Medical

Your medical plans for 2020 are:

  • Basic
  • Enhanced
  • Premium
LEARN ABOUT YOUR PLANS

All of the plans are administered by Anthem Blue Cross Blue Shield, cover the same medical services and use the same provider network. Enrollment in the prescription plan is included as part of your enrollment in the medical plan, and pharmacy coverage is the same for all 3 medical plans. However, financial aspects—such as deductible amounts, co-insurance levels and out-of-pocket maximums—differ. In general, as you increase the plan level (from Basic to Enhanced or from Enhanced to Premium), the bi-weekly per-paycheck premiums increase, while the out-of-pocket costs for services you receive decrease.

View a comparison chart of your plan choices.

The SBC notices provide plan details in a format designed to help you compare your options and make informed decisions about your health insurance. You can also see the SBCs using the links below:

CHOOSING A MEDICAL OPTION

When you think about what health plan is right for you, it’s important to look at the full picture – what you pay from your paycheck and what you’ll pay when getting care. Depending on which plan you choose and who you cover, your costs for 2020 may be increasing or decreasing. However, Capital One continues to cover the majority (80%, on average) of associates’ health care costs. As you consider your choices for 2020 benefits, we encourage you to:

  • Look at the whole picture, meaning it’s not just about how much you pay from your paycheck.
  • Think about how much coverage you need for the upcoming year.
  • Consider when and how you pay for care. Would you prefer to pay more out of your paycheck and less if and when you need care, or are you ok with paying less per paycheck and more if and when you go to the doctor?

You shouldn't pay more for more coverage than necessary. That's why we offer the Medical Plan Selector Tool, which gives you a personalized forecast of your costs during Open Enrollment, so you pick the right amount of coverage for your needs.

No-Cost Preventive Care AND PCP Visits

Regular preventive care can help you identify health risks before they lead to more serious medical issues. To encourage regular routine physical exams, screenings and immunizations, the Capital One medical plans pay the full cost of covered preventive care—with no expense to you (when using an in-network provider)*. This includes the cost of preventive care office visits and any related preventive care lab services. Here's a list of preventive care services.

Free in-network Primary Care Physician (PCP) visits, for both preventive/wellness check ups and sick visits, even for non-preventive care, to ensure you can get the care you need, when you need it!

*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.

LiveHealth Online

Using LiveHealth Online, you can have a private and secure video visit with a board-certified doctor, licensed therapist or lactation counselor on your smartphone, tablet or computer with a webcam. It’s an easy way to get the care you need at home or on the go. Use LiveHealth Online 24/7 if you have pinkeye, a cold, the flu, a fever, allergies, a sinus infection or other common health condition. A doctor can assess your condition, provide a treatment plan and even send a prescription to your pharmacy, if it’s needed.

If you’re feeling anxious or having trouble coping on your own and need some support, you can have a video visit with a therapist or psychiatrist using LiveHealth Online. You can get help for anxiety, depression, grief, panic attacks and more.

Get started
Register or make an appointment at livehealthonline.com or on the phone at 1-844-784-8409 from 7 a.m. to 11 p.m., seven days a week. Evening and weekend appointments are available.

WALK-IN OR RETAIL CLINICS

Walk-in/retail clinics are often found in retail locations, like CVS Minute Clinics or Walgreens Health Clinics. There is no co-pay for services rendered at an in-network walk-in clinic. Walk-in clinics generally:

  • Have longer hours than most local doctors’ offices and are open weekends and holidays.
  • Are staffed by knowledgeable nurse practitioners or physician assistants who treat common illnesses and injuries, as well as provide sports and camp physicals and wellness screenings.
  • Have comparable quality to primary care offices, cost less and have higher patient satisfaction scores.
  • Are convenient to where the majority of our associates live or work. To find a walk-in clinic near you, log in to anthem.com/capitalone click on top left Menu, then select Find Care, then you can select Find a Doctor, Vision Provider, ER alternative, LiveHealth or Nurseline. Your network is already selected as BlueCard PPO. Scroll down and click on the type of care needed from the menu. Narrow your search by entering location, specialty need or using the Show More Options menu.

PAYING FOR NON-PREVENTIVE CARE

Network Office Visits and Routine Lab Services
You pay a set dollar amount (co-payment) for frequently used services like network doctor office visits. PCP visits, routine X-ray and lab services are covered at 100%. More complex tests and imaging such as PET and CT scans, MRIs and MRAs are subject to deductible and co-insurance.

