Medical

Hampden-Sydney College is committed to providing a comprehensive health care plan with a complex web of doctors, physicians, and facilities to choose from. Anthem KeyCare coverage is just that. (Anthem is affiliated with Blue Cross/Blue Shield)

Most hospitals in Virginia accept KeyCare rates. Pre-Admission review is required for admission to a hospital (excluding out-patient services). If you are admitted in an emergency situation, pre-admission review must be done within 48 hours or the next business day.

If you travel outside the state, the KeyCare network of doctors and facilities does not apply. However, you should locate doctors and facilities that participate with Blue Cross Blue Shield in the state you are visiting. If you have a life-threatening emergency either in state or out of state, you will not be penalized for seeking services from a non-KeyCare or non-participating doctor or facility.

PREVENTIVE CARE
Anthem covers 100% of checkups, routine physicals, including office visits, lab work, immunizations, mammograms, pap tests, gynecological exams, PSA, colorectal cancer screenings, and certain blood and urine screenings and labwork. Note: Refer to Anthem's preventive care list to see what tests are covered. These tests are not considered routine if the procedure is performed due to a medical condition or diagnosis. If, in the course of a routine screening procedure, an abnormality or problem is identified that requires immediate intervention, the service may be converted from routine or diagnostic.

 

WELL BABY CARE
Anthem's Well Baby Care covers children from birth through age 6.

In addition expectant mothers may enroll in the Future Moms Program by contacting the Benefits Manager or Anthem directly.

 

DEDUCTIBLES SINGLE FAMILY

In-Network $300 $600

Out-of-Network $450 $900

MAXIMUM OUT OF POCKET

In-Network $2,000 $4,000

Out-of-Network $3,000 $6,000

COINSURANCE PERCENTAGES

In-Network Anthem pays 80% of allowable charges, individual pays 20%

Out-of-Network Anthem pays 60% of allowable charges, individual pays 40%

Note: deductibles and out-of-pocket expenses for in- and out-of-network services are not combined.

The College plan is a PPO;
you do not need a referral;
you do not need a primary care physician;
there are no co-payments


PRESCRIPTION DRUG COVERAGE

Your Anthem policy covers prescription drug coverage is with Express Scripts.

 

$10 - $35 - $55 co-pays per prescription

  • Tier 1 - generic drugs - $10 co-pay.
  • Tier 2 - brand name drugs - $35 co-pay.
  • Tier 3 - brand name drugs - $55 co-pay.

 Prescription drugs and devices approved by the FDA for use as contraceptives are covered.

 

VISION
Basic vision
insurance is included in your Anthem health insurance coverage. The coverage is with Davis Vision. Note: If during a routine exam a problem is found the claim may become diagnostic and may become a medical claim.

  • In-Network Basic Plan: Exam co-pay is $15. Frames, Lenses, and Contacts are discounted dependent upon selection and cost.
  • Out-of-Network Basic Plan: $30 reimbursement towards the cost of a routine eye exam or $35 towards the cost of a contact lens exam. There is no benefit for Frames, Lenses, and Contacts.

VOLUNTARY Buy-up Vision Insurance with Davis Vision:

  • Exam co-pay is $15.
  • Frames: $130 allowance then 20% off remaining balance every 2 years.
  • Lenses: $15 co-pay, then covered in full for single, bifocal, and trifocal - see brochure for upgrades.
  • Contacts: $130 allowance then 15% off the remaining balance for conventional; $130 allowance for disposable lenses.

MEMBERSHIP TIERS AND FUNDING FOR HEALTH PLANS

Monthly health, vision, and dental membership tiers are:

Employee only
Employee + one child
Employee + spouse/same-sex domestic partner
Employee + family
The College contributes % of monthly medical/dental premium based upon salary:
50% if the employee earns $40,001 or more
65% if the employee earns $20,001 to $40,000
80% if the employee earns $20,000 or less
Premiums are deducted from your paycheck on a before-tax basis.