Anthem Blue Cross - California
SmartSense PPO Plans
Its All About the Bottom Line....
Anthem BC Life & Health Insurance Company brings you the new SmartSense PPO plan for individuals. SmartSense offers solid protection that covers the essentials of full medical at one of thier lowest rates. Members can choose dedictibles from as low as $500 and up to $5,000 with premium levels that work for you making it even more budget-friendly.
SmartSense is a smart choice for you if this is what they want:
Low monthly rates
Full medical benefits
Four annual deductible options, ranging from $500 to $5,000
Immediate benefits for first three visits to a doctor
Choice of comprehensive or generic only prescription drug benefits
Access to our existing California PPO network
No maternity benefits
Up to $7,000,000 per member in lifetime benefits
What’s Different About SmartSense
Embedded (family) deductibles make it easier for families to satisfy deductible requirement:
Once any family member meets their single deductible, their deductible is satisfied
After one family member’s single deductible is satisfied, the family deductible can be met by one or more family members
Fourth quarter carry-over deductible feature
Separate in-network and out-of-network out-of-pocket maximums
No $500 per admittance charge for inpatient services or outpatient services related to surgery or infusion therapy at a participating hospital
Healthy Check and coverage for acupuncture and acupressure services are not included
Your clients’ annual out-of-pocket costs for brand name prescriptions are capped for their protection
SmartSense contract codes are based on:
Deductible
Rx selection
1 member vs. 2+ members
Each plan has a different contract code
How to Enroll
Enrolling is easy. Submit your application online by clicking the "APPLY NOW". If you have questions and would like an agent to contact you prior to applying then click on the Agent Assist link to the right or call us at 619.435.6700.
To enroll, you must be:
Age 64 3/4 or younger
A permanent legal resident of California
A U.S. resident for at least the lst 3 months
The applicant's spouse or domestic partner, age 64 3/4 or younger
The applicant's children (under 19 years of age), or the children (under 19 years of age) of the applicant's enrolling spouse or qualified partner or qualified domestic partner;
The applicant's unmarried dependent children between the ages of 19 through 22 ("dependent" as defined by the Internal Revenue Service)
Sales Assistance
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Anthem Blue Cross SmartSense PPO (To View Rates Popups must be enabled in your browser)
Lifetime Maximum (Combined for In-Network & Out-of-Network)
Health plan pays up to $7,000,000 per member
Annual Deductible Choices (Not combined for In-Network & Out-of-Network)
Single Member: $500 / $1,500 / $2,500 / $5,000
Family Member: $1,000 / $3,000 / $5,000 / $10,000
(Once 2 members each reach the deductible,
the deductible
is satisfied for the entire family.)
Single Member: $5,000
Family Maximum: $10,000
Annual Out-of-Pocket Maximum (in addition to deductible)
(Combined for In-Network & Out-of-Network)
$3,500/$5,000 per member, only hospital costs apply (Once 2 members each reach the maximum, the maximum is satisfied for the entire family)
Doctors' Office Visits
$30 copay for first three visits per member per year (deductible waived); after three visits and once deductible is met, then 30% of negotiated fee
50% of negotiated fee plus all excess charges
Professional Services (X-ray, lab, anesthesia, surgeon, etc.)
30% of negotiated fee
50% of negotiated fee plus excess charges
Hospital Inpatient (Overnight Hospital Stays)
30% of negotiated fee
All Charges except $650 per day
Hospital Inpatient (If You Don't Stay Overnight)
30% of negotiated fee
All Charges except $380 per day
Emergency Room Services
30% of negotiated fee
50% of customary and reasonable fees plus all excess charges
Maternity
Not Covered
Not Covered
Preventive Care
Annual physical exam(s): 30% of negotiated fee
Routine mammogram, Pap and PSA tests: 30% of negotiated fee (deductible waived)
Well Baby and Well Child (through age 6): 30% of negotiated fee
Annual physical exam(s): 50% of negotiated fee plus all excess charges
Routine mammogram, Pap and PSA tests: 50% of negotiated fee plus all excess charges
Well Baby and Well Child (through age 6): 50% of negotiated fee plus all excess charges
Ambulance
20% of negotiated fee
50% of negotiated fee plus all charges in excess of negotiated fee and in excess of the plan's $75 maximum payment per ground trip
30% of negotiated fee. Plan pays up to $2,500 per year for therapy and up to $500 per year for chiropactic services
50% of negotiated fee plus all excess charges. Plan pays up to $2,500 per year for therapy and up to $500 per year for chiropactic services
Prescription Drug
Coverage Options
In-Network (Receive negotiated savings)
Out-of-Network (Pay higher costs)
SmartSense with Generic Prescription Drug Coverage (Drugs on Generic Rx Formulary only)
Generic: $15 copay (or 40%, whichever is greater)
Generic: $15 copay (or 40%, whichever is greater)
SmartSense with Comprehensive Prescription Drug Coverage (Blue Cross Formulary Drugs)
Generic: $15 Copay (or 40%, whichever is greater)
$500 annual brand-name/specialty drug deductible (2 member maximum) applies before the following:
Brand-name: $15 copay (or 40%, whichever is greater); 40% of negotiated fee for self-administered injectables, except insulin.
Specialty: 40% - $4,500 annual out-of-pocket maximum (the most you will have to pay) (In-network only and in addition to brand-name/specialty drug deductible)
Generic: $15 Copay (or 40%, whichever is greater)
$500 annual brand-name/specialty drug deductible applies before the following:
Brand-name: $15 copay (or 40%, whichever is greater); 40% of negotiated fee for self-administered injectables, except insulin.
Specialty: Not covered
Consider Other Blue Cross of California PPO Plan Links
