To support your health and wellness, Capital One provides valuable benefits that help you and your family be well and pay for care if you get sick or injured.

 

Overview

You have access to three medical plan options through Anthem Blue Cross Blue Shield. These medical plan options offer you a range of coverage levels and costs, so you can choose the one that’s best for you and your family. You can enroll as a new hire, during Open Enrollment, or if you have a qualifying life event. To see your contributions and enroll, log in to the Capital One Benefits Center website.

2021 medical plans

Basic PPO

Reduce your paycheck costs with a plan that has lower contributions in exchange for a higher deductible, co-pays, and coinsurance, giving you more responsibility for the cost of your care.

Enhanced PPO

Pay less for the health care services you receive with a lower deductible along with lower co-pays and coinsurance, in exchange for higher contributions.

Premium PPO

Minimize your out-of-pocket costs with the lowest deductible, co-pays, and coinsurance, in exchange for the highest contributions.

Key features at a glance

All our medical plans provide:

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Comprehensive, affordable coverage

for the same range of health care services, including common services such as doctor visits, screenings and hospitalizations, as well as more specialized care like Applied Behavioral Analysis (ABA) therapy, fertility treatment, transgender surgery, and more.

Free in-network primary care physician (PCP) visits,

with both preventive/wellness checkups and sick visits (even non-preventive care) covered at 100% to ensure you can get the care you need. Preventive care includes services such as annual physicals, preventive lab work, recommended immunizations, and routine cancer screenings. See more covered preventive services.

Prescription drug coverage

included with each medical plan. Prescription benefits are provided by CVS Caremark.

Financial protection

through annual out-of-pocket maximums that limit the amount you’ll pay each year.

The same broad network of doctors and hospitals,

offering you more choices and better savings. Our medical plans also offer the flexibility to see out-of-network providers, but your costs will be higher.

Programs and resources

to support your health goals and help you get the most from your coverage.

Preventive care vs. diagnostic care: What’s the difference?

Preventive care helps you stay healthy and can detect any illnesses before you experience symptoms. Diagnostic care is used to find the cause of existing illnesses. For example, say your doctor suggests you have a colonoscopy because of your age when you have no symptoms. That's preventive care. On the other hand, say you have symptoms and your doctor suggests a colonoscopy to see what's causing them. That's diagnostic care.

Do you have a PCP?

Finding a primary care physician (PCP) you can relate to, feel comfortable with, and trust with private matters can make a big difference in your overall health and well-being. A PCP gets to know the “whole you,” and will have a more complete picture of your health needs. They’ll know your medical history and habits, and they’ll recognize changes and be able to recommend action to avoid any serious problems later.

If you’re healthy, a PCP helps you stay that way. And if you’re managing an ongoing health problem, they can make sure you have the support you need. Having this kind of care can mean lower health care costs, fewer sick days, and better access to specialized care when you do need it. To support you in establishing a relationship, all visits to in-network PCPs are covered at 100% under our medical plans. Find a doctor.

 

Plan Comparison

Here's a summary of how the plans compare:

Basic PPO Enhanced PPO Premium PPO
In-Network Out-Network In-Network Out-Network In-Network Out-Network
Annual deductible (individual / family) $1,000 / $2,000 $3,000 / $6,000 $600 / $1,200 $2,000 / $4,000 $500 / $1,000 $1,500 / $3,000
Annual out-of-pocket maximum (individual / family) $4,000 / $8,000 $10,000 / $20,000 $3,100 / $6,200 $7,000 / $14,000 $2,500 / $5,000 $5,000 / $10,000
Coinsurance (your portion of the cost) 30% 50% 20% 40% 10% 30%
Medical care: What you pay
Preventive care Covered at 100% Covered at 100%* Covered at 100% Covered at 100%* Covered at 100% Covered at 100%*
Office visit (primary care) No charge 50% coinsurance after deductible No charge 40% coinsurance after deductible No charge 30% coinsurance after deductible
Office visit (OBGYN / Psychiatrist / Psychologist) $30 co-pay** 50% coinsurance after deductible $25 co-pay** 40% coinsurance after deductible $25 co-pay** 30% coinsurance after deductible
Office visit (specialist) $60 co-pay** 50% coinsurance after deductible $50 co-pay** 40% coinsurance after deductible $40 co-pay** 30% coinsurance after deductible
LiveHealth Online telemedicine visit No charge NA No charge NA No charge NA
Urgent care visit $60 co-pay** 50% coinsurance after deductible $50 co-pay** 40% coinsurance after deductible $40 co-pay** 30% coinsurance after deductible
Emergency room visit (in- and out-of-network) 30% coinsurance after deductible 20% coinsurance after deductible 10% coinsurance after deductible

