Medical

Your medical plans for 2019 are:

  • Basic
  • Enhanced
  • Premium
LEARN ABOUT YOUR PLANS

All of the plans are administered by Anthem Blue Cross Blue Shield, cover the same medical services and use the same provider network. Enrollment in the prescription plan is included as part of your enrollment in the medical plan, and pharmacy coverage is the same for all 3 medical plans. However, financial aspects—such as deductible amounts, co-insurance levels and out-of-pocket maximums—differ. In general, as you increase the plan level (from Basic to Enhanced or from Enhanced to Premium), the monthly per-paycheck premiums increase, while the out-of-pocket costs for services you receive decrease.

View pages 14 and 15 for a comparison chart of your plan choices.

For more details, visit the Capital One online enrollment system. You’ll find complete information in the Resource Center about coverage and costs and a Summary of Benefits and Coverage (SBC) for each plan. The SBC notices provide plan details in a format designed to help you compare your options and make informed decisions about your health insurance. You can also see the SBCs using the links below:

CHOOSING A MEDICAL OPTION

Generally, the higher your per-paycheck cost of coverage, the lower your out-of-pocket costs for care—and vice versa. As you consider your medical plan options, you’ll also want to:

  • Identify the kind of health care services you expect to use—based on the historical use of medical care by you and your covered dependents, and your anticipated needs for the year.
  • Think about whether you and your covered dependents are likely to use medical services often or have high out-of-pocket costs.
  • Consider other coverage options you may have—for example, through your spouse’s employer—and compare the estimated total cost of using that plan versus the Capital One plan.

When selecting the best plan for you, consider your annual average claim costs, not including preventive care services, lab services, X-rays and prescriptions. Use the Medical Plan Selector Tool during Open Enrollment to review the best medical plan options for your needs based on the health care services you used over the course of the year.

No-Cost Preventive Care

Regular preventive care can help you identify health risks before they lead to more serious medical issues. To encourage regular routine physical exams, screenings and immunizations, the Capital One medical plans pay the full cost of covered preventive care—with no expense to you (when using an in-network provider)*. This includes the cost of preventive care office visits and any related preventive care lab services. Here's a list of preventive care services.

*For out-of-network providers, Anthem processes preventive care claims at 100% of the local plan pricing or allowed (reasonable and customary) charge. You may be required to pay out-of-pocket for any balance billed charges above the reasonable and customary charges.

LiveHealth Online

Using LiveHealth Online, you can have a private and secure video visit with a board-certified doctor, licensed therapist or lactation counselor on your smartphone, tablet or computer with a webcam. It’s an easy way to get the care you need at home or on the go. Use LiveHealth Online 24/7 if you have pinkeye, a cold, the flu, a fever, allergies, a sinus infection or other common health condition. A doctor can assess your condition, provide a treatment plan and even send a prescription to your pharmacy, if it’s needed.

If you’re feeling anxious or having trouble coping on your own and need some support, you can have a video visit with a therapist or psychiatrist using LiveHealth Online. You can get help for anxiety, depression, grief, panic attacks and more.

Get started
Register or make an appointment at livehealthonline.com or on the phone at 1-844-784-8409 from 7 a.m. to 11 p.m., seven days a week. Evening and weekend appointments are available.

WALK-IN OR RETAIL CLINICS

Walk-in/retail clinics are often found in retail locations, like CVS Minute Clinics or Walgreens Health Clinics. There is no co-pay for services rendered at an in-network walk-in clinic. Walk-in clinics generally:

  • Have longer hours than most local doctors’ offices and are open weekends and holidays.
  • Are staffed by knowledgeable nurse practitioners or physician assistants who treat common illnesses and injuries, as well as provide sports and camp physicals and wellness screenings.
  • Have comparable quality to primary care offices, cost less and have higher patient satisfaction scores.
  • Are convenient to where the majority of our associates live or work. To find a walk-in clinic near you, log in to anthem.com/capitalone click on top left Menu, then select Find Care, then you can select Find a Doctor, Vision Provider, ER alternative, LiveHealth or Nurseline. Your network is already selected as BlueCard PPO. Scroll down and click on the type of care needed from the menu. Narrow your search by entering location, specialty need or using the Show More Options menu.

PAYING FOR NON-PREVENTIVE CARE

Network Office Visits and Routine Lab Services
You pay a set dollar amount (co-payment) for frequently used services like network doctor office visits. Routine X-ray and lab services are covered at 100%. More complex tests and imaging such as PET and CT scans, MRIs and MRAs are subject to deductible and co-insurance.

Co-payments count toward the annual co-insurance out-of-pocket maximum, but not towards your annual deductible. They are eligible Flexible Spending Account (FSA) expenses, so you can get reimbursed with pre-tax dollars if you participate in the Health Care FSA.

Other Covered Care
You must first meet the individual or family calendar-year deductible before the plan begins paying most benefits. After the deductible, you pay a percentage of the cost—or co-insurance—for most other care. (Note: copays and prescription drug costs do not count toward the deductible.)

Eligible expenses count toward both your individual and family deductible

  • When an individual meets the deductible, the plan begins paying benefits for that person.
  • When combined eligible expenses for covered family members reach the family deductible, the plan pays benefits for all covered family members. No additional individual deductible amounts are required that year.

