A Simpler, More Predictable Healthcare Experience
Coupe Health is a copay-based medical plan with no deductible or coinsurance. Instead of meeting a deductible before the plan begins paying, you pay a set copay based on the care you receive and the provider you choose.
Through the Anthem Blue Cross and Blue Shield network, you can compare providers, understand your cost before receiving care, and choose providers based on both quality and cost.
Know Your Cost Before You Go
Predictable Costs
No deductible and no coinsurance. Copays are based on the service and, for certain services, the provider you choose.
Quality Choice
Access doctors, specialists, hospitals, and other healthcare providers through the Anthem Blue Cross and Blue Shield network.
Easy-to-Use Tools
Use the Coupe member portal to compare providers, review costs, access plan information, and manage your healthcare.
Need Help? Start with your Health Valet.
Not sure where to go for care or how your benefits work? A Coupe Health Valet can help you:
- Find providers
- Understand your benefits
- Compare care options
- Navigate your healthcare needs
Health Valet Concierge
When calling, let the representative know you’re with BrightSpring Health Services.
Medical Rates
| Monthly | Coupe |
|---|---|
| Employee Only | $442.03 |
| Employee + Spouse | $1,474.92 |
| Employee + Child(ren) | $798.92 |
| Family | $1,822.20 |
Benefits at a Glance
The Coupe Health plan has no deductible or coinsurance. Instead, you pay copays based on the service you receive. For certain services, your copay also varies based on the provider’s rating.
| Service | Preferred Providers | Standard Providers | Non-Preferred Providers | Out-of-Network Providers |
|---|---|---|---|---|
| Deductible | $0 | $0 | $0 | $0 |
| Individual Out of Pocket Maximum | $8,000 | $8,000 | $8,000 | $8,000 |
| Family Out of Pocket Maximum | $16,000 | $16,000 | $16,000 | $16,000 |
| Urgent Care | $115 | $115 | $115 | $115 |
| Emergency Room | $1,725 | $1,725 | $1,725 | $1,725 |
| Primary Care Office Visit | $65 | $85 | $145 | $175 |
| Specialist Office Visit | $145 | $195 | $325 | $390 |
| Pharmacy Benefit | ||||
| Generic (Retail) | $10 Copay | $10 Copay | $10 Copay | $10 Copay |
| Generic (Mail Order) | $25 Copay | $25 Copay | $25 Copay | $25 Copay |
| Preferred Brand (Retail) | $50 Copay | $50 Copay | $50 Copay | $50 Copay |
| Preferred Brand (Mail Order) | $125 Copay | $125 Copay | $125 Copay | $125 Copay |
| Non-Preferred Brand (Retail) | $100 Copay | $100 Copay | $100 Copay | $100 Copay |
| Non-Preferred Brand (Mail Order) | $250 Copay | $250 Copay | $250 Copay | $250 Copay |
| Specialty | Retail Copays Apply | Retail Copays Apply | Retail Copays Apply | Retail Copays Apply |
Important Plan Information
The benefits shown above are only a summary. Review the official plan documents, including the Summary of Benefits and Coverage (SBC) and Summary Plan Description (SPD), for complete information about covered services, exclusions, limitations, cost-sharing requirements, and other plan terms. If there is a difference between this summary and the official plan documents, the official plan documents govern.
Prescription Drug Coverage
Prescription drug benefits shown above is a summary. Visit the Pharmacy Benefits page for complete information, about covered medications, specialty medications, prior authorization requirements, and other plan provisions.
Provider Access & Ratings
Coupe Health uses the Anthem Blue Cross and Blue Shield network. When looking for care, use the Coupe provider tools to confirm provider access and compare available provider ratings and costs.
| Provider Rating | P-Preferred | S-Standard | NP-Non-Preferred | OON – Out-of-Network |
|---|---|---|---|---|
| Description | High-quality, cost-effective providers who meet or exceed quality standards. | Providers with average performance or insufficient rating data. | Providers who may not meet established quality or cost standards. | Providers outside of the plans network who are not rated. |
| What You Pay | $- lowest available in-network copay | $$-Mid Range in-network copay | $$$-Highest available in-network copay | $$$$ Highest overall copays; some services may not be covered. |
Learn more about provider ratings here.
Find Care
Use the Provider Directory to search for providers, compare ratings, and view care options available through the Anthem Blue Cross and Blue Shield network.
Programs Included with Your Medical Plan
Your Coupe Health coverage also provides access to programs and resources designed to support your health and help you navigate care.
