Medical

Choosing the right plan supports your physical and emotional health, as well as your financial well-being. 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: a Consumer-Driven Health Plan (CDHP) and two PPO 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 or enroll, go to the Benefits Application in Workday.

2024 medical plans

Explore the medical plan details on this page along with reviewing the interactive brochures below.

Keep in mind:

You are automatically enrolled in an HSA when you enroll in the CDHP.
You are eligible to enroll in a Health Care FSA if you are enrolled in a PPO medical plan OR if you are not enrolled in a Capital One medical plan.

We are committed to supporting our LGBTQ+ associates and their families, so we are making it easier than ever to find out more about Capital One benefits that support the physical, emotional, financial and social well-being of these communities. Check out the LGBTQ+ Benefits Guide to find a benefit highlights guide tailor-made for our LGBTQ+ associates and their loved ones.

All our medical plans provide:

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 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.
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.

Side-by-Side Medical Plan Comparison

As you compare the available plan options, it’s important to note the key distinctions between them. Note that the per paycheck cost of the Basic PPO and the CDHP are the same. Check out Cost of Coverage for more details.

First, here’s a breakdown of some key features of the CDHP and PPOs:

How the deductible works

Basic PPO and Enhanced PPOs	CDHP
Lower Deductibles: The deductible only applies to certain medical expenses and is lower compared to the CDHP. Which Services Don’t Apply to the Deductible: The PPO plans cover many items and services before the deductible is met, but co-pays for office visits and prescription drugs are not subject to the deductible. When You Cover Dependents: If you cover dependents, the family deductible can be met by any combination of family members, but an individual is only responsible for their own individual amount.	Higher Deductible: The deductible applies to both medical and prescription drug expenses. The deductible is higher compared to the PPOs. Full Family Deductible: If you cover any dependents, the full family deductible must be met before the plan will begin to pay benefits for any one person. The individual deductible will only apply if you enroll in associate-only coverage.

Basic PPO and Enhanced PPOs

CDHP

Lower Deductibles: The deductible only applies to certain medical expenses and is lower compared to the CDHP.
Which Services Don’t Apply to the Deductible: The PPO plans cover many items and services before the deductible is met, but co-pays for office visits and prescription drugs are not subject to the deductible.
When You Cover Dependents: If you cover dependents, the family deductible can be met by any combination of family members, but an individual is only responsible for their own individual amount.

Higher Deductible: The deductible applies to both medical and prescription drug expenses. The deductible is higher compared to the PPOs.
Full Family Deductible: If you cover any dependents, the full family deductible must be met before the plan will begin to pay benefits for any one person.

The individual deductible will only apply if you enroll in associate-only coverage.

How the out-of-pocket maximum works

Basic PPO and Enhanced PPOs	CDHP
Individual Out-of-pocket Maximum: If you cover any dependents, one person can meet the individual out-of-pocket maximum and the plan will cover expenses for that one person’s expenses at 100% for the remainder of the calendar year. Once the entire family out-of-pocket maximum is met, the plan will pay 100% for all family members.	Full Family Out-of-pocket Maximum: If you cover any dependents, the full family out-of-pocket maximum must be met before the plan will begin to pay benefits at 100% for the remainder of the calendar year. One person or a combination of family members can satisfy the full amount. The individual out-of-pocket maximum will only apply if you enroll in associate-only coverage.

Now, here's an overview of how the three medical plans pay benefits for medical expenses.

	CDHP		Basic PPO		Enhanced PPO
	In-Network	Out-Network	In-Network	Out-Network	In-Network	Out-Network
Capital One HSA Contribution*	$500 individual / $1,000 if you cover dependents		Not eligible for an HSA		Not eligible for an HSA
Annual Deductible (individual / family)	$2,000 / $3,200	$4,000 / $6,000	$1,000 / $2,000	$3,000 / $6,000	$500 / $1,000	$1,500 / $3,000
Annual Out-of-Pocket Maximum (individual / family)	$3,400 / $6,400	$6,800 / $12,800	$4,000 / $8,000	$10,000 / $20,000	$3,000 / $6,000	$6,000 / $12,000
Coinsurance	20%	40%	30%	50%	20%	40%
Preventive Care (Covered at 100%)	No charge	No charge	No charge	No charge	No charge	No charge
Office Visits (Primary Care)	You pay 20% after deductible	You pay 40% after deductible	No charge	You pay 50% after deductible	No charge	You pay 40% after deductible
Office Visits (OBGYN)	You pay 20% after deductible	You pay 40% after deductible	$30 co-pay	You pay 50% after deductible	$20 co-pay	You pay 40% after deductible
Office Visits (Specialist)	You pay 20% after deductible	You pay 40% after deductible	$60 co-pay	You pay 50% after deductible	$40 co-pay	You pay 40% after deductible
Behavioral Health (Psychiatrist & Psychologist)	You pay 20% after deductible	You pay 40% after deductible	$30 co-pay	50% coinsurance	$20 co-pay	40% coinsurance
LiveHealth Online Telemedicine Visit	You pay 20% after deductible	N/A	No charge	N/A	No charge	N/A
Be Well Health Center Visit	No charge for preventive care; $35 co-pay for all other care	N/A	No charge	N/A	No charge	N/A
Urgent Care Visit	You pay 20% after deductible	You pay 40% after deductible	$60 co-pay	You pay 50% after deductible	$40 co-pay	You pay 40% after deductible
Emergency Room Visit*	You pay 20% after deductible	You pay 20% after deductible	You pay 30% after deductible	You pay 30% after deductible	You pay 20% after deductible	You pay 20% after deductible

*Non-emergency use of the emergency room is not covered.

