Anthem Medical

Medical

There are three medical plan options administered by Anthem. Click on a button below to see highlights and key information for each plan option.

Eligibility & Enrollment

Eligibility

Associate: You are eligible to join the Medical Plan (“Plan”) on your thirtieth (30th) day of employment (this period is called the Waiting Period) if you are classified in Workday as a Full-Time Associate.

If your status changes to Full-Time in Workday, you are eligible to join or re-enter the Plan as of the first of the month after the status change.

Dependents: Eligible Full-Time Associates may cover eligible dependents, which include a Spouse/Domestic Partner and children under age 26.

Please refer to the Summary Plan Description (“SPD”) for more eligibility information. If you have any questions regarding dependent eligibility, please contact the CarMax Benefits Center.

Temporary Associates and Independent Contractors are not eligible to participate.

Enrollment

New Hire and Rehires: Enroll online at benefits.carmax.com within 30 days of your hire date. If enrolled in the Anthem Medical plan, you will be able to view your coverage on the Engage Wellbeing App. You will also receive a Medical/RX card in the mail.

Note: Generally, if you don’t enroll when first eligible, you may only be allowed to enroll if you experience a Qualified Change in Status Event (marriage, new baby, etc.) or during the next Open Enrollment.

You will receive your ID cards approximately three weeks after your effective date of coverage.

Getting Started with Enrollment

Plan Comparison Chart

Here's how you can compare the PPO to the High Deductible plan option. Watch a video here

In-Network Benefits	HRA Plan	HSA Plan	PPO Plan	Kaiser Plan
Company contribution to the Health Reimbursement Account and the Health Savings Account	Associate Only: $300 Associate + Dependent(s) or Family: $600	Associate Only: $300 Associate + Dependent(s) or Family: $600	N/A	N/A
Deductible	Associate Only: $2,500 Associate + Dependent(s) or Family: $5,000	Associate Only: $1,700 Associate + Dependent(s) or Family: $3,500	Associate Only: $1,000 Associate + Dependent(s) or Family: $2,000	Associate Only: $1,000 Associate + Dependent(s) or Family: $2,000
Out-of-Pocket Maximum	Associate Only: $6,550 Associate + Dependent(s) or Family: $13,100	Associate Only: $6,550 Associate + Dependent(s) or Family: $13,100	Associate Only: $6,550 Associate + Dependent(s) or Family: $13,100	Associate Only: $6,550 Associate + Dependent(s) or Family: $13,100

*Family deductibles are calculated differently for each plan option.
Note: These plans are in-network only. Out-of-network providers are not covered.

In-Network Benefits	HRA Plan	HSA Plan	PPO Plan	Kaiser Plan
Doctor's Office Visit
Preventive Care	$0, no deductible	$0, no deductible	$0, no deductible	$0, no deductible
Primary Care Physician (PCP)	40%, after deductible¹	30%, after deductible¹	$30 copay²	$30 copay
Specialist	40%, after deductible	30%, after deductible	$60 copay	$50 copay
Non-Preventive Lab/X-rays with Office Visits	40%, after deductible	30%, after deductible	20%, after deductible	$10 Labs 20%, up to $150 Specialty Imaging, no deductible

LiveHealth Online Virtual Visit	$0, no deductible	100% coverage, after deductible and applicable copay¹	$0, no deductible	$0, no deductible
Emergency Room	40%, after deductible	30%, after deductible	$250¹ + 20%, after deductible	20%, after deductible
Urgent Care	40%, after deductible	30%, after deductible	$60 copay	$30 copay

Mental Health
Inpatient Care	40%, after deductible	30%, after deductible¹	20%, after deductible	20%, after deductible
Outpatient Individual Therapy Visits	40%, after deductible	30%, after deductible	$30 copay/visit	$30 copay/visit
Outpatient Group Therapy Visits	40%, after deductible	30%, after deductible	$30 copay/visit	$15 copay/visit

Substance Abuse
Inpatient Detoxification	40%, after deductible	30%, after deductible	20%, after deductible	20%, after deductible
Outpatient Individual Therapy Visits	40%, after deductible	30%, after deductible	$30 copay/visit	$30 copay/visit
Outpatient Group Therapy Visits	40%, after deductible	30%, after deductible	$30 copay/visit	$5 copay/visit

Copays / Coinsurance
For most covered services [In/Out Patient Hospital, Other Outpatient]	40%, after deductible	30%, after deductible	20%, after deductible	N/A

¹Including Mental Health office visits.

²Copay is waived if admitted to the hospital.

