These charts provide a detailed list of services that are covered or not covered, and the percentages the insurance company will pay for in-network and out-of-network providers.

Please see  Benefits eGuide for weekly contributions.

Flexible Spending Accounts

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Medical Plans
Anthem Blue Cross Resources Express Scripts Resources Health Savings Account (HSA) Information for CDHP members
Anthem PPO	SBC	Grid	EOC
Anthem CDHP	SBC (Premium HSA) SBC (Basic HSA)	Grid Grid	EOC EOC
Anthem EPO (Non CA)	SBC	Grid	EOC
Anthem HMO (CA)	SBC	Grid	EOC
Kaiser Permanente Resources
Kaiser California	SBC	Grid
Kaiser Colorado	SBC	Grid
Kaiser Mid-Atlantic	SBC	Grid
Tricare Supplement	Grid

 

Dental and Vision
Delta Dental Resources
Delta Dental PPO	DPPO Premium Grid         SBC DPPO Basic Grid                 SBC
Delta Dental HMO	DeltaCare Grid                     SBC
VSP EasyOptions	VSP Basic Grid VSP Premium Grid