*For out-of-network providers, Anthem processes preventive care claims at 100% of the local plan pricing or allowed (reasonable and customary) charge. You may be required to pay out-of-pocket for any balance-billed charges above the reasonable and customary charges.
** Deductible does not apply.

For more information: Please refer to the Summary Plan Description (SPD) or view the Summary of Benefits and Coverage (SBC) for each plan below:

Don’t pay for more coverage than necessary!

The Medical Plan Selector Tool gives you a personalized forecast of your costs, so you can pick the right amount of coverage for your needs. Visit the Capital One Benefits Center to start estimating your costs.

 

Basic PPO (2021)

The Basic PPO allows you to keep more of your paycheck by offering the lowest contribution costs. With this plan, you’ll pay more when you need care because of the higher deductible, coinsurance, and co-pays. You can see any provider you wish, but you will save money when you stay in network.

How the Basic PPO works

You pay the plan’s contributions from your paycheck to have coverage.

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Co-pay

You pay a small fee for in-network doctor visits and prescriptions. Co-pays do not count toward your deductible.

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Deductible

For care that doesn’t charge a co-pay, such as hospital services, you pay 100% of the costs until you meet the annual deductible.

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Coinsurance

After meeting the deductible, you and the plan share the cost of certain services, with the plan paying 70% in-network and you only pay 30%.

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Out-of-Pocket Maximum

You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year once you reach the maximum.

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Save money with an FSA ― and get matching contributions from Capital One.

A Health Care Flexible Spending Account (FSA) lets you take advantage of tax-free savings when paying for health care. And, you even get FSA funding from Capital One. The company will match $0.50 of every $1 you contribute to your FSA (up to $500 each in both the Health Care FSA and Dependent Care FSA). Keep in mind, this contribution counts toward the maximum amount that can be contributed to your FSAs.

Be sure to plan your FSA contributions carefully.

Based on IRS rules, FSAs are "use-it-or-lose-it" accounts. That means you'll lose any money left in the 2021 account after the claim deadline (April 30, 2022), so it's important to carefully estimate your contribution amount for the year. You may roll over up to $550 from your 2021 Health Care FSA if you re-elect the Health Care FSA in 2022. If you do not enroll in a Health Care FSA in 2022 or if you have a balance in excess of $550, those funds will be forfeited after the claim deadline.

 

Enhanced PPO (2021)

The Enhanced PPO offers a balanced approach to health care costs, with moderate contributions and moderate out-of-pocket expenses. With this plan, you can see any provider you wish, but you will save money when you stay in network.

How the Enhanced PPO works

You pay the plan’s contributions from your paycheck to have coverage.

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Co-pay

You pay a small fee for in-network doctor visits and prescriptions. Co-pays do not count toward your deductible.

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Deductible

For care that doesn’t charge a co-pay, such as hospital services, you pay 100% of the costs until you meet the annual deductible.

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Coinsurance

After meeting the deductible, you and the plan share the cost of certain services, with the plan paying 80% in-network and you only pay 20%.

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Out-of-Pocket Maximum

You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year once you reach the maximum.

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Save money with an FSA ― and get matching contributions from Capital One!

A Health Care Flexible Spending Account (FSA) lets you take advantage of tax-free savings when paying for health care. And, you even get FSA funding from Capital One. The company will match $0.50 of every $1 you contribute to your FSA (up to $500 each in both the Health Care FSA and Dependent Care FSA). Keep in mind, this contribution counts toward the maximum amount that can be contributed to your FSAs.

