Compare Medical Plans

The County of San Luis Obispo offers 5 different types of medical plans for different needs and budgets. Every plan includes free preventive care from network providers to check that you’re staying healthy. Each plan provides its own network of doctors, hospitals and labs. The differences are in cost, flexibility and access to care. For the most current plan information, please review the current Employee Benefits Brochure. 

Anthem PPO Plans (Preferred Provider Organizations)

Diagram of How PPO plans work: You can go directly to a doctor or specialist. You don't need a referral. You pay less for services and specialists inside the PPO network. You pay more for services and specialists outside the PPO network.

A PPO gives you flexibility and choice, but you might pay more. You can go to any doctor without a referral, but you will pay more of the cost if they are not in the plan's network. You’ll need to meet an annual deductible before the plan starts to pay.

Anthem PPOs coordinate with Express Scripts for your pharmacy benefits. 

The County offers three PPO plans with differing premium costs, provider networks, and out of pocket maximums. Please review the table below for a comparison.

County PPO Plan Comparison
  Anthem Select Anthem Choice Anthem Care
Network Narrow Network of Providers Larger Network of Providers Larger Network of Providers
Out of Pocket Maximum Higher Out of Pocket Maximum Higher Out of Pocket Maximum Lowest Out of Pocket Maximum
Premium Costs Lowest Premiums Higher Premiums Highest Premiums
PPO Summary of Benefits and Evidence of Coverage
  Anthem Select Anthem Choice Anthem Care
Summary of Benefits 2023 PPO Select Summary of Benefit 2023 PPO Choice Summary of Benefit 2023 PPO Care Summary of Benefit
Evidence of Coverage 2022 PPO Select Evidence of Coverage 2022 PPO Choice Evidence of Coverage 2022 PPO Care Evidence of Coverage

Unsure what some of these terms mean for you and your dependents? Visit the Choosing a Medical Plan page to learn more about these key terms and other considerations. 

Anthem EPO Plan (Exclusive Provider Organizations)

Diagram of How EPO plans work: You do not need to select a PCP. You can go directly to a doctor or specialist in the EPO network without a referral. Doctors and services in the EPO network. Not covered: any doctors you see or services you get outside the network, except emergency and urgently needed care.

An EPO gives you more predictable costs but less flexibility. Out-of-network care is not covered except in an emergency. You pay a fixed copay for most services.

The Anthem EPO plan coordinates with Express Scripts for your pharmacy benefit. 

EPO Summary of Benefits and Evidence of Coverage
Anthem EPO
Summary of Benefits 2023 EPO Summary of Benefits
Evidence of Coverage 2022 EPO Evidence of Coverage

Anthem HDHP (High Deductible Health Plan)

You're in the driver’s seat when it comes to managing your medical care and finances. A HDHP is the only plan with a Health Savings Account (HSA) funded by your own tax-free dollars and any employer contributions. The HSA helps you pay your deductible and other healthcare expenses. HDHPs have higher annual deductibles and out-of-pocket maximum limits than other PPO plans. You can visit any provider, but if you stay in-network, you’ll be able to save more of your HSA dollars for future healthcare needs.

HDHP Video Thumbnail

With a HDHP, the annual deductible must be met before plan benefits are paid for services, other than in-network preventative care services, which are 100% covered. Once your annual out-of-pocket expenses for covered services from in-network providers, including deductibles, copayments, and coinsurance, reaches the pre-determined out-of-pocket limit, the plan pays 100% of the allowable amount for the remainder of the calendar year. You are required to meet your medical annual deductible for both medical expenses and prescription drugs before the plan's coinsurance cost sharing begins. This means you pay the fully cost of your medication until you reach your deductible, not a co-pay. 

Another key difference between the HDHP and PPOs/EPOs is that under a HDHP, the deductible is aggregate, not embedded. Lastly, note that the HDHP has a separate deductible for in-network services and out-of-network services, so it is advised you try and stay in-network as much as possible. 

The HDHP plan coordinates with CareIonRx for your pharmacy benefit. 

HDHP Summary of Benefits and Evidence of Coverage
Anthem High Deductible Health Plan (HDHP)
Summary of Benefits 2023 HDHP Summary of Benefits
Evidence of Coverage 2022 HDHP Evidence of Coverage

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