Prescription Drugs	HRA Plan¹	HSA Plan	PPO Plan	Kaiser Plan
Retail: 30-day supply
Generic	$10	$10, after deductible	$10	$10 Generic (up to 100-day supply)
Formulary (Preferred)²	30% ($40 min, $100 max)	30% ($40 min, $100 max), after deductible	30% ($40 min, $100 max)	$40 Brand (up to 100-day supply)
Non-Formulary (Non-Preferred)	30% ($60 min, $150 max)	30% ($60 min, $150 max), after deductible	30% ($60 min, $150 max)	$40 Brand (up to 100-day supply)

Mail Order:90-day supply
Generic	$20	$20, after deductible	$20	$10 Generic (up to 100-day supply)
Formulary (Preferred)²	30% ($80 min, $200 max)	30% ($80 min, $200 max), after deductible	30% ($80 min, $200 max)	$40 Brand (up to 100-day supply)
Non-Formulary (Non-Preferred)	30% ($120 min, $300 max)	30% ($120 min, $300 max), after deductible	30% ($120 min, $300 max)	$40 Brand (up to 100-day supply)

¹Note, under the HSA Plan, your deductible applies to medical and prescription drug expenses, and you must pay the full cost of your medical and prescription drug expenses until you meet your deductible. However, certain prescriptions on the preventive drug list are not subject to the deductible. Also note that in the HSA plan, some eligible preventive care prescription drugs are available at no cost. See the Preventive Drug List on the CVS Caremark website. Note, the list is subject to change at any time.

²A list of formulary drugs can be found at caremark.com

Out-of-pocket costs and negotiated rates

The Transparency in Coverage Final Rules (and related sub-regulatory guidance(see Q&A 1 and 2)) require group health plans to disclose on a public website information regarding: (1) the in-network provider rates for covered items and services (see “in-network-rates” in filename); and (2) the historical out-of-network allowed amounts and billed charges for covered items and services (see “allowed-amounts” in filename) in two separate machine-readable files (MRFs).The files must, in part, also include plan option/coverage identifier information; billing codes to identify items and services for claims processing; and all applicable rates.

The MRFs for the group health plan(s) in the CarMax, Inc. Health Plan, for the Anthem Self-Funded Options and the Kaiser Insured Options are linked below:

The MRFs were prepared using this technical implementation guide. Please refer to the guide for additional details regarding the format, data types, file naming convention, and schemas that were followed when creating and posting the MRFs linked above to help ensure they are publicly discoverable and maintain their integrity.

Medical Plan Credit (MPC)

All Associates who enroll in an Anthem option under the Medical Plan are asked to participate in our voluntary Commitment to Health program. This program asks you and your covered Spouse/Domestic Partner to take the steps outlined in the Commitment to Health Policy to receive a Medical Plan Credit (MPC) of $23.08 per paycheck (up to $600 each for the full Plan Year).

The Commitment to Health program includes a Health Assessment, an online questionnaire about your health history and personal habits (diet, exercise, etc.) to create a snapshot of your current health risks.

Our Commitment to Health Program is administered by Anthem. If you have any questions about the Program, please contact Anthem at (833) 290-2480. See the Commitment to Health Policy for more information, including program deadlines

Rewards with Anthem Engage Wellbeing

In addition, you and your covered Spouse/Domestic Partner can each earn up to $300 in gift cards to use at popular retailers for completing simple, health-focused steps like:

Using the Engage Wellbeing app;
Working with a digital coach;
Tracking activity;

*NOTE: Gift cards are taxable. Kaiser Plan members and non-Medical Plan members are only eligible for Engage Wellbeing sweepstakes rewards.

When Coverage Ends

If your employment with CarMax ends, coverage in this plan will end on your last day of employment. If you move from a Full-time position to a Part-time position, coverage in this plan will end at the end of the month in which you move to a Part-time position.

Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you and your qualified beneficiaries (that is, your enrolled Spouse and enrolled dependents) may continue group health coverage for a period of time if coverage under the Plan ceases. CarMax also extends a continuation of coverage option to enrolled Domestic Partners.

You will receive a COBRA notice approximately 2 weeks following your separation of service with instructions and the costs associated with the continuation of coverage. Please refer to the Plan’s SPD for more information.

Additional Anthem Programs

Lantern - New as of 3/1/2025

Anthem members will have access to Lantern. Lantern connects you to excellent care at little to no cost.

Surgery Care - Lantern will match you with the best surgeon in Lantern’s network for planned, non-emergency surgery. They will answer your questions and provide support during your surgery process. Lantern covers more than 1500 procedures.
Cancer Care - Lantern is there to ensure you understand your diagnosis and treatment plan and, if necessary, assist you with getting a second opinion. They can answer questions and assist with getting appointments at local and national cancer centers faster. They can even help you find support options in your community.
Infusion Care - Lantern can help get you the care you need either at home or at an infusion center.

Lantern is available at no cost to you if you are enrolled in the PPO or HRA Plan and no cost to you after deductible if you are enrolled in the HSA Plan. We know from your feedback that medical affordability is really important.

Sharecare - New as of 3/1/2025

Sharecare will replace Engage as your new well-being platform. You’ll be able to access features like:

The RealAge® Test: Sharecare’s scientifically based health assessment provides your body’s true age.
Health Trackers: Track core factors such as activity, steps, diet, stress, sleep, etc. The Benefits Hub: Provides one centralized location to easily access all your CarMax benefits.
Incentives: Get rewarded for your healthy activities throughout the plan year!
Sharecare App: Enjoy convenient 24/7 digital access to manage your benefits, health care, and well-being needs.