Be sure to plan your FSA contributions carefully.

Based on IRS rules, FSAs are "use-it-or-lose-it" accounts. That means you'll lose any money left in the 2021 account after the claim deadline (April 30, 2022), so it's important to carefully estimate your contribution amount for the year. You may roll over up to $550 from your 2021 Health Care FSA if you re-elect the Health Care FSA in 2022. If you do not enroll in a Health Care FSA in 2022 or if you have a balance in excess of $550, those funds will be forfeited after the claim deadline.

 

Premium PPO (2021)

The Premium PPO offers the lowest out-of-pocket costs and the highest contribution costs. With this plan, you have a relatively small deductible to meet before coinsurance begins. And your co-pay and coinsurance amounts are also lower than the other plans. You can see any provider you wish, but you will save money when you stay in network.

How the Premium PPO works

You pay the plan’s contributions from your paycheck to have coverage.

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Co-pay

You pay a small fee for in-network doctor visits and prescriptions. Co-pays do not count toward your deductible.

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Deductible

For care that doesn’t charge a co-pay, such as hospital services, you pay 100% of the costs until you meet the annual deductible.

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Coinsurance

After meeting the deductible, you and the plan share the cost of certain services, with the plan paying 90% in-network and you only pay 10%.

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Out-of-Pocket Maximum

You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year once you reach the maximum.

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Save money with an FSA ― and get matching contributions from Capital One!

A Health Care Flexible Spending Account (FSA) lets you take advantage of tax-free savings when paying for health care. And, you even get FSA funding from Capital One. The company will match $0.50 of every $1 you contribute to your FSA (up to $500 each in both the Health Care FSA and Dependent Care FSA). Keep in mind, this contribution counts toward the maximum amount that can be contributed to your FSAs.

Be sure to plan your FSA contributions carefully.

Based on IRS rules, FSAs are "use-it-or-lose-it" accounts. That means you'll lose any money left in the 2021 account after the claim deadline (April 30, 2022), so it's important to carefully estimate your contribution amount for the year. You may roll over up to $550 from your 2021 Health Care FSA if you re-elect the Health Care FSA in 2022. If you do not enroll in a Health Care FSA in 2022 or if you have a balance in excess of $550, those funds will be forfeited after the claim deadline.

 

Prescription Drugs

When you enroll in a Capital One medical plan, you automatically receive prescription drug benefits through CVS Caremark. Coverage is the same for all three medical plans. Your CVS Caremark information can be found on your Anthem ID card.

Drug tiers

The cost of your prescription drugs under each medical plan depends on the tier of the medication — generic, preferred brand, non-preferred brand, or specialty.

All prescription carriers have a formulary, which is a list of preferred drugs determined to be both effective and reasonable in cost. A group of practicing physicians and pharmacists routinely reviews drugs to include in the formulary. If clinical data shows several drugs are equally effective, the most cost-effective drug is usually chosen. The formulary may change from time to time. To see if medication you take is on the formulary, go to caremark.com.

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Generic drugs

Contain the same active ingredients as brand-name equivalents and meet the same standards for quality and effectiveness, but usually cost much less.

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Preferred drugs

Are brand-name medications included on the CVS Caremark formulary because they have been proven to be both effective and reasonable in cost.

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Non-preferred drugs

Are brand-name medications not included on the CVS Caremark formulary. These drugs are also effective for treatment, but cost more.

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Specialty drugs

Include medications used to treat certain conditions and are only filled only through CVS Caremark’s Specialty Pharmacy to ensure the highest quality and best discounts.

