Plan Comparison Charts

If you are going to the doctor and want to know what services are covered, click on the plan charts below for plan summary and comparison grids. These charts provide a detailed list of services that are covered or not covered, and percentages the insurance company will pay for in-network and out-of-network providers. 

(Please see  Benefits Guide for weekly contributions.)

Medical Plans 

  Summary Details More Details
Anthem PPO SBC Grid EOC
Anthem CDHP SBC Grid EOC
Anthem EPO SBC Grid EOC
Anthem HMO SBC Grid EOC
Kaiser California SBC Grid EOC
Kaiser Colorado SBC Grid EOC
Kaiser Mid-Atlantic SBC Grid EOC
Tricare Supplement SBC Grid EOC

Anthem Claim Form

Anthem Concierge Cancer Care  (For Anthem PPO, EPO and CDHP members)

Dental and Vision Plans

  Details More Details
Anthem Dental Net (DHMO) Grid EOC
CIGNA Dental (DHMO) Grid EOC
Delta Dental (PPO) Grid EOC

VSP Vision
VSP EasyOptions

Grid EOC


Preventive Care Benefits

More Information about the Consumer Driven Health Plan (CDHP)

Health Savings Account (HSA) Information for CDHP members only

Flexible Spending Accounts (FSA) 

Mobile and Online Apps

  • Anthem
    • Mobile App – Available for all Anthem members 
    • LiveHealth OnlineAt home or on the go, see a doctor or therapist (Available for Anthem PPO, EPO, and CDHP members)
  • Kaiser – My Health Manager
    • Mobile App – email doctor’s office, view test results, refill most prescriptions, etc. Register at
    • Telephone Appointments – call to speak with a doctor for minor health conditions (Southern California only)

Express Scripts ®