EPO 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 various copays for most office visits and some other services, depending on the plan option you select.
  • 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.

Find a Doctor

Visit Anthem’s website and click “Find Care” and follow the prompts. On the Find Care page, select Guests, choose Texas as your state, choose Medical (Employer-Sponsored) as the type of plan, and select National PPO (Blue Card PPO) as the plan/network. On the next page, type in your city or zip and click on the type of Care Provider to complete the search.

Use Your EPO Plan Wisely

Here are ways to make the most of your Anthem EPO 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 $610 of unused money in your FSA to the next calendar year; amounts over $610 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 Low Plan Anthem EPO High Plan
In-Network Out-of-Network* In-Network Out-of-Network*
Annual Deductible
(Individual/Family)		 $0/$0 $3,500/$10,500 $0/$0 $3000/$9000
Out-of-Pocket Maximum
(Individual/Family)		 $5,000/$10,000 $10,000/$20,000 $2,500/$5,000 $9,000/$18,000
PCP Required No No No No
Preventive Care Covered in full 50% after deductible Covered in full 50% after deductible
Office Visits:
Primary Care/Specialist		 $30 copay/
$30 copay		 50% after deductible $20 copay/
$20 copay		 50% after deductible
Urgent Care $30 copay 50% after deductible $20 copay 50% after deductible
Emergency Room $200 copay $200 copay $125 copay $125 copay
Maternity Care (Inpatient) 30% after deductible 50% after deductible $250 copay 50% after deductible
Inpatient Hospital 30% after deductible 50% after deductible $250 copay 50% after deductible
Outpatient Surgery 30% after deductible 50% after deductible $125 copay 50% 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.