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

CDHP with HSA

The Consumer-Driven Health Plan (CDHP) is a type of medical plan with low premiums, a higher deductible, and a tax-free Health Savings Account (HSA), that gives you the flexibility to spend or save your health care dollars.

The CDHP provides the same comprehensive medical coverage as both PPOs; however, the plan has a higher deductible that you’ll need to meet before the plan begins to pay benefits.

You’ll automatically be enrolled in a Health Savings Account (HSA)* when you enroll in the CDHP. As an added bonus, Capital One will contribute to your HSA — $500 for individual coverage and $1,000 if you cover any dependents. You can also contribute pre-tax dollars up to the annual IRS maximum and then use these funds to help pay for current medical expenses, or save them for the future.

Please note: HSA contributions are prorated for mid-year enrollments. While enrolled in the plan, Capital One will contribute the following per pay period: $19.23 for individual coverage, $38.46 when you cover a dependent.

*Per the USA PATRIOT Act, you may be asked to provide additional information in order for your HSA to be established. If you do not provide the required information to open your account (or are not able to open an account), you forfeit the company HSA contributions.

With the CDHP, you can see any provider you wish, but you will save money when you stay in network.

You pay the plan contribution from your paycheck to have coverage.

HSA

You can set aside tax-free money from your paycheck (and will receive Capital One's contributions) to help cover your costs — now, or in the future.

Deductible

You pay 100% of your medical and prescription costs until you meet the annual deductible.*

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%.

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.

Basic PPO & Enhanced PPO

The Basic PPO offers balance by allowing you to keep more of your paycheck, with lower contributions and a moderate deductible. Compared to the Enhanced PPO, you'll pay more with this plan when you need care because of the moderate deductible, coinsurance, and co-pays. You can see any provider you wish, but you will save money when you stay in network.

The Enhanced PPO offers predictability, with higher per paycheck contributions and a lower deductible. With this plan, you can see any provider you wish, but you will save money when you stay in network.

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

Co-pay

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

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.

Coinsurance

After meeting the deductible, you and the plan share the cost of certain services, with the Basic PPO plan paying 70% in-network and you only pay 30%, and the Enhanced PPO plan paying 80% and you only pay 20%.

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.

Prescription Drugs

When you enroll in a Capital One medical plan, you automatically receive prescription drug benefits through CVS Caremark. Your CVS Caremark information can be found on your Anthem Blue Cross Blue Shield ID card.

The cost of your prescription drugs under each medical plan depends on the tier of the medication — generic/Tier 1 Brand, preferred brand, non-preferred brand, or specialty.

All prescription benefit managers 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.

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.

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.

Non-preferred drugs

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

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.

Prescription costs

Your prescription drug costs will vary depending on your medical plan choice, the type of medication, and the way you fill your prescription.

Prescription Drug Coverage (In-network Only)
	CDHP	Basic PPO	Enhanced PPO
Retail – up to 30-day Supply (Must use an in-network pharmacy)	You pay 20% after the deductible	Generic – $10 co-pay Preferred – $50 co-pay Non-preferred – $100 co-pay	Generic – $10 co-pay Preferred – $50 co-pay Non-preferred – $100 co-pay
Mail Order or CVS – 90-day Supply	You pay 20% after the deductible	Generic – $20 co-pay Preferred – $100 co-pay Non-preferred – $200 co-pay	Generic – $20 co-pay Preferred – $100 co-pay Non-preferred – $200 co-pay
*Specialty 30-day purchased through CVS Caremark Specialty Program**	You pay 20% after the deductible	Generic – $40 co-pay Preferred – $100 co-pay Non-preferred – $200 co-pay	Generic – $40 co-pay Preferred – $100 co-pay Non-preferred – $200 co-pay

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

**In states where Maintenance Choice is not available, an 84+ days retail prescription will be dispensed.

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 and/or lower side-effect risk profile medications first.

Be Well Pharmacy Discount Program

The Be Well Pharmacy Discount Program is available for those who are enrolled in a PPO, have chronic conditions, and engage with Anthem nurses. If you are managing a chronic condition, such as diabetes, hypertension, high cholesterol, COPD/asthma or congestive heart failure, contact the Anthem Nurse Line to see if you qualify for the discount. 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).

The Be Well Pharmacy Discount Program is not available to individuals enrolled in the CDHP.

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.

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 Care → Find 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.