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Options for filling your prescription

Your medication costs will also vary depending on how you fill your prescription. Through your prescription drug coverage, you may fill prescriptions:

  • At a participating retail pharmacy for short-term prescriptions. You’ll pay a set amount for a 30-day supply based on the drug tier of the prescription. Participating pharmacies include CVS, Giant, Walgreens, Walmart, and many independent pharmacies. This option is generally best for medications you’ll need to take for 60 day or less (two fills).
  • Through CVS Caremark’s mail-order pharmacy for long-term prescriptions. Using the Maintenance Choice program saves you money on 90-day supplies of your medication and provides the convenience of having maintenance medication mailed directly to your home or address of your choosing. Or, you can elect to have your maintenance medications filled in a 90-day supply at a CVS pharmacy.
  • At the Knolls, Plano, and West Creek Health Centers and Pharmacies. The Knolls, Plano, and West Creek Health Centers offer a pharmacy for short-term medications (like antibiotics), 90-day supply for maintenance medications, and a limited selection of over-the-counter medications. See Pulse for more information.
Reminder about specialty medications

Associates who routinely take medications for certain conditions must use CVS Caremark’s Specialty Pharmacy program to receive coverage. No part of the cost of these medications is covered if purchased from a retail pharmacy. Please log in to caremark.com or call 1-877-210-3556 for more information.

Medications for the following conditions are considered specialty:

  • Anemia
  • Chrohn’s disease
  • Cystic fibrosis
  • Growth Hormone, related disorders and other hormonal therapies
  • Hepatitis B and Hepatitis C
  • HIV
  • Immune disorders
  • Infertility
  • Macular degeneration
  • Multiple sclerosis
  • Cancer
  • Osteoporosis
  • Pulmonary arterial hypertension
  • Pulmonary disorders
  • Rheumatoid arthritis/Psoriasis
  • RSV prevention
  • Transplants

Prescription costs

Your prescription drug costs are the same with all three medical plans. The amount you pay depends on the type of medication and the way you fill your prescription.

Type of Drug Retail
(up to a 30-day supply)
Mail Order or CVS
(up to a 90-day supply)
CVS Caremark
Specialty Pharmacy*
(30-day supply)
Generic $10 co-pay $20 co-pay $40 co-pay
Preferred Brand $50 co-pay $100 co-pay $100 co-pay
Non-Preferred Brand $100 co-pay $200 co-pay $200 co-pay

*Specialty medication must be purchased through the CVS Caremark Specialty Pharmacy and will not be covered if filled at a regular retail pharmacy.

Note: Some prescriptions must meet defined criteria before they are covered by the plan. Additional controls may apply for certain high-cost medications and specialty medications. These controls include prior authorizations and requirements to try certain lower cost medications first.

Be Well Pharmacy Discount Program

If you have diabetes, hypertension, high cholesterol, asthma/COPD, or congestive heart failure, you may be eligible to receive your prescription medication for free or at a reduced cost. The Be Well Pharmacy Discount program is available to patients with one of these chronic conditions who work with an Anthem nurse to manage their health. The discounted pricing below applies to mail order prescriptions only.

Type of Drug Mail Order
(up to a 90-day supply)
Generic $0
Preferred Brand $20 co-pay
Non-Preferred Brand $100 co-pay

Call an Anthem Nurse to qualify for the discount at 1-844-390-4133, press option 4 to speak with a nurse (Monday through Friday from 8 a.m. to 11 p.m. ET).

Pharmacy Advisor Counseling

As an added benefit to you, CVS retail pharmacists will provide support to you in the store. This service includes confidential advice, medication information, tips to help manage or avoid medication side effects, and additional guidance.

Save money on your prescriptions!

The cost of prescription drugs is rising faster than many other health care services and supplies. But, there are ways for you to save.

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  • Use generic.

    Generic medications are chemically and therapeutically equivalent to their brand-name counterparts, but generally cost between 20% and 70% less. If your doctor prescribes a brand-name prescription and a generic equivalent exists, typically pharmacists will automatically dispense the generic version. If you request that a brand-name prescription be filled as written, even though it has a generic equivalent available, you’ll pay the brand cost share under the plan and the difference between the brand and the generic equivalent. This additional cost applies even if your doctor notes “Dispense as Written” or “DAW” on your prescription.

  • Use the Maintenance Choice program for long-term prescriptions.

