Medical Insurance - Anthem Blue Access PPO HSA
Worthington Schools offer a High Deductible Health Care Plan with Anthem. Anthem will send new identification cards to employees newly enrolled in the plan via mail within 7-10 business days of January 1, 2025. It should be noted that ID cards will come in plain white envelopes and will only contain up to 4 cards per envelope. If you have a larger family, your ID cards will arrive in two separate envelopes. If your ID cards are not received by January 1, 2025, and you need to see a doctor or pick up a prescription, you can email Beth Hohenstein to obtain a temporary ID card.
Once you receive your ID card, new enrollees should consider downloading the Anthem Sydney app or create an account on the Anthem website to be able to track deductible amounts met, find network physicians, compare costs of services, view Explanations of Benefits, utilize virtual care options, and find important information on other available programs, services and discounts.
After your deductible is met, the only item that would apply to the Out of Pocket Maximum is the $250 emergency room copayment per ER visit, which is waived if you are admitted. The out of pocket maximum is $2500 for single and $5000 for family for emergency room visit purposes.
The monthly premium for health care coverage is split into two equal deductions withheld on the first and second pay of each month.
2025 Medical Insurance Premiums:
Annual Network Deductibles:
- Single Deductible: $1,750
- Family Deductible: $3,500
Annual Out-of-Network Deductibles:
- Single Deductible: $3,500
- Family Deductible: $7,000
The Certificate of Coverage is a description of benefits and coverage under the plan and provides more in-depth detail about covered services and exclusions.
High Deductible Health Plans provide the opportunity for you to open a Health Savings Account to help you to save to pay for eligible medical, dental, vision and prescription drug expenses if you meet eligibility requirements. The Board of Education provides a flat dollar amount of funding to an HSA opened by you through CME Federal Credit Union. See additional information under Health Savings Accounts.
Dependent Eligibility: Dependent children can be covered under the plan up to age 26 regardless of financial dependence, student status, residence or marital status. Dependents are automatically dropped from health insurance coverage at the end of the month in which the dependent turns 26.
New enrollees in the Medical Plan are required to send the following documentation to enroll a spouse and dependents:
- Birth Certificates (Children)
- Marriage Certificate (Spouse)
Please send to WEC, Attn: Beth Hohenstein before December 31, 2024
Searching the Provider Network
If you are not currently enrolled in the district's medical coverage through Anthem, but are considering it, you can search Anthem's network as a guest. You can search as a guest on Anthem.com using the Blue Access PPO network until your coverage begins on January 1, 2025. If you wish to search for network providers you and/or your dependents can use for out of state care, please be sure to search the National PPO (Blue Card PPO) network.
Once benefits become effective, you will be able to easily search for network providers by creating a user account on the Anthem website or downloading the Sydney Health App.
If you are traveling out of the country or have an insured dependent traveling abroad, please contact Beth Hohenstein for more details on international coverage.
Prescription Drug Information
The formulary for prescription drugs can be viewed through your online Anthem account OR on the Anthem Sydney app. In the meantime, click here for a searchable formulary to determine which tier of coverage your medication falls in and if a prior authorization is needed. If your prior authorization has expired or if you have been newly prescribed a medication requiring prior authorization, your physician will need to provide the required information to Anthem before your prescription can be obtained.
While members are welcome to use Anthem's mail order pharmacy, Carelon, for prescription services, it is not required. Maintenance medications can be obtained at a network retail pharmacy as long as the prescription is written for a 90-day supply. In addition, we are pleased to announce that many preventive medications for conditions such as asthma, diabetes, heart issues, cholesterol, and osteoporosis may be obtained at no cost. Click here for a complete listing of those preventive medications. Please note that formularies do change throughout the year to comply with the Food & Drug Administration recommendations.
