The Power of Blue

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Transcript The Power of Blue

Individual & Family

Medical, Dental & Life Plans

Policies and Plans Anthem Blue Cross Life & Health Insurance Policies

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SmartSense Plus

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ClearProtection Plus

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CoreGuard Plus

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Lumenos HSA Plus

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Premier Plus

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Tonik 5000 Anthem Blue Cross Plans

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PPO Share

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HMOs

Deductible Options

Three options!

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2- member maximum

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Once 2 members each reach the deductible, the deductible is satisfied for the entire family. (Share PPO, HMO Plans) Aggregate

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When one or more family members’ eligible covered expenses (combined) meet the aggregate amount, the requirement is satisfied for all covered family members. (Lumenos HSA) Embedded deductible

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The family deductible can be satisfied by 2 or more family members. (Premier Plus, SmartSense Plus, CoreGuard Plus, ClearProtection Plus)

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Policy/Plan Terms

Network Discounts-

Negotiated costs between Anthem Blue Cross and our participating providers.

Coinsurance

- The percentage of the cost of covered services that the member is responsible for, after the annual deductible has been met.

Deductible

- The amount you have to pay each calendar year for covered services before your health plan starts paying.

Out-Of-Pocket Maximum-

The most that you would have to pay in a calendar year for deductible and coinsurance for in-network covered services.

Formulary

- a list of prescription drugs our health plans cover.

Specialty Drugs-

typically high in cost, scientifically engineered drugs used to treat complex, chronic conditions.

Health Savings Account (HSA) –

is a special bank account that can be set up by a member enrolled in a qualified HSA-compatible high deductible health plan if they choose. Contributions to this account can be made with certain tax advantages if used for qualified health care expenses.

Find a plan that meets your clients needs

You can achieve this by simply asking the following questions to your client:

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PPO or HMO?

Are you looking for maternity coverage?

What type of prescription coverage are you looking for? Generic? Name brand?

What does your budget look like?

Are you looking for coverage that is comparable to group?

Things to keep in mind

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Maternity and Pharmacy are the main cost drivers on each plan.

The higher the deductible option, the lower the premium.

If coming off of group coverage, enrollment under Individual is medically underwritten.

To increase client retention always include a quote for dental and life products. Social security numbers are not needed to apply, only California residency for at least 3 months.

The earliest effective date available would be 15 calendar days after receipt of the application.

PPO Policies/Plans

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Premier Plus SmartSense Plus ClearProtection Plus CoreGuard Plus Lumenos HSA Lumenos HSA Plus Tonik 5000 PPO Share

Premier Plus

       Six deductible options from a $1000-$6000 Unlimited - First dollar (no deductible) office visits with separate office visit copays for family practice and specialist ($30 & $50) Routine vision exam 100% Preventive Care Coverage Comprehensive drug coverage from generics to specialty drugs “Embedded” family deductible and out-of-pocket maximum No maternity coverage

Benefits shown are in-network

Annual Out-of-Pocket Maximum Single/Family (in addition to deductible) Annual Deductible (embedded deductible) Office Visits ( Deductible waived ) Preventive Care Professional/Diagnostic Services (x-ray, lab, anesthesia, surgeon, etc.) Inpatient/ Outpatient Services Maternity

Premier Plus

$4,500/$9,000 (

family out of pocket can be satisfied by 2 or more members

) $1,000, $1,500, $2,500, $3,500, $5,000, $6,000 (single) $2,000, $3,000, $5,000, $7,000, $10,000, $12,000

(

family

)

(

family deductible can be satisfied by 2 or more members

) $30 copay for primary care physician; $50 copay for specialist (Deductible waived) Includes all nationally recommended preventive services including well-child care, immunizations, PSA screenings , PAP tests, mammograms and more.