    If you take maintenance medication to treat a long-term condition — such as an allergy, heart disease, depression, or acid reflux — the convenience and cost savings of the home delivery prescription program through CVS Caremark will save you time and money. You also have the option to fill a 90-day prescription at your local CVS retail pharmacy. CVS can work with you on payment options for your medications. Please contact CVS Caremark at 1-877-210-3556 or log in to caremark.com for more information about signing up for these programs.

  • If eligible, take advantage of the Be Well Pharmacy Discount Program.

    This program offers reduced costs for the prescription drugs that help manage certain chronic conditions, including diabetes, hypertension, high cholesterol, asthma/COPD, or congestive heart failure. Call an Anthem Nurse to qualify for the discount at 1-844-390-4133, press option 4 to speak with a nurse (Monday through Friday from 8 a.m. to 11 p.m. ET).

 

Programs & Resources

Take advantage of these valuable programs and resources to better manage your and your family’s health, emotional wellness, and financial well-being.

LiveHealth Online

Through your Anthem medical plan, you can have private, secure video visits with a board-certified doctor, licensed therapist, or lactation counselor 24/7, 365 days a year. All you need is a smartphone, tablet, or computer with a webcam. It’s an easy way to get the care you need at home or on the go. Turn to LiveHealth Online when you have a common health condition, such as a cold, the flu, a fever, allergies, pinkeye, or a sinus infection. A doctor can assess your condition, provide a treatment plan, and even send a prescription to your pharmacy, if it’s needed.

LiveHealth Online also offers behavioral health support. If you’re feeling anxious or having trouble coping on your own, you can have a video visit with a therapist or psychiatrist. Telemedicine appointments are available for anxiety, depression, grief, panic attacks, and more.

All visits are available at no cost to associates and family members covered under a Capital One medical plan. To get started, register or make an appointment on the LiveHealth Online website or call 1-888-548-3432 from 7 a.m. to 11 p.m., seven days a week. Evening and weekend appointments are available.

Autism Coverage

To help families living with autism, Capital One offers additional support under our medical plans:

  • Applied Behavior Analysis (ABA) is covered at 100% whether you use an in-network or out-of-network therapist, with no plan dollar limits or age limits. Capital One’s medical plans cover ABA therapy at 100% of billed charges.
  • Speech, Occupational, and Physical Therapy are all covered with no dollar maximums, visit limits, or age limits.

 

Anthem Health Programs

As an Anthem member, you have access to a variety of Anthem Health Programs:

  • Anthem Member Services – Anthem’s Member Services, also known as Anthem Health Guides, work closely with health care professionals like nurses, health coaches, social workers, and others, to help you make the most of your plan’s benefits. Anthem Health Guides can connect you with programs and support covered by your benefits, remind you to make appointments for routine care, including checkups, tests, and preventive screenings, help you find in-network doctors, and much more. To contact Anthem Health Guides, call 1-844-390-4133, Monday through Friday, from 8 a.m. to 11 p.m. ET (the number is also on your Anthem ID card), or log in to the Anthem website and select Customer Support > Message Center to either send a secure email or chat live.
  • Personal Health Consultant – With the Personal Health Consultant, your family has a primary nurse and health professionals who are there to discuss your health needs and help you reach your health goals. When you need more specialized advice, your primary nurse can connect you to medical professionals like dietitians or pharmacists.
  • ConditionCare – This program provides extra support to people of all ages who are managing the symptoms of asthma or diabetes. It’s also for adults who are dealing with chronic obstructive pulmonary disease (COPD), heart failure, or coronary artery disease and need a little extra attention and support.
  • Future Moms – This program gives expecting moms support and guidance from registered nurses for a healthy pregnancy and a safe delivery.
  • 24/7 NurseLine – You have access to registered nurses wherever you are, whenever you need them. The nurses can answer questions you have about your health and help you decide where to go for care.
  • Blue Distinction Centers/Blue Distinction Centers+ ‒ Blue Distinction Centers and Blue Distinction Centers+ can give you peace of mind when making important decisions about major health care issues. Blue Distinction Centers and Blue Distinction Centers+ are facilities and providers known for their expert health care team, their high volume of procedures performed, and their track record for results in specialized care.

