Network Only plan offers a high level of benefits of the listed plan options; however, in order to receive benefits under this plan, you must visit in-network doctors and hospitals. Click into the buttons below a for full Summary Plan Description on each plan.
PPO 1500 Plan
Anthem
In-Network
Calendar Year Deductible (Individual / Family)
$1,500 / $4,500
Calendar Year Out-of-Pocket Maximum (Individual / Family)
Includes Deductibles & Copays
$4,500 / $13,500
Lifetime Benefit Maximum
Unlimited
Physician Visit (Primary / Specialist)
Copay Per Visit
$25 / $40
Preventive Care
No Charge
Hospital Services (Inpatient Care / Outpatient Surgery)
After Deductible
30% / 30%
X-ray & Lab Services1
Copay per Visit; Eligible Expenses After Deductible
$40; 30%
MRI, Nuclear Medicine, & Other High-Tech Services1
Copay per Visit; Eligible Expenses After Deductible
$40; 30%
Emergency Care2
Eligible Expenses After Deductible
30%
Urgent, Non-Routine, After-Hours Care2
Copay per Visit; Eligible Expenses After Deductible
$40; 30%
Vision3
Covered under Anthem’s vision network
Chiropractic & Acupuncture Care4
Copay per Visit
$40
Out-of-Network
Calendar Year Deductible (Individual / Family)
$4,500 / $13,500
Calendar Year Out-of-Pocket Maximum (Individual / Family)
Includes Deductibles & Copays
$13,500 / $20,000
Lifetime Benefit Maximum
Unlimited
Physician Visit (Primary / Specialist)
Eligible Expenses After Deductible
50% / 50%
Preventive Care
Eligible Expenses After Deductible
50%
Hospital Services (Inpatient Care / Outpatient Surgery)
Eligible Expenses After Deductible
50% / 50%
X-ray & Lab Services1
Eligible Expenses After Deductible
50%
MRI, Nuclear Medicine, & Other High-Tech Services1
Eligible Expenses After Deductible
50%
Emergency Care2
Eligible Expenses After Deductible
30%
Urgent, Non-Routine, After-Hours Care2
Copay per Visit; Eligible Expenses After Deductible
$40; 30%
Vision3
Covered up to $42
Chiropractic & Acupuncture Care4
Eligible Expenses After Deductible
50%
PPO 500 Plan
Anthem
In-Network
Calendar Year Deductible (Individual / Family)
$500 / $1,000
Calendar Year Out-of-Pocket Maximum (Individual / Family)
Includes Deductibles & Copays
$2,250 / $4,500
Lifetime Benefit Maximum
Unlimited
Physician Visit (Primary / Specialist)
Copay Per Visit
$20 / $30
Preventive Care
No Charge
Hospital Services (Inpatient Care / Outpatient Surgery)
After Deductible
20% / 20%
X-ray & Lab Services1
Copay per Visit; Eligible Expenses After Deductible
$30; 20%
MRI, Nuclear Medicine, & Other High-Tech Services1
Eligible Expenses After Deductible
20%
Emergency Care2
Copay per Visit
$150
Urgent, Non-Routine, After-Hours Care2
Copay per Visit
$75
Vision3
Covered under Anthem’s vision network
Chiropractic & Acupuncture Care4
Copay per Visit
$30
Out-of-Network
Calendar Year Deductible (Individual / Family)
$1,000 / $2,000
Calendar Year Out-of-Pocket Maximum (Individual / Family)
Includes Deductibles & Copays
$4,500 / $9,000
Lifetime Benefit Maximum
Unlimited
Physician Visit (Primary / Specialist)
Eligible Expenses After Deductible
40% / 40%
Preventive Care
Eligible Expenses After Deductible
Children: No charge | Adults: 40%
Hospital Services (Inpatient Care / Outpatient Surgery)
Eligible Expenses After Deductible
40% / 40%
X-ray & Lab Services1
Copay per Visit; Eligible Expenses After Deductible
$30; 40%
Nuclear Medicine, & Other High-Tech Services1
Eligible Expenses After Deductible
40%
Emergency Care2
Copay per Visit
$150
Urgent, Non-Routine, After-Hours Care2
Eligible Expenses After Deductible
40%
Vision3
Covered up to $42
Chiropractic & Acupuncture Care4
Eligible Expenses After Deductible
40%
PPO In-Network Plan
Anthem
In-Network Only
Calendar Year Deductible (Individual / Family)
None
Calendar Year Out-of-Pocket Maximum (Individual / Family)
Includes Deductibles & Copays
$1,500 / $3,000
Lifetime Benefit Maximum
Unlimited
Physician Visit (Primary / Specialist)
Copay Per Visit
$20 / $30
Preventive Care
No Charge
Hospital Services (Inpatient Care / Outpatient Surgery)
Copay per Visit; Eligible Expenses After Deductible
$500; 10% / $250; 10%
X-ray & Lab Services1
Eligible Expenses After Deductible
