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| BCBS
of Indiana Lumenos HSA Plan: |
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|
Features
|
Anthem
Lumenos HSA
|
| Lifetime
Maximum Benefit |
- Lumenos
Plans offer unlimited coverage |
| Doctor
Office Visits |
- 100%,
80% after deductible |
| Wellness
Benefit
* |
- 100%
All approved preventive care covered ** |
Prescription
Drugs
|
- 100%,
80% after deductible |
| Hospital
Services |
- 100%,
80% after deductible |
Plan
Deductible
This is the amount
you pay each calendar
year before benefits are paid. |
- Please run an instant
quote for deductibles in your area
|
| Chiropractic
Care |
- 100%,
80% after deductible |
Network
Coinsurance
This is the percentage of
covered medical
expenses Anthem pays after
the deductible is met. |
- 100%,
80% after deductible |
Non-network
Coinsurance
If you go out of network,
this is the limit of
covered medical expenses
you pay after the deductible is met. |
- 70%,
60% after deductible |
All
Other Services
|
- All
Covered Services, including prescription
drugs, are subject to deductible
and coinsurance. |
|
| * |
Children
services are not subject to deductible for age appropriate
visits and routine immunizations, and are subject
to the coinsurance limits of your plan. Age
specific mammogram screening and prostate screening
are covered and are not subject to deductible or
coinsurance. Maximum payment of $500 per year. |
| ** |
When
you use providers in the network, nationally recommended
preventive care services are paid for by Anthem,
at zero cost to you. |
This
information is presented only as a very brief overview
of some of the benefits of this plan, and is intended
only for general education. The amount of benefits
provided depends on the plan selected. Premium will
vary with the type of benefits selected. These
plans contain exclusions from and limitations of coverage.
Please see the product brochure for more complete
information, as well as information about terms of
renew ability, preexisting conditions, out-of-network
penalties, and notification requirements. Plans
are subject to health underwriting. To be considered
for reimbursement, expenses must qualify as covered
expenses. Expenses are also subject to reasonable
and customary limits, unless you use a network, and
all other policy provisions, including determinations
of medical necessity.
Coverage
Synopsis:
The
Blue Cross Blue Shield of Indiana Lumenos HSA
plan is available in a 100% or an 80/20 version.
100%
Plan: this option pays 100% of all covered expenses
up to the lifetime maximum after your deductible has
been met.
80/20
Plan: this option pays 80% of all covered expenses
up to $3,000 for individuals and $6,000 for families,
after the deductible has been met, then 100% up to
the lifetime maximum. Your out of pocket maximum
is $5,000 for individuals and $10,000 for families
with in-network services.
The
deductible for each of these plans needs to be met
only once for the entire family. Please run
an instant
quote for deductibles in your area.
All
nationally recommended preventive care services are
100% covered.
You
choose your own doctor and you never need referrals-but
when you use Anthem's network providers, you can save
money by receiving Anthem's negotiated discounts on
services and prescriptions.
You'll
have access to these exclusive Health Tools and
Personalized Services:
- An
online Health Assessment designed to help you measure
your overall health.
-
A Personal Health Coach Program, Smoking Cessation
Program, and Weight Management Program.
- 24-Hour
Nurse Advice Line when you need a quick answer to
a routine health question or advice on a medical
issue.
-
An online health site with tools and information,
including network provider listings, hospital quality
ratings, prescription drug costs, wellness articles,
and much more.
Plan
Options :
|
Choose
the Best Individual Plan for
You
|
|
Deductible
|
Coinsurance
amount plan pays
in-network/out-of-network after
deductible is met
|
Annual
Out-of-pocket Maximum
|
|
$1,500
|
100%
/ 70%
|
$1,500
|
|
$1,500
|
80%
/ 60%
|
$5,000
|
|
$3,000
|
100%
/ 70%
|
$3,000
|
|
$3,000
|
80%
/ 60%
|
$5,000
|
|
$5,000
|
100%
/ 70%
|
$5,000
|
|
|
|
|
Choose
the Best Family Plan for You
|
|
Deductible
|
Coinsurance
amount plan pays
in-network/out-of-network after
deductible is met
|
Annual
Out-of-pocket Maximum
|
|
$3,000
|
100%
/ 70%
|
$3,000
|
|
$3,000
|
80%
/ 60%
|
$10,000
|
|
$6,000
|
100%
/ 70%
|
$6,000
|
|
$6,000
|
80%
/ 60%
|
$10,000
|
|
$10,000
|
100%
/ 70%
|
$10,000
|
|
|
|
Note:
Please run an instant
quote for exact deductibles in your area.
Lumenos
HAS also offers an optional maternity rider that is
subject to a 12-month waiting period.
