For Active Employees and non-Medicare Retirees Effective July 1, 2024

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 $20
Office visit with a specialist who participates in the Anthem network $40
Visit to a participating walk-in clinic (PDF) $25
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 $600 $3,000 $1,200 $6,000
Coinsurance rate - participating provider 10% 40% 10% 40%
Annual maximum out-of-pocket expense
(deductible + coinsurance + health copay)
$2,000 $5,000 $4,000 $10,000

Prescription Coverage

Medication Category Up to 30-Day Supply
Copay Amount Per Prescription
Up to 90-Day Supply
Copay Amount Per Prescription
Generics $10 $15
Preferred brand-name $30 $45
Non-preferred brand name $45 $70
Specialty 25% coinsurance up to $150 25% coinsurance up to $225
Lifestyle $50 $75

To Register for Capital Rx -

1.) Visit

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

State of Maine Statute: Title 5 285, 285-A and 286