10%
MRI, Nuclear Medicine, & Other High-Tech Services1
Eligible Expenses After Deductible
10%
Emergency Care2
Copay per Visit
$150
Urgent, Non-Routine, After-Hours Care2
Copay per Visit
$75
Vision3
Covered under Anthem’s vision network
Chiropractic & Acupuncture Care4
Copay per Visit
$30
Out-of-Network
Calendar Year Deductible (Individual / Family)
N/A
Calendar Year Out-of-Pocket Maximum (Individual / Family)
Includes Deductibles & Copays
N/A
Lifetime Benefit Maximum
Unlimited
Physician Visit (Primary / Specialist)
Eligible Expenses After Deductible
N/A
Preventive Care
Eligible Expenses After Deductible
N/A
Hospital Services (Inpatient Care / Outpatient Surgery)
Eligible Expenses After Deductible
N/A
X-ray & Lab Services1
Copay per Visit; Eligible Expenses After Deductible
N/A
Nuclear Medicine, & Other High-Tech Services1
Eligible Expenses After Deductible
N/A
Emergency Care2
Copay per Visit
N/A
Urgent, Non-Routine, After-Hours Care2
Eligible Expenses After Deductible
N/A
Vision3
N/A
Chiropractic & Acupuncture Care4
Eligible Expenses After Deductible
N/A
Notes:
- No additional charge if included as part of an office visit or emergency room visit.
- Waived if admitted to hospital.
- Limited to one eye exam every 24 months.
- Limited to 20 visits per calendar year.
Online Member Access
Access your benefits, ID card, pharmacy info, and more on www.anthem.com or the Sydney Health app.
Find an in-network provider at anthem.com/find-care
What is a...
Deductible: Amount you have to pay for a covered medical expense before your coinsurance kicks in.
Coinsurance: The “cost-share” between you and the insurance carrier. It is a percentage of the costs you pay “out-of-pocket” for covered expenses after you meet your deductible.
Copay: Fixed fee you may need to pay for health care services (i.e., office visits, prescriptions).
Out-of-Pocket Maximum: You will not have to pay more than this amount during your plan year – once you reach it, your insurance plan will cover all additional expenses.
Prescription (Rx) Highlights
Your Benefit Deductions
Benefit deductions are calculated on 26 pay periods per year. Deductions will begin on the first paycheck following your benefits effective date. Your portion of premiums is automatically deducted from your paycheck pretax, unless required to be post-tax. This reduces your taxable income, which lowers your tax liability.
Employee Only
PPO 1500 Plan: $17.50
PPO 500 Plan: $80.68
PPO In-Network Only Plan: $104.51
Employee + Spouse
PPO 1500 Plan: $184.88 ($231.04 with Surcharge)
PPO 500 Plan: $329.83 ($375.98 with Surcharge)
PPO In-Network Only Plan: $384.50 ($430.66 with Surcharge)
Employee + Child(ren)
PPO 1500 Plan: $130.69
PPO 500 Plan: $249.87
PPO In-Network Only Plan: $294.82
Employee + Family
PPO 1500 Plan: $300.07 ($346.23 with Surcharge)
PPO 500 Plan: $499.78 ($545.93 with Surcharge)
PPO In-Network Only Plan: $575.08 ($621.23 with Surcharge)
Additional Resources
Contact the provider of these benefits:
Anthem - (877) 811-3106, www.anthem.com
ABOUT THIS GUIDE: Actual plan provisions for Mercy Housing (“the Company”) benefits are contained in the appropriate plan documents, including the Summary Plan Description (SPD) and incorporated benefit/carrier booklets. The Digital Benefits Hub is a summary only and does not describe each benefit option. This Digital Benefits Hub provides updates to your existing SPD as of the first day of plan year, which describes your health and welfare benefits in greater detail. Until the Company provides you with an updated SPD, this guide is intended to be a Summary of Material Modification (SMM) and should be retained with your records along with your SPD. As always, the official plan documents determine what benefits are available to you. If any discrepancy exists between this guide and the official documents, the official documents will prevail. The Company reserves the right to amend or terminate any of its plans or policies, make changes to the benefits, costs, and other provisions relative to benefits at any time with or without notice, subject to applicable law.