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OPERATING ENGINEERS
TRUST FUNDS

Health and Welfare Benefit Summaries

  • Covered Features

    Anthem HMO is one of the three medical plans available to eligible participants in certain areas of California.
  • Choice of Providers

    Must use only Anthem HMO Health Plan Providers
  • Plan Maximums

    No plan maximum
  • Out-of-Pocket Maximums

    $1,500/individual
    $3,000/for 2 family members
    $4,500/for 3+ family members
  • Doctor Visits or Hospital

    Your co-payment is:
    $25 per visit
    No Charge
  • In-Patient Hospital Co-Pay

    Your co-payment is $250 per confinement.
    No charges for surgeon or assistant surgeon.
  • Anesthesia

    $35 co-pay per occurrence
  • Emergency Room Co-Pay

    Your co-pay is $100 for bona fide emergencies. Waived if admitted.
  • Ambulance Services

    $50 co-pay per trip.
  • Outpatient Lab and X-Ray

    No charge
  • Preventive Health Care 
    (Routine check-ups, well baby care, immunizations, preventive screenings, etc.)

    100% preventive care coverage is available in accordance with the Affordable Care Act. Click here for more information.
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  • Prescriptions

    Co-Payment for Generic Co-Payment for Name Brand
    Retail Pharmacy on Recommended Drug List $10 per 30-day supply $30 per 90-day supply
    Mail Service Pharmacy on Recommended Drug List $20 per 90-day supply $60 per 90-day supply
    Retail Pharmacy not on Recommended Drug List $30 per 30-day supply 50% per 90-day supply
    Mail Service Pharmacy not on Recommended Drug List $60 per 30-day supply 50% per 90-day supply
  • Mental Health and Substance Abuse Treatment Benefits

    $250 co-pay per admission.
    Detoxification covered for Substance Abuse.
  • Contact Information

    Website: www.anthem.com
    Phone: (800) 522-0088

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