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California Health Insurance > Anthem Blue Cross > ClearProtection $5000 Plus
Anthem Blue Cross ClearProtection $5000 Plus
Key Benefits (as of April 2011)
- Deductible - $5,000 (For Inpatient/Surgical and Emergency Room Services) OR
- $8,500 (For Outpatient/Professional and Diagnostic Services)
- Out of Pocket max - $8,500 (this amount includes the deductibles)
- Coinsurance - 40% (For Inpatient/Surgical and Emergency Room Services)
- 0% (For Outpatient/Professional and Diagnostic Services)
- Lifetime max - Unlimited
Covered Service before the deductible
- Office Visit - $40 Copay (2 visits per year, per member)
- Additional visits 100% of negotiated fee, then 0% after out of pocket is met
- Preventive Care - No Charge (Includes all nationally recommended preventive services including Pap testing, mammograms, PSA screening, immunizations, well-child care and more)
Covered Service after deductible has been met
- Professional and Diagnostic - Inpatient: 40% Coinsurance
- Outpatient: 100% of negotiated fee, then 0% Coinsurance after out of pocket is met
- Emergency Room Services - 40% Coinsurance plus $100 Emergency Room Copay
- Outpatient Services - Surgery: 40% Coinsurance
- Other Service: 100% of negotiated fee, the 0% Coinsurance after out of pocket is met
- Inpatient Services - 40% Coinsurance
Services Not Covered
Prescription Drug Coverage
- Tier 1 (generic drugs) $15 Copay
- Tier 2 (brand name drugs) $40 Copay after $7,500 deductible
- Tier 3 (non formulary drugs) $60 Copay after $7,500 deductible
- Specialty drugs 25% coinsurance up to a $2,500 annual out-of-pocket maximum, in addition to the $7,500 deductible.
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