We are an Authorized Independent Agent for Anthem Blue Cross & Blue Shield Anthem
Plan Descriptions
Plans Effective 8-1-10 - EMPLOYEE ELECT PLANS (Brochure)
|
||||
Health
Plan Name |
Office
Visit Copay |
Hospital
Copay |
Outpatient Copay |
Prescriptions |
$45 |
$750 + 40%, $4750 max |
$750 + 40%, $4750 max |
$15 generic only |
|
| $35 Copay GenRx | $35 |
$500 + 30%, $4000 max |
$500 + 30%, $4000 max |
$15 generic only |
$50/$75 |
$1500 + 40%, $6000 max |
$1500 + 40%, $6000 max |
$15 generic only |
|
| PPO $40/60 Copay $5000 Ded | $40/$60 |
$5000+30%, $8,000 max |
$5000+30%, $8,000 max |
$15/$40/$60/30% |
$30/$60 |
$3000 + 30%, $6000 max |
$3000 + 30%, $6000 max |
$15/$40/$60/30% | |
| PPO
$30/$60 Copay $2000 Ded |
$30/$60 |
$2000 + 30%, $5000 max |
$2000 + 30%, $5000 max |
$15/$40/$60/30% |
| PPO $25/$50 Copay $1500 Ded |
$25/$50 |
$1500 + 20%, $4000 max |
$1500 + 20%, $4000 max |
$15/$40/$60/30% |
| PPO $25/$50 Copay $1000 Ded |
$25/$50 |
$1000 + 20%, $4000 max |
$1000 + 20%, $4000 max |
$15/$40/$60/30% |
| PPO $20/$40 Copay $500 Ded | $20/$40 |
$500 + 20%, $3000 max |
$500 + 20%, $3000 max |
$15/$40/$60/30% |
Deductible, then 0% |
Deductible, then 0% |
Deductible, then 0% |
Deductible, then $15/$40/$60/30% |
|
Lumenos HSA 2000 Deduct. 90% |
Deductible, then 10% |
Deductible, then 10% |
Deductible, then 10% |
Deductible, then 10% |
Deductible, then 20% |
Deductible, then 20% |
Deductible, then 20% |
Deductible, then 20% |
|
| Lumenos HSA 3000 Deductible 90% | Deductible, then 10% |
Deductible, then 10% |
Deductible, then 10% |
Deductible, then 10% |
| Lumenos HSA 3000 Deduct. 80% | Deductible, then 100% |
Deductible, then 100% |
Deductible, then 100% |
Deductible, then 20% |
| Lumenos HSA 5000 Deductible | Deductible, then 0% |
Deductible, then 0% |
Deductible, then 0% |
Deductible, then $15/$40/$60/30% |
| Lumenos HIA Plus 2000 Deductible | Deductible, then 100% |
Deductible, then 100% |
Deductible, then 100% |
Deductible, then $15/$40/$60/30% |
| Lumenos HIA Plus 3000 Deductible | Deductible, then 100% |
Deductible, then 100% |
Deductible, then 100% |
Deductible, then $15/$40/$60/30% |
| Classic HMO | $20 |
$500 |
$250 |
$15/$40/$60/30% |
| Classic HMO Select | $20 |
$500 |
$250 |
$15/$40/$60/30% |
| HMO Select $45 Copay | $45 |
Deductible then 40% |
Deductible then 40% |
$15 copay generic only |
| HMO Select $40 Copay | $40 |
Deductible then 30% |
Deductible then 30% |
$15/$40/$60/30% |
| PPO Exclusions | ||||
| HMO Exclusions | ||||
BENEFITS PLANS (Brochure) |
||||
Health
Plan Name |
Office
Visit Copay |
Hospital
Copay |
Outpatient Copay |
Prescriptions |
| Hospital Benefits | Not Covered |
Deductible & Coinsurance |
Deductible & Coinsurance |
$15 copay generic only |
| Hospital Benefits Plus | 50% |
Deductible & Coinsurance |
Deductible & Coinsurance |
$15 copay generic only
|
| Hospital Benefits Preferred | 50% |
Deductible & Coinsurance |
Deductible & Coinsurance |
$15 copay generic only
|
$45 |
$750 + 40%, $4750 max |
$750 + 40%, $4750 max |
$15 generic only |
|
| Lumenos HSA 3000 Deductible | Deductible, then 0% |
Deductible, then 0% |
Deductible, then 0% |
Deductible, then $15/$40/$60/30% |
| HMO Select $40 $1000 Ded | $40/$60 |
$1000+20%, $5000 max |
$1000+20%, $5000 max |
$15/$40/$60/30% |
$30/$59 |
$2000 + 30%, $5000 max |
$2000 + 30%, $5000 max |
$15/$40/$60/30% |
|
Old Plans
Plans Prior to 8-1-10 - EMPLOYEE ELECT PLANS (Brochure)
|
||||
| Health
Plan Name |
Office
Visit Copay |
Hospital
Copay |
Outpatient Copay |
Prescriptions |
$30 |
$500 + 20%, $3500 max |
$500 + 20%, $3500 max |
$15/$30/$50/30% |
|
