Retiree Optional Plan (ROP) Medical at a Glance
Retiree Optional Plan (ROP) Administered by Anthem Blue Cross
General
May use provider of choice or network provider; $400 annual deductible per individual, up to family maximum of $1,200; $4,000 annual out-of-pocket maximum per individual, up to family maximum of $8,000. No lifetime maximum; no pre-existing condition exclusions. All plan benefits and out-of-pocket maximums are based on Eligible Expenses only.
Hospital Stay
70% after deductible for semi-private room (private if Medically Necessary); includes intensive care; pre-authorization is required for non-emergency care, except for Medicare-eligible members; $250 penalty for not obtaining required pre-authorization.
Skilled Nursing Facility
70% after deductible after 3 days in hospital; covers semi-private room; excludes custodial care. Pre-authorization is required for both Medicare and non-Medicare members.
Outpatient Hospital Surgery & Emergency Room Care
70% after deductible.
Maternity Care
Covered as any other condition.
Well-Baby Care
70% after deductible.
Office Visits
70% after deductible for office and home visits.
Urgent Care Visits
70% after deductible.
Routine Physical Examinations
70% after deductible.
Immunizations and Injections
70% after deductible.
Eye Examinations
Not covered.
Diagnostic X-rays and Lab Tests
70% after deductible.
Pre-Admission Testing
70% after deductible.
Home Health Care & Home Hospice Care
70% after deductible; requires prior authorization; excludes custodial care.
Inpatient Hospice Care
70% after deductible; requires prior authorization; excludes custodial care.
Outpatient Physical Therapy
70% after deductible.
Outpatient Prescription Drugs
Covered by separate prescription drug plan administered by Express Scripts, Inc. (see the Prescription Drug Coverage section for details).
Mental Health
70% after deductible.
Inpatient and Outpatient Substance Abuse
70% after deductible.
Durable Medical Equipment
70% after deductible.
Chiropractic Care
70% after deductible; 10-visit maximum; maintenance care not covered.
Acupuncture
70% after deductible.
Hearing Aids and related expenses
Covered effective January 1, 2014
80% for Medically Necessary only; one hearing aid per ear every three years
Other Benefits
  • Infertility—70% after deductible; $7,000 lifetime maximum. Balances from prior plans carry forward.
  • Transplant Services – 70% after deductible, pre-authorization required for transplant services for non-Medicare members.
  • Hearing aids – 70% up to $2,800 annually through 2013. See new coverage effective January 1, 2014.