Free in-network Primary Care Physician (PCP) visits
For both preventive/wellness check ups and sick visits, even for non-preventive care, your PCP visits are covered in-network at 100%. Make sure you designate a PCP early in the year.

Other Covered Care
You must first meet the individual or family calendar-year deductible before the plan begins paying for most non-routine care. After the deductible, you pay a percentage of the cost—or co-insurance—for most other care. (Note: copays, including prescription drug copays, do not count toward the deductible, but they do count towards the Out of Pocket maximum.)

  • When an individual meets the deductible, the plan begins paying benefits for that person.
  • When combined eligible expenses for covered family members reach the family deductible, the plan pays benefits for all covered family members. No additional individual deductible amounts are required that year.

Out-of-Pocket Maximum
You are protected from catastrophic medical expenses by the annual out-of-pocket maximum. Here's how it works: When your out-of-pocket expenses (deductible, co-insurance and co-pays) reach the out-of-pocket maximum, the plan pays the full cost for any covered care you receive for the rest of the year. Penalties and excess charges above the allowed amount do not count toward reaching your annual out-of-pocket maximum.

Gender Reassignment
Gender reassignment surgery is covered at the same level as other surgeries covered by the plans. Associated prescription drugs required for gender reassignment are also covered as other similarly situated drugs. Like other surgeries, pre-authorization from Anthem is required. This coverage reinforces Capital One’s commitment to diversity and our values.

Also Covered by the Medical Plan

  • Hearing aids are up to $2,000 per ear every 24 months

AUTISM COVERAGE

To help families living with autism, Capital One offers additional support under its 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. ABA therapy is covered at 100% billed charges under the plans. These services are subject to pre-certification through Anthem.
  • Speech Therapy, Occupational Therapy and Physical Therapy are covered with no dollar maximums, visit limits or age limits.

Consumer Medical

Get information from expert physicians to address your questions or uncertainty around any condition or treatment from back pain to surgery to other serious medical conditions. It’s available to all U.S. associates, including your family members (even if they aren’t enrolled in our plans or eligible dependents).

Here’s How It Works
You’ll be an assigned a doctor as a direct contact to lead you through the process.

Review is based on your medical information—collected with your consent—so recommendations are personalized for you.

You’ll get expert insights, highlighting opportunities to optimize treatment and addressing your questions about future care.

Ready to Get a Second Opinion? Call Consumer Medical's Virtual Second Opinion program and speak with a nurse at 1-888-361-3944 Monday–Friday, 8:30 a.m. – 11:00 p.m. ET to get started.

Anthem Nurse Programs

Through our health care benefits administrator Anthem, our associates have access to Anthem Nurse Programs:

  • 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, anytime. The nurses can answer any questions you have about your health and help you decide where to go for care.
Anthem Discount Program

The Anthem Discount Program is part of 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 anthem.com/capitalone to view all available discounts (Under Learn About on the home page).

Win Fertility

WINFertility Program will help associates receive the highest quality care for fertility treatment services.

For associates of the medical plan, WIN will assist in maximizing your insured benefit by explaining the most effective treatment options based on your individual treatment needs, helping select a high quality, in-network provider, and managing your infertility prescriptions to ensure you get the most out of your infertility medication benefit.

Key features of the WIN Fertility Program include:

  • Help with provider selection.
  • 24/7 access to education and emotional support provided by WIN's FertilityCoachSM Nurses with decades of experience with infertility 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.
  • For those who have exhausted their benefit, medical treatment and pharmacy savings of 10-30% off retail prices and financing options to make paying for treatment even more manageable.
  • Complimentary supply of folic acid to help prevent neural tube defects. The WIN Fertility programs will also connect you with the existing maternity program once you become pregnant to ensure a healthy pregnancy and the healthy birth of your baby.
Milk Stork

Milk Stork provides Capital One associates who are on U.S. business travel and are breastfeeding with everything they need to ship a day's supply of fresh milk home to their babies.

HOW MILK STORK WORKS

She Plans Her Trip: A mom orders her kits at milkstork.com. When she arrives at her hotel, there will be a package with all of the Milk Stork Kits she ordered for her trip. The kits are pharmaceutical-grade shipping coolers that provide her with everything she needs to ship or tote her milk home.

Pump & Pack: Available in two sizes: 34oz. and 72 oz., the coolers are easy-to-use with “push button” activation. There is no freezing required and no gel packs.

Ship or Tote: Pump & Ship coolers arrive preaddressed with FedEx Priority Overnight shipping labels. Pump & Totes arrive with a convenient tote.