Colorado Plan Benefits
With BlueAdvantage HMO, you get more of what you want – more choices, more convenience and more control. That’s a lot of more. And with Anthem, you get a dedicated, dependable partner to join you on your journey.
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Let's break down some more details of the BlueAdvantage HMO.
- You have to stay in network
- No referrals required
- No annual deductible
Pharmacy Benefits for BlueAdvantage HMO High Option
Prescription Drug Copays for 2022
Level 1 |
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|---|---|---|---|---|
| 30-Day Supply (Retail) | Yearly Cost 30-Day Supply (Retail) | 90-day Supply (Mail Order) | Yearly Cost 90-Day Supply (Mail Order) | |
| Tier 1 | $5 copay | $60.00 | $10 copay | $40.00 |
| Tier 2 | $60 copay | $720.00 | $150 copay | $600.00 |
| Tier 3 | $80 copay | $960.00 | $200 copay | $800.00 |
| Tier 4 | 25% of our allowance ($275 maximum per prescription) |
— | 90-day supply is not available | 90-day supply is not available |
Prescription Drug Copays for 2022 at Level Two - BlueAdvantage HMO High Option
Level 2 |
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|---|---|---|---|---|
| 30-Day Supply (Retail) | Yearly Cost 30-Day Supply (Retail) | 90-day Supply (Mail Order) | Yearly Cost 90-Day Supply (Mail Order) | |
| Tier 1 | $15 copay | $180.00 | N/A | N/A |
| Tier 2 | $70 copay | $840.00 | N/A | N/A |
| Tier 3 | $90 copay | $1,080.00 | N/A | N/A |
On the next page, choose Essentials Tier-4
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Let’s break down some details for the BlueAdvantage HMO HDHP Option
- You must stay in the network to receive care.
- You don’t need a referral for in-network providers.
- Comes with a health savings account (HSA) to help you pay out-of-pocket expenses.
Pharmacy Benefits for BlueAdvantage HMO HDHP Option
Prescription Drug Copays for 2022
Level 1 |
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|---|---|---|---|---|
| 30-Day Supply (Retail) | Yearly Cost 30-Day Supply (Retail) | 90-day Supply (Mail Order) | Yearly Cost 90-Day Supply (Mail Order) | |
| Tier 1 | $10 copay after calendar year deductible | $120.00 | $20 copay after calendar year deductible | $80.00 |
| Tier 2 | $40 copay after calendar year deductible | $480.00 | $100 copay after calendar year deductible | $400.00 |
| Tier 3 | $70 copay after calendar year deductible | $840.00 | $175 copay after calendar year deductible | $700.00 |
| Tier 4 |
20% of our allowance after calendar year deductible
($300 maximum per prescription) |
— | 90-day supply is not available | 90-day supply is not available |
Prescription Drug Copays for 2022 at Level Two - BlueAdvantage HMO HDHP Option
Level 2 |
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|---|---|---|---|---|
| 30-Day Supply (Retail) | Yearly Cost 30-Day Supply (Retail) | 90-day Supply (Mail Order) | Yearly Cost 90-Day Supply (Mail Order) | |
| Tier 1 | $15 copay after calendar year deductible | $180.00 | $20 copay after calendar year deductible | N/A |
| Tier 2 | $60 copay after calendar year deductible | $720.00 | $100 copay after calendar year deductible | N/A |
| Tier 3 | $90 copay after calendar year deductible | $1,080.00 | $175 copay after calendar year deductible | N/A |
| Tier 4 | Must use Specialty Pharmacy Only for Tier 4 | — | 90-day supply is not available | 90-day supply is not available |
On the next page, choose Essentials Tier-4
