Anthem Indiana- Discontinued Plans

Anthem Blue Cross and Blue Shield – Plan Descriptions

Anthem Blue Cross and Blue Shield is the largest health insurance company in the state with over 5.5 million members. They offer health plans that can be customized for individuals, children, and families that include consumer-driven plans, Health Savings Accounts, dental plans, and short-term medical plans, and Medicare Supplements. The different plans are described below

Premier Plus Plan

The Premier Plus plan is Anthem’s most comprehensive policy. Doctor’s office visit coverage (number of visits) is unlimited with a $30 copay for primary care physician visits and a $40 copay for specialist visits. This coverage also can be removed.

Two prescription benefits are available (Standard and Upgrade). The standard benefit includes a $250 deductible (per person) for brand-name drugs for Tiers 2, 3 & 4. The upgrade benefit provides a broader coverage and potentially lower out-of-pocket costs on expensive drugs.

Major medical deductible options for this Anthem Indiana plan range from $500 to $10,000 with a 20% coinsurance (capped). A 0% coinsurance option is also available with the higher deductibles. Naturally, higher deductibles will substantially reduce the rate.

Nationally recommended preventive services are covered at 100% with no waiting period, deductible or coinsurance. Some of these services include Pap tests, mammograms, annual routine physicals, immunizations, well-child care and PSA screenings.

Premier Plus Plan highlights include:

• Blue Access PPO network
• $30 office visit copayment, $40 specialist copay
• Prescription drug co-payment card for generic and brand name drugs (deductible waived), prescription upgrade available
• Optional maternity coverage
• Choice of 100% or 80% coinsurance
• Preventive care covered at 100% for adults and children

SmartSense Plus Plan

Our Rating:

The SmartSense plan provides coverage for 3 office visits per year to a primary care physician or specialist with a $35 office visit copay. Additional doctor visits are subject to the plan deductible.

A “Standard” and “Upgrade” prescription benefit is available. If the “Standard” option is selected, Non-Formulary drugs will only receive the Anthem negotiated discount. The “Upgrade” benefit includes a combination of copays and coinsurance, depending on the type of drug.

Preventive benefits are also included at 100% coverage with no waiting periods, copays or coinsurance. Unlike the Premier Plus plan, maternity benefits are not available as a rider. However, dental and vision riders are available on both the plans.

The Anthem Indiana SmartSense plan costs substantially less than the Premier Plus plan and is recommended for persons that want affordable coverage without some extra benefits that may not be used.

SmartSense Plan Highlights include:

• Limited $35 office visit co-pay benefit (3 visits per year)
• Choice of 70% or 50% coinsurance
• Access to the Blue Access PPO Network
• Standard Drug Coverage – $15 presciption co-payment for generic drugs, member is responsible for entire cost of drugs not on the formulary after applied Anthem discount
• Upgrade Drug Coverage – $15 presciption co-payment for generic drugs, greater of $30 co-pay or 40% coinsurance for brand drugs after $250 Rx Deductible per member
• Unlimited lifetime maximum

The SmartSense Plans do NOT cover:

• Maternity Benefits
• Brand name drugs unless the optional drug coverage upgrade is selected

CoreShare Plan

The Coreshare plan is an inexpensive plan that also has higher out-of-pocket costs for many covered benefits. Coinsurance for many services is 50%. Also, a $750 facility copayment applies to outpatient surgeries and inpatient hospital visits for plan with a $5,000 deductible or less. Higher deductibles over $5,000 will not include this extra charge.

Although qualified preventive benefits are covered at 100%, non-preventive office visits are subject to a deductible. A $7,500, $10,000, $15,000, and $25,000 deductibles are available with a 0% coinsurance option.

CoreShare Plan Highlights include:

• 50% coinsurance for plans with a $5,000 deductible or less
• 100% coinsurance for plans with a deductibles over $5,000
• Access to the Blue Access PPO Network
• $15 presciption co-payment for generic drugs, greater of $15 or 40% coinsurance for all other formulary drugs
• 100% coverage for extensive preventive care services (deductible waived)
• Unlimited lifetime maximum

Blue Access Value Plan

The Blue Access Value Plan is Anthem’s least expensive PPO plan, but provides more comprehensive benefits than the Economy Plan. The Blue Access Value Plan costs less because it has much higher deductibles.

The Blue Access Value Plan highlights include:

• Limited $30 office visit co-pay benefit (3 visits per year)
• Blue Access PPO Network
• Presciption co-payments for generic and brand name drugs ($500 combined annual maximum Rx benefit)
• $5,000,000 lifetime maximum
• Preventive care for adults (does not include preventive care for children)
• Mental health and substance abuse benefits

Lumenos HSA Plans

Anthem Lumenos Plans are consumer-driven health plans that give you more control and information to help maintain and improve your health. The plans utilize Health Savings Accounts (HSAs) and Health Incentive Account (HIA) plans to help control your health care costs while still providing great, comprehensive coverage. These plans include:

• 100% coverage for recommended preventive care (including annual physicals) when you see an in-network provider (deductible waived)
• Traditional Health Coverage to help cover additional health care expenses
• A single customer service organization for both the health insurance and the health account components of Lumenos plans

Lumenos HSA Plan 1

Lumenos HSA Plan 1 is a health savings account (HSA) plan that provides generous, comprehensive benefits after the deductible is satisfied. It features the highest level of benefits of any HSA plan offered by Anthem Blue Cross and Shield in Indiana.

Lumenos HSA Plan 1 highlights include:

• Access to Blue Access PPO network
• 100% coverage for extensive preventive care services
• 100% coverage after satisfaction of deductible
• Unlimited lifetime maximum benefit

HSA Administration

Setting up a Health Savings Account (HSA) is optional, but it is highly recommended in order to utilize the tax advantages of this plan. If you want to open an HSA, you have the option of electing Anthem’s integrated HSA from Mellon Bank or any bank or financial institution of your choice. However, there are some advantages of electing Anthem’s integrated HSA from Mellon Bank, which they will help set up your account during the application process.

Lumenos HSA Plan 2

Lumenos HSA Plan 2 is cheaper version of HSA Plan 1 above because it provides 80% coverage instead of 100% coverage after the deductible

Lumenos HSA Plan 2 highlights include:

• Access to Blue Access PPO network
• 100% coverage for extensive preventive care services
• 80% coverage after satisfaction of deductible
• More competitive pricing
• Unlimited lifetime maximum benefit

HSA Administration

Setting up a Health Savings Account (HSA) is optional, but it is highly recommended in order to utilize the tax advantages of this plan. If you want to open an HSA, you have the option of electing Anthem’s integrated HSA from Mellon Bank or any bank or financial institution of your choice. However, there are some advantages of electing Anthem’s integrated HSA from Mellon Bank, which they will help set up your account during the application process.