AmeriBen medical coverage
At IMA, our goal is to help you reach your highest potential and be the best version of yourself. This starts with taking care of your overall health. You and your eligible family members can choose from two medical plans:
The Blue Option PPO and Green Option Qualified HDHP are administered by AmeriBen and use the Anthem nationwide network of providers and facilities. Although both plans offer you the freedom and flexibility to see any doctor, you will save the most money by staying in-network for care. To find a provider, visit anthem.com/find-care.
When deciding which medical plan is right for you and your family, it is important to consider the total cost of coverage. This includes what you pay in premiums and what you pay for services out of your pocket. While both medical plans cover in-network preventive screenings in full, the plans vary on annual deductibles, copays and levels of coinsurance. The ideal medical plan should cover most of your health needs with out-of-pocket costs that meet your budget.
The Blue Option PPO allows you to choose a primary care physician (PCP) to help coordinate your medical needs or you can see any specialist in the network on your own, without a referral.
While your monthly premium is higher than the Green Option Qualified HDHP, you will pay a lower annual deductible. Both preventive and virtual care services are 100% covered. Once you meet your deductible, the Blue Option PPO generally pays 80% of eligible healthcare costs.
You can contribute pre-tax dollars to a Healthcare Flexible Spending Account to pay for eligible healthcare expenses.
The Green Option Qualified HDHP offers a variety of benefits, like lower monthly premiums and a tax-advantaged account, but it’s important to understand how the plan works to see if it’s the right choice for you.
You will pay 100% of the costs for medical care until you reach the deductible of $3,400 individual / $6,800 family (embedded deductible). You can use your Health Savings Account (HSA) dollars to pay for expenses tax-free.
After you reach your deductible, the plan pays 100% of eligible medical and prescription costs for the rest of the plan year.
| Plan Features | AmeriBen Blue Option PPO | AmeriBen Green Option QHDHP |
|---|---|---|
| In-Network | In-Network | |
| Network Access | National PPO (BlueCard PPO) Preferred Blue Option-Utah only |
|
| Annual Deductible Individual/Family | $1,000 / $2,000 | $3,400 / $6,800 |
| Annual Out-of-Pocket Maximum Individual/Family | $4,000 / $8,000 | $3,400 / $6,800 |
| IMA Annual HSA Contribution (pro-rated) Individual/Family | N/A | $500 / $1,000 |
| FSA Eligibility | General Purpose Healthcare and/or Dependent Care FSA | Limited Purpose Healthcare and/or Dependent Care FSA |
| You pay: | You pay: | |
| Preventive Care Visit | Covered in full | Covered in full |
| Telemedicine | Covered in full | Covered in full |
| Primary Care Visit | $25 copay | 0% after deductible |
| Specialist Visit | $50 copay | 0% after deductible |
| Diagnostic Lab & X-ray | 20% | 0% after deductible |
| Urgent Care | $50 copay | 0% after deductible |
| Emergency Room (copay waived if admitted) | $200 copay | 0% after deductible |
| Inpatient/Outpatient Hospital Stay | 20% after deductible | 0% after deductible |
| Bariatric Surgery Coverage | 20% after deductible Require use of Anthem Blue Distinction Center |
0% after deductible Require use of Anthem Blue Distinction Center |
| Lantern (surgery care) | 0% after deductible | 0% after deductible |
| Infertility Services | $20,000 lifetime max* | $20,000 lifetime max* |
| Prescription Drugs: Retail (up to a 30-day supply) | ||
| Generic | $10 copay | 0% after deductible |
| Brand Formulary** | $30 copay | |
| Non-Preferred Brand Formulary** | $60 copay | |
| Specialty/Self-Injectables | $0 copay when using PrudentRx*** | |
| Prescription Drugs: Mail Order (up to a 90-day supply) | ||
| Generic | $25 copay | 0% after deductible |
| Brand Formulary** | $75 copay | |
| Non-Preferred Brand Formulary** | $150 copay | |
| Specialty/Self-Injectables | Not covered | Not covered |
*Includes coverage for IVF, GIFT and ZIFT.
**AmeriBen Blue & Green—review formulary exclusions at caremark.com or through our Member Services Department at 1.866.475.7589.
*** If you opt out of the PrudentRx program, a 30% coinsurance will apply. PrudentRx is available through the AmeriBen plans.
AmeriBen Engage Your All-in-One Healthcare App
AmeriBen Engage™ is designed to support you throughout your healthcare journey, making it easier than ever to manage your health benefits. With this enhanced member experience, you can:
Get started by downloading the app or visiting engage.ameriben.com. For assistance, contact the AmeriBen number in the contacts section.
To learn more, please review the flyer.
AmeriBen’s medical and pharmacy plans will cover medically necessary bariatric surgeries performed at an Anthem Blue Distinction Center and weight loss prescriptions with a prior authorization. When using a Distinction Center for bariatric surgery, the AmeriBen medical plan will provide assistance with travel and lodging costs.
AmeriBen members should reach out to medical management team to connect with a clinical team member who will assist you with pre-surgery requirements and will determine if you are a candidate for bariatric surgery.
To find out if you qualify, call 1.888.235.3813
If you’re 18 or older and enrolled in an IMA AmeriBen or California Kaiser medical plan, you have access to gender-affirming services as a benefit when they are medically necessary or when the services meet the criteria for surgery or treatment of gender-affirming care. Some services include medically necessary hormone therapy, preventive screenings, behavioral health assessments, sex reassignment surgery and referrals to culturally responsive community resources. In addition, the AmeriBen medical plan will provide up to a combined calendar year maximum of $2,000 in travel benefits for treatment of gender-affirming services.
Your mental health is as important as your physical health. The IMA AmeriBen medical plans provide the following mental health services.
The IMA AmeriBen Medical plans will cover the cost of a breast pump purchased 90 days prior to the birth or up to 12 months following delivery. In addition, the plan also covers breastfeeding support and counseling.
For information regarding your plan’s prescription coverage, please refer to the prescription drug coverage page.
Through Anthem, AmeriBen creates and publishes the Machine-Readable Files on behalf of IMA Financial Group, Inc. To link to the Machine-Readable Files, please click on the URL provided: https://www.anthem.com/machine-readable-file/search/
Lantern Care creates and publishes Machine-Readable Files on behalf of IMA Financial Group, Inc. To link to the Machine-Readable Files, please click on the URL provided: https://www.edhc.com/ProviderPricingTransparency/