| PPO $30 Copay $3000 Ded. | $30 |
$3000+20%, $8000 max |
$3000+20%, $8000 max |
$15/$30/$50/30% |
| PPO $40 Copay | $40 |
$500 + 30%, $4000 max |
$500 + 30%, $4000 max |
$15/$30/$50/30% |
| PPO $40 Copay $5000 Ded | $40 |
$5000+30%, $13,000 max |
$5000+30%, $13,000 max |
$15/$30/$50/30% |
$35 |
$500 + 30%, $3500 max |
$500 + 30%, $3500 max |
$15 generic only |
|
| PPO
$45 Copay Gen Rx |
$45 |
$750 + 40%, $4000 max |
$750 + 40%, $4000 max |
$15 generic only |
| Premier
PPO $15 Copay |
$15 |
$150 + 10%, $2500 max |
$150 + 10%, $2500 max |
$10/$30/$50/30% |
| Premier
PPO $25 Copay |
$25 |
$150 + 20%, $3000 max |
$150 + 20%, $3000 max |
$15/$30/$50/30% |
| PPO $25 Copay $2000 Ded | $25 |
$2000 + 20%, $5000 max |
$2000 + 20%, $5000 max |
$15/$30/$50/30% |
| Deductible, then 0% |
Deductible, then 0% |
Deductible, then 0% |
Deductible, then $15/$40/$60/30% |
|
Deductible, then 100% |
Deductible, then 100% |
Deductible, then 100% |
Deductible, then 20% |
|
| Lumenos HSA 3000 Deductible | Deductible, then 0% |
Deductible, then 0% |
Deductible, then 0% |
Deductible, then $15/$40/$60/30% |
| Lumenos HSA 3000 Deduct. 80% | Deductible, then 100% |
Deductible, then 100% |
Deductible, then 100% |
Deductible, then 20% |
| Lumenos HSA 5000 Deductible | Deductible, then 0% |
Deductible, then 0% |
Deductible, then 0% |
Deductible, then $15/$40/$60/30% |
| Lumenos HIA Plus 2000 Deductible | Deductible, then 100% |
Deductible, then 100% |
Deductible, then 100% |
Deductible, then $15/$40/$60/30% |
| Lumenos HIA Plus 3000 Deductible | Deductible, then 100% |
Deductible, then 100% |
Deductible, then 100% |
Deductible, then $15/$40/$60/30% |
| Classic HMO | $20 |
$500 |
$250 |
$15/$40/$60/30% |
| Classic HMO Select | $20 |
$500 |
$250 |
$15/$40/$60/30% |
| HMO Select $45 Copay | $45 |
Deductible then 40% |
Deductible then 40% |
$15 copay generic only |
| HMO Select $40 Copay | $40 |
Deductible then 30% |
Deductible then 30% |
$15/$40/$60/30% |
| PPO Exclusions | ||||
| HMO Exclusions | ||||
BENEFITS PLANS (Brochure) |
||||
Health
Plan Name |
Office
Visit Copay |
Hospital
Copay |
Outpatient Copay |
Prescriptions |
| Hospital Benefits | Not Covered |
Deductible & Coinsurance |
Deductible & Coinsurance |
$15 copay generic only |
| Hospital Benefits Plus | 50% |
Deductible & Coinsurance |
Deductible & Coinsurance |
$15 copay generic only
|
| Hospital Benefits Preferred | 50% |
Deductible & Coinsurance |
Deductible & Coinsurance |
$15 copay generic only
|
$35 |
$500 + 30%, $3500 max |
$500 + 30%, $3500 max |
$15 generic only |
|
| Lumenos HSA 3000 Deductible | Deductible, then 0% |
Deductible, then 0% |
Deductible, then 0% |
Deductible, then $15/$40/$60/30% |
| Classic HMO Select | $20 |
$500 |
$250 |
$15/$40/$60/30% |
| $25 Copay $2000 Ded | $25 |
$2000 + 20%, $5000 max |
$2000 + 20%, $5000 max |
$15/$30/$50/30% |
| Health Plan Name |
Office Visit Copay |
Hospital Copay |
Outpatient Copay |
| Basic HMO | $40/$60 |
$500/day, max $2000 |
$300 |
| Standard HMO | $25/$40 | $250/day, max $1000 | $150 |
| Basic PPO | $40/$60 | $4000 deductible + 30%, $8000 max |
$4000 deductible + 30%, $8000 max |
| Standard PPO | $25/$40 | $1500 deductible + 20%, $3500 max |
$1500 deductible + 20%, $3500 max |
The following plans were discontinued
by Anthem as of 10-31-05. Some plans may be renewed in 2006, other
plans will
have to be converted to a new plan design. Please call
(303) 721-1145 for details.
BluePreferred PPO Plans
| Plan Name |
Office Visit Copay |
Deductible |
Coinsurance |
$15 |
$0 |
10% to $1K + copays |
|
$25 |
$0 |
20% to $2K + copays |
|
$25 |
$0 |
20% to $2K + copays |