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California Health Insurance > Anthem Blue Cross > SmartSense Plus
Anthem Blue Cross SmartSense Plus
The Smart Sense Plus Individual and Family PPO plans from Anthem Blue Cross of California are the most popular of the plans currently offered. They have a low monthly premium and reasonable benefits. Doctor visits are limited to three per year before the deductible applies. You can select one of two prescription benefit options: the lower cost one has brand Rx after a $7500 calendar year deductible; and the other more expensive plan has a $500 brand Rx deductible. The plans are easy to understand because the medical deductible is added to the $3,500 per calendar year Out-of-Pocket Maximum. The lifetime maximum benefit is unlimited and there is no copayment for preventative services. No maternity benefits are available on this plan.
Key Benefits (as of April 2011)
- Deductible - $1000, $2000, $3500, $6000
- Out of Pocket max - $3500 (in addition to the deductible)
- Coinsurance - 30% after deductible has been met
- Lifetime max - Unlimited
Covered Service before the deductible
- Office Visit - $30 Copay (3 visit per year, per member)
- Additional visits 30%
- 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 - 30% Coinsurance
- (X-ray, lab, anesthesia, surgeon, etc.)
- Emergency Room Services - $100 Copay plus 30% Coinsurance
- Outpatient Services - 30% Coinsurance
- (Without overnight hospital / facility stays)
- Inpatient Services - 30% Coinsurance
- (Overnight hospital / facility stays)
Services Not Covered
Prescription Drug Coverage
- Standard Drug Coverage
- Tier 1 (generic drugs) $15 Copay
- Tier 2 (brand name drugs) $40 Copay after $7500 deductible
- Tier3 (non formulary drugs) $60 Copay after $7500 deductible
- Specialty drugs 25% coinsurance up to a $2500 annual out-of-pocket maximum, in addition to the $7500 deductible.
- Upgrade Drug Coverage
- Tier 1 (generic drugs) $15 Copay
- Tier 2 (brand name drugs) $40 Copay after $500 deductible
- Tier 3 (non formulary drugs) $60 Copay after $500 deductible
- Specialty drugs 25% coinsurance up to a $2500 annual out-of-pocket maximum, in addition to the $500 deductible.
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