 

Anthem Discount Program

The Anthem Discount Program is an added benefit that comes with your Capital One medical plan. The program offers discounted health and wellness products and services, including fitness, weight management, and hearing services. You can use the discounts whenever you want, as often as you want. Log in to the Anthem website to view all available discounts (Under Learn About on the home page).

WINFertility

The WINFertility Program is available to help associates receive the highest quality care for fertility treatment services.

If you’re enrolled in a Capital One medical plan, WINFertility will assist in maximizing your insured benefit by explaining the most effective treatment options based on your individual treatment needs, helping you select a high quality, in-network provider, and managing your fertility prescriptions to ensure you get the most out of your fertility medication benefit. WINFertility offers help with provider selection, and provides access to WIN’s FertilityCoachSM nurses and savings opportunities. Most importantly, it works with you and your provider to authorize a treatment plan. WINFertility’s plans use evidence-based protocols and expert clinical advice, leading to an improved likelihood of successful outcomes.

Key features of the WINFertility Program include:

  • Help with provider selection to ensure you find a high quality, in-network provider.
  • 24/7 access to education and emotional support provided by WIN's FertilityCoachSM nurses, who have decades of experience with fertility patients.
  • Guidance to help increase efficient use of hormonal medications to avoid wastage and the risks of over-stimulation.
  • Improved likelihood of successful outcomes through WIN's evidence-based protocols, expert clinical advice, and treatment by qualified subspecialists.
  • Discounts for those who have exhausted their medical benefit, saving you 10-30% off retail prices for medical treatment and pharmacy products, along with financing options to make paying for treatment even more manageable.
  • Complimentary supply of folic acid to help prevent neural tube defects. The WINFertility Program will also connect you with the Anthem Future Moms program once you become pregnant to ensure a healthy pregnancy and the healthy birth of your baby.

Call 1-844-323-7539 or go to the WINFertility website for more information.

Cancer Concierge Program

The Anthem’s Cancer Concierge Program gives those with a cancer diagnosis access to extra support services, available clinical trials, and top cancer treatment centers to help you get the best care possible. Call Anthem Member Services at 1-844-390-4133 to get started.

 

Find a Doctor

Through Anthem Blue Cross Blue Shield, you have access to one of the largest national networks of doctors, hospitals, and other health care specialists who deliver quality care according to network standards at preferred rates for covered services. That means better savings and more choices for you.

In-network providers also offer the added convenience of automatically filing your claims, coordinating pre-authorizations for certain services, and there is no balance billing for you to worry about.

To search for in-network providers, log in to anthem.com/capitalone and select "Find a Doctor, Vision Provider, Hospital or Urgent Care." You can also call 1-844-390-4133 Monday through Friday from 8 a.m. to 11 p.m. ET to ask about in-network providers.

Don’t have a personal doctor? You should. Here’s why.

 

  • Better health. Getting the right health screenings each year can reduce your risk for many serious conditions. Preventive care is free, so there’s no excuse to skip it.
  • A healthier wallet. Having a doctor you can call helps you avoid costly trips to the emergency room and decide when you really need to see a specialist.
  • Peace of mind. Advice from someone you trust ... it means a lot when you’re healthy, but it’s even more important when you’re sick. Your personal doctor gets to know you and your health history and can help coordinate any care you need.
 

Money-Saving Tips

Being a good health care consumer can help you live well and save more. To do this, you need to take an active role in your health care, educating yourself about the options that best fit your needs, so that you can make informed decisions about all aspects of your well-being.