0% Coinsurance, not subject to deductible 25% after the deductible 25% after the deductible Not covered

Drug Benefits Routine Vision Exam Tier1: (Generic drugs)

$15 copay

$500 annual Prescription Drug deductible per member applies before the following

Tier2: (Formulary Brand name drugs)

$40 copay

Tier3 : (Non-Formulary Brand name drugs)

$60 copay

Specialty:

25% Coinsurance up to a $2,500 Annual OOP Max (the most you’ll have to pay), in-network only and in addition to $500 annual deductible $20 copay (deductible waived) for vision exam only

Benefits shown are in-network

SmartSense Plus

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**Choice of 4 new deductibles**

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Choice of standard or upgrade drug coverage

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“Embedded” family deductible and out-of pocket maximum

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3 office visits before deductible

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No maternity coverage

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100% Preventive care

Benefits shown are in-network

SmartSense Plus

Annual Out-of-Pocket Maximum Single/Family (in addition to deductible)

$3,500/$7,000

Annual Deductible

$1,000, $2,000, $3,500 or $6,000 (single) $2,000, $4,000, $7,000 or $12,000 (family)

Office Visits Preventive Care

3 before deductible w/ $30 copay, then 30% after deductible Includes all nationally recommended preventive services including well child care, immunizations, PSA screenings , PAP tests, mammograms and more.

0% Coinsurance, not subject to deductible

Hospital In/Outpatient Drug Benefits Standard Upgrade

30% after deductible

Generic: Brand/Specialty:

$15 copay $7,500 annual brand deductible per member, then: $40 copay (formulary brand), $60 copay (non-formulary brand), Specialty 25% up to $2,500 annual OOP max. (plus $7,500 deductible)

Generic:

$15 copay

Brand/Specialty:

$500 annual brand deductible per member, then: $40 copay (formulary brand), $60 copay (non-formulary brand), Specialty 25% up to $2,500 annual OOP max. (plus $500 deductible)

Maternity

Not covered

Benefits shown are in-network

Lumenos HSA Plus

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Consumer-Driven Health Plans (CDHPs

)

HSA-compatible 100% coverage after deductible Preventive care benefits Various deductible options Special programs for Smoking Cessation and Weight Management Powerful online health management tools

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Access to our 24-Hour nurse Line

Benefits shown are in-network

Lumenos HSA Plus HSA Account Annual Out-of-Pocket Maximum (in addition to deductible) Annual Deductible Coinsurance after deductible Office Visits Preventive Care (nationally recommended services) Hospital In/ Outpatient Maternity Drug Benefits

   Funded by subscriber, up to maximum limit set by U.S. Treasury Unused dollars rollover year-to-year Subscriber “owns” HSA 0% Single: $3,000/$4,500/$5,950 Family: $3,500/ $5,500 (Aggregate Deductible) or Family: $7,500/$11,900 (Embedded Deductible) 0% 0% $0 (deductible waived) 0% Not covered 0%

Benefits shown are in-network

Lumenos HSA Plus Examples – 2 members on policy Lumenos HSA Plus $3500 (aggregate)

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Husband meets $1750

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After wife meets other $1750, they both are covered at 100%

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Family deductible can also be met by just one family member (example once husband meets $3500 both him and his wife will be covered 100%)

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Lumenos HSA Plus $7500 (embedded) Husband meets $3750 (half of the family deductible) then he is covered 100%

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After wife meets the additional $3750, she gets covered 100% ***Please note examples given are based on In-Network benefits

Lumenos Health Savings Account (HSA)-Compatible HSA Account Annual Out-of-Pocket Maximum/Member (in addition to deductible) Annual Deductible Coinsurance after deductible Office Visits Preventive Care (nationally recommended services) Hospital In/ Outpatient Maternity Drug Benefits

 Funded by subscriber, up to maximum limit set by U.S. Treasury  Unused dollars rollover year-to-year  Subscriber “owns” HSA $3,500 (single) $7,000 (family) $1,500 (single) $3,000 (family maximum) 30% 30% after deductible 0% (deductible waived) 30% after deductible Not covered 30% after deductible

