These charts provide a detailed list of services that are or are not covered and the percentages the insurance company will pay for in-network/out-of-network providers. Please see  Benefits eGuide for weekly contributions.

*2027 Grids are posted below.
SBC & EOC will be updated as soon as possible. 

Flexible Spending Accounts

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Medical Plans    Anthem Blue Cross Resources 2027 Express Scripts Drug Formulary Health Savings Account (HSA) Information for CDHP members
Anthem PPO	SBC	Grid*	EOC
Anthem CDHP with HSA	SBC (Premium ) SBC (Basic)	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
Vision Service Plan	VSP Premium Grid* VSP Basic Grid*