Get the most value from your medical benefits by following these tips for being a good health care consumer:

  1. Use in-network providers. Using in-network providers can save you money because they have agreed to charge a negotiated, discounted fee. If you use out-of-network providers, you may be charged more than your plan allows. If that happens, you’ll have to pay your coinsurance, as well as the difference between what your plan pays and what the provider charges. Anthem offers a broad network of providers, so before seeking care, make sure your provider is in-network.
  2. Keep up with preventive care. Be sure to get your recommended preventive health care, such as annual physicals, well-woman visits, and age-appropriate screenings. Preventive care helps you stay healthy and can detect any illnesses before you experience symptoms. When you see an in-network provider, there is no cost to you.
  3. Set aside tax-free dollars. Contributing to a Health Care Flexible Spending Account (FSA) is easy and saves you money on medical expenses for you and your family. The money you and the company contribute to your Health Care FSA will be available on January 1.
  4. Shop smart for prescriptions. Ask your doctor or pharmacist about generic medications and be sure to check CVS Caremark’s preferred drug list when you are prescribed a brand-name medication. If you take a maintenance medication, you will save money by filling your prescription for 90 days through mail order or CVS pharmacies.
  5. Take advantage of the Be Well Rewards Program. It offers valuable resources to help you improve your health, which could prevent the need for costly care. Plus, you’ll earn rewards when you participate in wellness activities!
  6. Be proactive with your health. When you have a health need, don’t delay seeking care. Schedule a visit with your primary care physician (PCP) to discuss your health concerns. It’s free when you see an in-network provider.
  7. Use telemedicine for non-urgent care. Visits through LiveHealth Online, the Be Well Health Centers, or virtual visits with your regular doctor are either low or no cost options.
Telemedicine Doctor’s office Urgent care clinic Emergency room
Use it for
A common, non-emergency medical issue that can be diagnosed by phone or online A condition that doesn’t need immediate attention and can wait until the next day A condition that needs immediate care but is not life- or limb-threatening A life-threatening or potentially crippling condition that needs immediate attention
Examples
  • Colds and allergies, flu/cough
  • Ear infections, pink eye, rashes
  • Behavioral health
  • Sore throat, fever
  • Routine exam, screening
  • Checkup, vaccine, prescription refill
  • Broken bone, severe sprain or strain
  • Cut requiring stitches
  • Anxiety attack
  • Sudden weakness, dizziness, or loss of consciousness
  • Significant loss of blood
  • Chest pain, difficulty breathing
Cost
You pay nothing You pay nothing You pay: $$ You pay: $$$
Find it
Go to LiveHealth Online or Be Well Health Centers Call your primary care physician (PCP) or search for an in-network provider on the Anthem website Locate urgent care centers near you Call 911 or search online for the nearest hospital
 

Health Care 101

Health care can be confusing. Here’s a quick explanation of some common terms that will make it easier for you to understand your Capital One health care benefits.

  • Contributions – This is what you pay from your paycheck to have coverage; often called “premiums.”
  • Deductible – This is the amount you pay in health care expenses before the plan starts paying a portion of your costs. For example, if your plan deductible is $1,000, you pay your health care bills in full until your expenses reach $1,000. Then you’ve met the deductible. Remember, services for which you pay a co-pay don’t apply towards your deductible.
  • Coinsurance – After you meet the deductible, coinsurance begins. This is the percentage of the cost you pay, and the plan pays the rest. For example, your coinsurance might be 20% and the plan pays 80%.
  • Co-pay – This is a flat fee you pay for doctor’s office visits and prescriptions; the deductible doesn’t apply.
  • Out-of-Pocket Maximum – This is the most you’ll have to pay out-of-pocket for health care in a year. The out-of-pocket maximum includes your deductible, coinsurance, and co-pays. It does not include your contributions, any amounts balanced billed by your providers, or services not covered by your plan. If you reach this amount, the plan starts paying 100% of your costs.
  • In-network/Out-of-network – Each health plan establishes a network of providers. You can see any doctor you want (either in or out of the network), but you’ll pay less if you go to providers who are in your plan’s network. Providers who belong to the network have agreed to charge a negotiated, discounted fee, which saves you money. If you use out-of-network providers, you may be charged more than your plan allows. If that happens, you’ll have to pay an higher deductible and coinsurance, as well as the difference between what your plan pays and what the provider charges. Anthem offers a broad network of providers, so before seeking care, make sure your provider is in-network.