Benefits shown are in-network

CoreGuard Plus

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Higher percentage of member cost sharing in exchange for lower premiums Choice of 5 deductibles Full drug coverage “Embedded” family deductible and out-of-pocket maximum No maternity coverage Inpatient/outpatient facility copays for 3 lowest deductibles Separate in-network and out-of-network deductibles and out-of pocket maximums

Benefits shown are in-network

CoreGuard Plus

Annual Out-of-Pocket Maximum Single/Family (in addition to deductible) Annual Deductible Office Visits Preventive Care Inpatient/Outpatient Drug Benefits Maternity

$3,500/$7,000 $750, $1,500, $2,500, $3,500, $5,000 (single) $1,500, $3,000, $5,000, $7,000, $10,000 (family) 50% after deductible Includes all nationally recommended preventive services including well child care, immunizations, PSA screenings , PAP tests, mammograms and more.

0% Coinsurance, not subject to deductible 50% after deductible plus: For $750/$1500/$2500 plans: $500 inpatient facility copay for first 3 days, $200 outpatient facility copay per admission

Generic: Brand name:

$15 copay $7500 annual brand deductible per member, then: $40 copay for brand name; $60 copay non-formulary 25% coinsurance for specialty up to $2500 annual drug out-of-pocket maximum in addition to $7500 deductible Not covered

Benefits shown are in-network

ClearProtection Plus

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Two deductible levels (negotiated rates apply before and after meeting deductible)

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Lower deductible for Inpatient/Outpatient Surgical and Emergency Room Higher deductible for Outpatient/Professional/Diagnostic (this deductible is equal to the plan out-of-pocket maximum) Two deductibles work together to meet out-of-pocket maximum 2 office visits before deductible Full drug coverage with unique formulary and $2000 brand/specialty deductible “Embedded” family deductible and out-of-pocket maximum No maternity coverage Coverage for generic and brand name prescription drugs

Benefits shown are in-network

ClearProtection Plus

Annual Out-of-Pocket Maximum (including deductible) Annual Deductible (inpatient/Outpatient Surgical/ER) Annual Deductible (outpatient/professional/diagnostic) Office Visits Preventive Care Inpatient/Outpatient Drug Benefits Maternity

$4,500/$6,800 (single) $9,000/$13,600 (family) $1,000 or $3,300 (single) $2,000 or $6,600 (family) $4,500/$6,800 (single) $9,000/$13,600 (family) 2 before deductible w/ $40 copay, then 0% after out-of-pocket met Includes all nationally recommended preventive services including well-child care, immunizations, PSA screenings , PAP tests, mammograms and more.

0% Coinsurance, not subject to deductible Inpatient/Outpatient Surgical/ER: 40% after deductible Outpatient professional/diagnostic services: 0% after out-of-pocket met

Generic: Brand name:

Benefits shown are in-network

Tonik

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Lowest out of pocket maximum 100% coverage after deductible/ out of pocket have been met Built in dental and vision benefits 100% preventive care coverage Non maternity coverage Generic prescription coverage $15 copay

Benefits shown are in-network

Tonik 5000

Annual Out-of-Pocket Maximum/Member (in addition to deductible) Annual Deductible Coinsurance after deductible Office Visits Preventive Care (nationally recommended services) Hospital In/ Outpatient Maternity Dental Vision Drug Benefits

$0 $5,000 0% $20 copay/first 4 visits, then 0% after deductible $0 (deductible waived) $0 after deductible Not covered $0 for cleanings, exams, and X-rays $25 for basic eyeglass lenses and receive up to $100 towards frames or $80 towards contact lenses every 24 months $15 for a 30-day supply

Benefits shown are in-network

PPO Plans PPO Share

(7500/5000/3500)

Comprehensive PPO plans

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Once deductible is met, member pays 0% or 30% co-insurance (depending on plan) for most covered services

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Deductible waived for office visits, annual physical exam and preventive care Maternity coverage Generic and Brand name prescription coverage

Benefits shown are in-network

PPO Share (7500/5000/3500)

Annual Out-of-Pocket Maximum (in addition to deductible) (2-member maximum, par/non-par) Annual Deductible (2-member maximum) Office Visits Preventive Care

(deductible waived)

Hospital In/ Outpatient Maternity Drug Benefits (Anthem Blue Cross Formulary) (2-member maximum for brand deductible) 7500 5000 3500

$0 per member $2,500 per member $4,000 per member $7,500 per member $40 copay

deductible waived

$5,000 per member $40 copay

deductible waived

$3,500 per member $40 copay

deductible waived

Includes all nationally recommended preventive services including well-child care, immunizations, PSA screenings , PAP tests, mammograms and more.