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:

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.
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.
Set aside tax-free dollars. If you are enrolled in a PPO or not enrolled in a Capital One medical plan, you are eligible to contribute to a Health Care Flexible Spending Account (FSA). This 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, of the date you enroll, whichever is later. For CDHP enrollees, you can contribute to a Health Savings Account (HSA), then use your HSA to accumulate tax-free money you can spend on eligible medical, prescription, dental, and vision expenses anytime — even in retirement.
Receive free money. Take advantage of the Capital One contribution to your Health Savings Account (HSA) when you enroll in the CDHP. Capital One will automatically contribute up to $500 if you enroll in individual coverage or up to $1,000 if you enroll in family coverage, to your HSA each year. You’ll receive Capital One’s contribution with each paycheck that you are enrolled ($19.23 for individuals, $38.46 for families). Capital One also provides funding to the Health Care FSA. You’ll receive up to $500 ($19.23 per paycheck) if you enroll in a Health Care FSA and make the minimum $500 contribution. This company money counts toward the annual IRS maximum contribution allowed for Health Care FSAs—$3,050 in 2024.
Visit a CVS or participating pharmacy when filling a prescription. If you take ongoing maintenance medication, you will save money by filling your prescription for 90 days through CVS Caremark’s mail order program or a local CVS pharmacy.
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!
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.
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.

Live Health Online-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
PPOs: You pay nothing CDHP: You pay $	PPOs: You pay nothing CDHP: You pay $$	PPOs: You pay $ CDHP: You pay $$	PPOs: You pay $$$ CDHP: You pay $$$$
Find it
Go to LiveHealth Online or Be Well Health Centers* *Associates not enrolled in PPO will pay $35.	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 — let’s start with the basics! Here’s a quick explanation of some common terms that will make it easier for you to understand your Capital One health care benefits.

Deductible

the amount you pay in health care expenses before the plan starts paying a portion of your costs

Coinsurance

after you meet the deductible, coinsurance begins – this is the percentage of the cost you pay, and the plan pays the rest

Co-pay (PPOs only)

the flat fee you pay for doctor’s office visits and prescriptions; co-pays do not count towards your deductible

In-network/Out-of-network

you can see any doctor you want, but you’ll pay less if you go to providers who have agreed to be in your plan’s network

Out-of-Pocket Maximum

the most you’ll have to pay for health care in a year; if you reach this amount, the plan pays 100% of in-network costs for the remainder of the calendar year

Contributions

what you pay from your paycheck to have coverage; often called “premiums”

Transparency in Coverage Rules

The federal Transparency in Coverage Rules require certain group health plans to publicly disclose price and cost-sharing information. This information includes in-network provider rates as well as historical out-of-network allowed amounts and billed charges for covered items and services, which is to be shared via two separate machine-readable files (MRFs). The machine-readable files are formatted to allow researchers, regulators and application developers to more easily access and analyze data. The MRFs for Capital One's medical plan carrier, Anthem, can be found at https://www.anthem.com/ca/machine-readable-file/search/.

Medical

Overview

2024 medical plans

Consumer-Driven Health Plan (CDHP) + Health Savings Account (HSA)

Preferred Provider Organizations (PPO) + Optional Health Care Flexible Spending Account (Health Care FSA)

Keep in mind:

Introducing a new LGBTQ+ Benefits Guide

Key features at a glance

Get to know your plan

Save money

Access health resources

Side-by-Side Medical Plan Comparison

CDHP with HSA

How the CDHP works

Basic PPO & Enhanced PPO

How the Basic PPO & Enhanced PPO plans work

Prescription Drugs

Drug tiers

Prescription costs

Be Well Pharmacy Discount Program

Programs & Resources

Find a Doctor

Money-Saving Tips

Health Care 101

Transparency in Coverage Rules

Medical

Overview

2024 medical plans

Consumer-Driven Health Plan (CDHP) + Health Savings Account (HSA)

Preferred Provider Organizations (PPO) + Optional Health Care Flexible Spending Account (Health Care FSA)

Keep in mind:

Introducing a new LGBTQ+ Benefits Guide

Key features at a glance

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

Do you have a PCP?

Get to know your plan

Save money

Access health resources

Side-by-Side Medical Plan Comparison

How the deductible works

How the out-of-pocket maximum works

CDHP with HSA

How the CDHP works

To help you out, you get your own tax-free savings account.

We’ll jumpstart your savings with a contribution to your HSA!

Basic PPO & Enhanced PPO

How the Basic PPO & Enhanced PPO plans work

Save money with an FSA ― and get up to a $500 contribution from Capital One!

Be sure to plan your FSA contributions carefully.

Prescription Drugs

Drug tiers

Prescription costs

Options for filling your prescription

Reminder about specialty medications

Be Well Pharmacy Discount Program

Pharmacy Advisor Counseling

Programs & Resources

LiveHealth Online

Autism Coverage

Anthem Health Programs

Anthem Discount Program

WINFertility

Cancer Concierge Program

Monument Alcohol Use Support

Hinge Health – Digital Exercise Therapy

Find a Doctor

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

Money-Saving Tips

Health Care 101

Transparency in Coverage Rules