Out-of-Pocket Maximum
You are protected from catastrophic medical expenses by the annual co-insurance out-of-pocket maximum. When your co-insurance during a calendar year reaches the out-of-pocket maximum, the plan pays the full cost for any covered care you receive for the rest of the year. Medical and prescription copays and co-insurance count towards your medical out-of-pocket maximum. Penalties and deductible amounts do not count toward reaching your annual co-insurance out-of-pocket maximum.

Gender Reassignment
Certain gender reassignment surgery is covered at the same level as other surgeries covered by the plans. Associated prescription drugs required for gender reassignment are also covered as other similarly situated drugs. Covered Medical Expenses include charges in connection with a medically necessary Transgender (Sex Change) Surgery as long as you or a covered dependent have obtained pre-certification from Anthem and meet the plan clinical criteria. This coverage reinforces Capital One’s commitment to diversity and our values.

Also Covered by the Medical Plan

  • Hearing aids are up to $2,000 per ear every 24 months

AUTISM COVERAGE

To help families living with autism, Capital One offers additional support under its medical plans:

  • Applied Behavior Analysis (ABA) is covered at 100% whether you use an in-network or out-of-network therapist, with no plan dollar limits or age limits. These services are subject to pre-certification through Anthem Blue Cross Blue Shield.
  • Speech Therapy, Occupational Therapy and Physical Therapy are covered with no dollar maximums, visit limits or age limits. Subject to deductibles and co-insurance of the plan in which you are enrolled. Out-of-network therapists are covered as in-network at the allowed charges with the deductible waived.

CASTLIGHT

All eligible Capital One associates and dependents enrolled in the medical plan have free access to Castlight, a personalized online health care resource that helps you shop for doctors, prescriptions and medical services.

Castlight will provide you with cost information before you book an appointment, and empower you to make informed health care decisions.

With Castlight, you can shop for doctors and medical services as easily as you shop for anything else. Castlight shows you quality and price information, so you won’t be surprised when the bill comes. The quality information includes reviews and ratings from nationally recognized organizations such as Center for Medicare and Medicaid and from patients like you. The cost estimates are actually personalized to take into account your plan details and deductible status.

Read this handy Quick Start Guide or visit mycastlight.com/capitalone.

Anthem Blue Cross Blue Shield Health Programs

Through our health care benefits administrator Anthem, our associates have access to Anthem Nurse Programs:

  • Personal Health Consultant
    With the Personal Health Consultant, your family has a primary nurse and health professionals who are there to discuss your health needs and help you reach your health goals. When you need more specialized advice, your primary nurse can connect you to medical professionals like dietitians or pharmacists.
  • ConditionCare
    This program provides extra support to people of all ages who are managing the symptoms of asthma or diabetes. It’s also for adults who are dealing with chronic obstructive pulmonary disease (COPD), heart failure or coronary artery disease and need a little extra attention and support.
  • Future Moms
    This program gives expecting moms support and guidance from registered nurses for a healthy pregnancy and a safe delivery.
  • 24/7 NurseLine
    You have access to registered nurses wherever you are, anytime. The nurses can answer any questions you have about your health and help you decide where to go for care.
Anthem Discount Program

The Anthem Discount Program is part of your Capital One Medical Plan. The program offers discounted health and wellness products and services, including fitness, weight management and hearing services. You can use the discounts whenever you want, as often as you want. Log in to anthem.com/capitalone to view all available discounts (Under Learn About on the home page).

Win Fertility

WINFertility Program will help associates receive the highest quality care for fertility treatment services.

For associates of the medical plan, WIN will assist in maximizing your insured benefit by explaining the most effective treatment options based on your individual treatment needs, helping select a high quality, in-network provider, and managing your infertility prescriptions to ensure you get the most out of your infertility medication benefit.

Key features of the WIN Fertility Program include:

  • Help with provider selection.
  • 24/7 access to education and emotional support provided by WIN's FertilityCoach5M Nurses with decades of experience with infertility patients.
  • Guidance to help Increase efficient use of hormonal medications to avoid wastage and the risks of over-stimulation.
  • Improved likelihood of successful outcomes through WIN's evidence-based protocols, expert clinical advice, and treatment by qualified subspecialists.
  • For those who have exhausted their benefit, medical treatment and pharmacy savings of 10-30% off retail prices and financing options to make paying for treatment even more manageable.
  • Complimentary supply of folic acid to help prevent neural tube defects. The WIN Fertility programs will also connect you with the existing maternity program once you become pregnant to ensure a healthy pregnancy and the healthy birth of your baby.
Milk Stork

Milk Stork provides Capital One associates who are on U.S. business travel and are breastfeeding with everything they need to ship a day's supply of fresh milk home to their babies.

HOW MILK STORK WORKS

She Plans Her Trip: A mom orders her kits at milkstork.com. When she arrives at her hotel, there will be a package with all of the Milk Stork Kits she ordered for her trip. The kits are pharmaceutical-grade shipping coolers that provide her with everything she needs to ship or tote her milk home.

Pump & Pack: Available in two sizes: 34oz. and 72 oz., the coolers are easy-to-use with “push button” activation. There is no freezing required and no gel packs.

Ship or Tote: Pump & Ship coolers arrive preaddressed with FedEx Priority Overnight shipping labels. Pump & Totes arrive with a convenient tote.