0% Coinsurance, not subject to deductible 30% of negotiated fee or 0% (with 7,500 deductible plan) 30% of negotiated fee or 0% (with 7,500 deductible plan) $15 generic or 40% which ever is greater; $15 generic or 40% which ever is greater; $15 brand copay or 40% which ever is greater after $750 brand deductible $15 generic; $35 brand copay after $750 brand deductible $15 brand copay or 40% which ever is greater after $750 brand deductible

Benefits shown are in-network

HMO Plans

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HMO Saver

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Individual HMO

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Select HMO

HMO Plans HMO Saver, Individual HMO, Select HMO

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First dollar coverage

on:   

Office visits Generic drugs Preventive care

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Unlimited office visits with set copays

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Coverage for services from doctors and hospitals in HMO network

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Comprehensive drug plan

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Maternity coverage

Benefits shown are in-network

HMO Plans

Annual Out-of-Pocket Maximum (in addition to deductible) Annual Deductible Office Visits (unlimited) Preventive Care HMO Saver Individual HMO Select HMO

$1500/member (2-member maximum) $3,000/member (2-member maximum) $1,500/member for Inpatient, Outpatient and ASCs only $10 copay/visit 0% Coinsurance, not subject to deductible No deductible $25 copay/visit 0% Coinsurance

Hospital In/Outpatient Maternity Drug Benefits (Anthem Blue Cross formulary) $1,500 deductible, then: Inpatient:

20% of negotiated fee

Outpatient:

20% of negotiated fee (emergency & non emergency services subject to deductible)

Inpatient:

20% of negotiated fee

Outpatient:

20% of negotiated fee

Inpatient:

$250 copay/day first 4 days; then covered at 100%

Outpatient:

20% of negotiated fee,

250/surgery Office visits: $10 copay Inpatient/Outpatient: 20% of negotiated fee, after deductible Office visits: $10 copay Inpatient/Outpatient: 20% of negotiated fee, after deductible Office Visits: $25 copay Inpatient: $250 copay per day up to the first 4 days, then 0% per admission

10 generic; $30 brand copay after $250 brand deductible (2-member maximum)

Benefits shown are in-network

Plan Options Based on Prospect’s Needs

If Main Need Is: Budget Immediate coverage for office visits before deductible Recommended Plans:

Tonik 5000, Premier PPO, ClearProtection Plus, CoreGuard Plus PPO Share and HMO (unlimited) Tonik 5000 (4 visits before deductible) Premier Plus (unlimited) ClearProtection Plus (2 visits before deductible) SmartSense Plus (3 visits before deductible) Individual HMO or Select HMO

No deductible 100% coverage of most services after deductible Control over finances, including health care expenses

Lumenos HSA plus Tonik 5000 Lumenos HSA Lumenos HSA Plus

Maternity coverage

PPO Share HMO

Benefits shown are in-network

Dental Plans Three Individual dental options:

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Dental Blue Basic*

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Dental Blue Enhanced*

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Dental SelectHMO**

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*Anthem Blue Cross Life & Health Insurance Company

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**Anthem Blue Cross

Dental Plans

Dental SelectHMO

Individual Life Insurance Term Life Insurance

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Anyone who qualifies for one of medical plans can purchase:

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$15,000, $30,000, $50,000, $75,000 or $100,000 (if over age 19) $15,000 or $30,000 (ages 1-19)

Health • Dental • Life Thank You for Selling Anthem Blue Cross!

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross names and symbols are registered marks of the Blue Cross Association.