For Active Employees and non-Medicare Retirees Effective July 1, 2025
Please note: There are some exceptions to the tables below; please see the Benefits Summary for a more complete explanation of health coverage.
Health Coverage
| Type of Visit or Test | Copay Amount |
|---|---|
| Office visit with a primary care doctor who participates in the Anthem network | $30 |
| Office visit with a specialist who participates in the Anthem network | $50 |
| Visit to a participating walk-in clinic (PDF) | $40 |
| Visit to an emergency room (copay is waived if admitted to in-patient status) | $300 |
- Office visit copay is waived for preventive visits
- No referral required by the insurance plan for visits to specialist or walk-in clinic
| Out-of-Pocket Expense | Individual | Family | ||
|---|---|---|---|---|
| In-Network | Out-of-Network | In-Network | Out-of-Network | |
| Calendar year deductible | $800 | $3,000 | $1,600 | $6,000 |
| Coinsurance rate - participating provider | 15% | 40% | 15% | 40% |
| Annual maximum out-of-pocket expense (deductible + coinsurance + health copay) |
$3,750 | $7,500 | $5,000 | $10,000 |
Prescription Coverage
| Medication Category | 30-Day Supply | 90-Day Supply |
|---|---|---|
| Generics | $25 | $50 |
| Preferred brand-name | $50 | $100 |
| Non-preferred brand name | $80 | $160 |
| Specialty | 25% coinsurance up to $150 | 25% coinsurance up to $200 |
| Mail Order | 1.5x the Retail Co-Pay | 2x the Retail Co-Pay |
To Register for Capital Rx -
1.) Visit https://app.cap-rx.com/register
2.) Fill in your personal information and click VALIDATE
3.) Complete credentials form and click CREATE ACCOUNT
4.) Check your email and locate the verification code sent from Capital Rx
5.) Enter the code provided to validate your email address
Registration is complete! You can now login using your credentials established during registration