Sharecare will be available to all CarMax Associates and Anthem-enrolled spouses/domestic partners starting March 1, 2025.

Spring Health - New as of 3/1/2025

Spring Health will replace our current Anthem Employee Assistance Program, or EAP. Spring Health offers access to high quality mental health resources, which CarMax Associates have been asking for. This is just one of the reasons Spring Health was selected as our new EAP offering.

The program includes counseling sessions, coaching sessions, legal, financial, and professional development services and resources, which is an enhancement over our current offering! Even better, Spring Health’s quick and easy online scheduling system, self-guided assessments, and personalized care plans ensure that you can get the care you need when you need it.

Spring Health will be available to all CarMax Associates, as well as spouses or domestic partners, members of your household, and dependents up to the age of 26 starting March 1, 2025.

Eden Health

A modern primary care experience, including preventive care, acute care, chronic condition management, and care coordination, that’s easy to access through a convenient app.

This benefit is available at no cost to CarMax Associates and their covered dependents who are enrolled in an Anthem medical plan.

* Adults 18+ and their covered dependents have full access, and pediatric services are available for dependents 2–17 years old.

Hinge Health

Free access to programs for back, knee, hip, neck, shoulder pain and more, including wearable sensors, coaching, and personalized exercise therapy.

This benefit is available at no cost to CarMax Associates age 18+, and their covered dependents who are enrolled in an Anthem Medical plan.

Rx Savings Solutions (RxSS)

CarMax works with RxSS to help you manage the rising cost of prescription drugs. This free and confidential service connects with your CarMax Athem Health plan to show you all the lower-cost options you have for your medications, where applicable.

RxSS doesn’t replace your current prescription plan; it’s an additional program designed to help you and your family save money.

This benefit is available at no cost to CarMax Associates and their covered dependents who are enrolled in an Anthem Medical plan.

LiveHealth Online

Anthem members have access to the LiveHealth Online program which provides you with 24/7/365 access to doctors by online video. LiveHealth Online is a convenient and affordable option that allows you to talk to a doctor who can diagnose, recommend treatment, prescribe medication, when appropriate, for many of your medical issues.

Future Moms Maternity Program

You or your covered Spouse/Domestic Partner who are enrolled in the medical plan administered by Anthem are eligible to participate in Anthem’s Future Moms Maternity Program and receive a financial incentive up to $150. This is a voluntary, free, and comprehensive maternity program to help you take care of yourself and your baby during your pregnancy. Additional information is available in the SPD.

24 Hour Nurse Hotline

Anthem offers Plan Members a free 24-Hour Nurseline to help you anytime day or night. To reach a nurse, call (800) 700-9184 and select the option to speak to a nurse. The nurses can help you:

Learn about medical procedures and treatment options
Prepare for a conversation with your doctor
Determine if you need immediate care (e.g., the Emergency Room) or if you can wait to see your doctor during normal business hours

Retail Walk-In Clinics

Retail Walk-in Clinics are typically found in retail businesses such as CVS Pharmacies, Target stores, or Walgreens Pharmacies. These clinics are run by either RNs, Nurse Practitioners, or Physician Assistants. You should consider a Retail Walk-in Clinic when you have the need for immediate care that is not urgent – examples include the treatment of cold/flu symptoms, rashes, or basic infections. You can also get many wellness exams and routine physicals.

To find a Retail Walk-in Clinic near you, log into Anthem Engage Wellbeing online or using the mobile app and click Find Care and type “Retail Health Clinic” in the search field.

Concierge Cancer Care (C3)

Being diagnosed with cancer can be a life changing experience that’s difficult to navigate all on your own. However, receiving support through the C3 cancer support program can help you learn more about your condition, give you confidence in your treatment plan, and help keep you encouraged.

The C3 program is a cancer support program that provides you with 24/7 physician guidance, plus travel benefits to facilities that are designated as Centers of Excellence.

For more information, contact Anthem at (833) 290-2480. C3 is available to Associates enrolled in the medical plan administered by Anthem and their covered dependents.

Cleveland Clinic Cardiac Concierge

Getting a second opinion can help you feel confident in your diagnosis, understand the pros and cons of treatment options, and make informed decisions.

The Cleveland Clinic Cardiac Concierge program is here to support you and your covered dependents - by ensuring you have access to top heart doctors, helping you learn about treatments that may be available to you only at Cleveland Clinic, and providing travel for you and a companion to see top heart doctors for surgery and other treatments.

For more information, contact Anthem at (833) 290-2480. The Cleveland Clinic Cardiac Concierge program is available to Associates enrolled in the medical plan administered by Anthem and their covered dependents.

Explore Your Health Benefits

Medical Plan Credit