Blue
Preferred Term Life plan is also available with most
individual medical plans. A great benefit is
that there will be no medical exams or the need to
fill out additional forms. The bills for your
health insurance and life insurance will be billed
on one statement. Check out more information
at Blue
Preferred® Term Life.
Also
available with Lumenos is Dental Blue. Your
coverage is 100% for preventative and diagnostic care
when you see a network provider. Check out more
information at Dental
Blue®.
Rate
Information:
Rates
are available on our instant
quote page. Rates are regulated by state
law, and no one offers lower rates than HSA
for America.
Rates
are the same throughout Indiana, and don't change
by zip code or effective date. Though rates
may change at any time, readjustments typically occur
on January 1st of each year.
The
premium can be paid monthly, quarterly, semi-annual,
or annual billing, or a monthly bank draft. The
bank draft will occur on either the first or the sixteenth
of each month. The initial premium can be paid
with a check or credit card.
PPO
Network:
Anthem
gives you access to one of the largest networks in
Indiana, with nearly 8,500 health care providers
and over 60 hospitals throughout the state. The
large list of doctors and hospitals can be viewed
at the Anthem
PPO Online Provider Directory.
Make sure to choose the "BluePreferred
PPO" plan. Policyholders can go to Blue
Cross doctors anywhere in the country, and can even
access a world-wide network.
Underwriting:
The
underwriting process is very fast if no medical records
are needed. While it is always a good idea to
apply at least three weeks prior to the time you need
your new coverage to take effect, most applications
that are done online are approved by Anthem within
24 hours. If medical records must be ordered,
the application process will take longer.
The
company does have the right to accept or decline any
individual or family application. Certain conditions
may be waivered with a temporary rider (usually for
one to two years), or an indefinite rider. If
you are currently being treated for depression, anxiety,
or high cholesterol, please let us know before you
apply so we can avoid unnecessary delays in getting
you covered.
For
an infant less than 6 months of age, Anthem requires
nursery records from the hospital where the infant
was born, office records from the infant’s pediatrician,
and results of the newborn screening laboratory tests
(available from the hospital or pediatrician).
Anyone
applying for Anthem coverage that has any of the
following pre-existing conditions also needs to
complete the appropriate form and return it to our
office via fax toll
free at 1-866-284-0082
as promptly as possible.
Effective
dates:
The
coverage can go into effect in as quickly as 24 hours,
though the applicant risks being declined if claims
are submitted before the underwriting process is completed.
You may request an effective date any time after the
date you sign the application and 60 days later. Please
note that you will be billed starting on your requested
effective date, even if you have not yet been notified
that you have been approved. This is very good
for someone who does not have any present coverage
and would like for their benefits to begin right away.
For those who are already covered, it is suggested
that you maintain your current coverage in force until
you have received notice from either HSA
for America
or directly from Anthem that your policy has
been approved and is in force.
Your
earliest possible effective date will be the day after
Anthem has received all the necessary documents and
information needed to process your application.
HSA
Administrator
You
may set up your health savings account with any qualified
HSA trustee or administrator, regardless from which
insurance company your purchase your HSA-qualified
health insurance. We recommend that you set
up your HSA separate from your health insurance, and
choose an administrator from our HSA
administrator page.
Anthem
Blue Cross and Blue Shield has chosen JPMorgan Chase
to be their administrator of choice. If you
would like to set up your health savings account with
JPMorgan Chase, you may submit your HSA application
together with your health plan application.
The Anthem-sponsored JPMorgan Chase HSA has the following
fees:
-
Account set-up fee: $20.00 one time
- HSA
administration fee: $3.00 per month
- ATM
usage fee: $1.00 per transaction
- Check
book issuance (if requested): $9.95 per check
book
- Convenience
check fee: $0.25 per check processed
- Duplicate
check fee: $10.00 per duplicate check
- Account
closing fee: $20.00
About
Blue Cross Blue Shield of Indiana:
The
company known today as Anthem is the outgrowth of
two Indianapolis-based corporations formed in 1944
and 1946 as mutual insurance companies. Those
two companies were created to provide health insurance
to residents of Indiana as Blue Cross Blue Shield
of Indiana. In the mid-1980s, Blue Cross and
Blue Shield of Indiana began to diversify and expand,
primarily through Blue Cross and Blue Shield mergers
and acquisitions. The Anthem Blue Cross and
Blue Shield companies are independent licensees of
the Blue Cross and Blue Shield Association and currently
serve more than 12.6 million customers in nine different
states.
Anthem
is listed on the New York Stock Exchange under the
trading symbol ATH, and is the fifth largest publicly
traded health benefits company in the United States.
Anthem
Blue Cross Blue Shield of Indiana has been
assigned a rating of "A" (Excellent)
from the A.M.
Best Company, an independent insurance rating
organization.
HSA
for America is an independent authorized
Anthem Blue Cross Blue Shield of Indiana agent.
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