Medical
Xavier offers two health insurance plans through Anthem. You choose the plan that is best for you and your family. Option 1 is the Traditional PPO and Option 2 is the High Deductible Health Plan (HDHP) with a Health Savings Account. Both plans include pharmacy coverage. Pharmacy copays and co-insurance do apply to the dedcutible and out-of-pocket maximum.
Within both plans are three tiers of coverage. Tier 1 and 2 are both in-network coverage while Tier 3 is out-of-network coverage. Tier 1 offers the best discounts and a lower deductible/co-insurance. Tier 2 offers moderate discounts and a slightly higher deductible/coinsurance. Below you will find the in-network coverage (Tier 1 and Tier 2) details:
| PPO Tier 1 | PPO Tier 2 | HDHP Tier 1 | HDHP Tier 2 | |
| Deductible | $750 single / $1,500 family | $1,250 single / $2,500 family | $3,300 single / $6,400 family | $3,500 single / $7,000 family |
| Co-insurance | 90%/10% | 80%/20% | 90%/10% | 80%/20% |
| Out-of-Pocket Maximum | $2,000 single / $4,000 family | $2,000 single / $4,000 family | $4,000 single / $8,000 family | $4,000 single / $8,000 family |
| PCP/Specialist Office Visit | $20/$40 | $20/$40 | Ded. then 10% | Ded. then 20% |
| Inpatient Hospital | Ded. then 10% | Ded. then 20% | Ded. then 10% | Ded. then 20% |
| Outpatient Hospital | Ded. then 10% | Ded. then 20% | Ded. then 10% | Ded. then 20% |
| Emergency Room | $150 copay | $150 copay | Ded. then 10% | Ded. then 20% |
| Urgent Care Facility | $35 copay | $35 copay | Ded. then 10% | Ded. then 20% |
Use these instructions to find the Tier of your provider or facility.
Summary of Benefits
Both Anthem plans cover preventative care, screenings, and immunizations as well as preventative care for chronic conditions (per IRS guidelines) at 100% with in-network providers. For information on other care and services, review the following:
Summary of Benefits - PPO
Summary of Benefits - HDHP
Benefit Booklet - PPO
Benefit Booklet - HDHP
Anthem Contact Information
(833) 952-2042
www.anthem.com
Group Number
PPO - OH2061M016
HDHP - OH2061M017
Sydney Health
Use Anthem’s Sydney App to find which tier your providers are in, check costs, review benefits and view/email your ID card. The app is available for download on iOS and Android phones. Need help or have questions? Call (844) 714-6012.
Travel Coverage
The Anthem BlueCard PPO Program provides access to care across the U.S. as well as internationally. View for more on the BlueCard PPO Program or call (844) 714-6012. In-network providers will submit the claim on your behalf. With out-of-network providers, you may need to submit your own international claim form.
Pharmacy (New for 2025)
Beginning in 2025, pharmacy coverage has been carved out from Anthem to a new Pharmacy Benefit Manager, ARORx (Alternative Reimbursement Opportunties for Rx) through EVO. ARORx focuses on high-cost, specialty medications (>$400 generic and >$1,000 name brand) which means members receive qualified high-cost medications for free or at a low cost by using pharmacy assistance programs offered by drug manufacturers or international fill options primarily through Canada. The ARORx pharmacy card is separate from the Anthem medical card. Be sure to present your pharmacy card when filling prescriptions.
| Tier | PPO (30/90 day copays) | HDHP (coinsurance) |
| 1 - Generic | $15/$30 | Deductible then 10% |
| 2 - Brand | $40/$100 | Deductible then 10% |
| 3 - Non Preferred Brand | $60/$150 | Deductible then 10% |
| 4 - Speciality** | 25% up to $250 (30 day-supply) | Deductible then 10% |
**For Speciality under the PPO and HDHP - it is a $0 copay when paid through international procurement or manufacturer program.
Maintenance medications and medication for acute illness or injury can be filled at any retail pharmacy. ARORx partners with Kroger for mail order pharmacy. ARORx also provides the availability to fill a 90-day supply of medications at most retail pharmacies; mail order is not required.
ARORx Contact Information
(833) 306-4092
Samaritan Fund Program (New for 2025)
Beginning in 2025, Xavier has partnered with the Samaritan Fund Program. This program helps support those who have serious medical conditions or high-cost medications that are a financial burden, even with insurance in place. All Xavier employees and their family members who are enrolled in the University's medical plan are eligible to apply for assistance. Those accepted receive an individual health insurance plan combined with financial assistance from the SFP resulting in little to no out-of-pocket costs for insurance (this includes premiums, co-pays and deductibles). Those not accepted reamin on the University's Anthem medical plan.
How Does It Work?
Employees who wish to apply should complete and submit the SFP HIPAA form no later than December 1, 2024. A representative from the SFP reaches out to discuss the program and, if eligible, select an individual medical insurance plan that meets your needs. After an acceptable plan is found, a formal application is completed. If accepted, the SFP helps obtain the new insurance and set up the Samaritan Fund Program to take care of expensese associated with medical care.
Samaritan Fund Program Contact
1-866-764-9290
service@samaritanfundprogram.com