smartsense ppo plans new plan design launched december 2007
TRANSCRIPT
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SmartSense Highlights
Reliable protection with some of our lowest monthly rates
Choice of annual deductible/monthly rate combination
In-network office visits available before deductible
Choice of prescription drug benefits (Generic Only or Comprehensive)
$7 million lifetime maximum benefit
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SmartSense Benefits
In-Network Out-of-Network
DeductibleIndividual/Family $5,000/$10,000
• Separate in-network and out-of-network deductibles
• Embedded (family) deductiblesOnce a member meets their single deductible, their deductible is satisfied. After any one family member meets the single deductible, then two or more family members can meet the family deductible.
• 4th Quarter carry-over deductible feature
4 OPTIONS
$500/$1,000
$1,500/$3,000
$2,500/$5,000
$5,000/$10,000
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SmartSense Benefits
In-Network Out-of-Network
Coinsurance 30% 50%
Annual OOP MaximumIndividual/Family
$2,500/$5,000 $10,000/$20,000
Lifetime Maximum $7 million
• Separate in-network and out-of-network OOP Maximum
• OOP maximum amount shown is in addition to deductible
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In-Network Out-of-Network
Physician Office Visits
$30 copay for first 3 visits
then in-network deductible and 30% coinsurance
50% coinsurance after out-of-network
deductible plus all excess charges
In/Outpatient Hospital Care
30% coinsurance after in-network deductible
IP: All charges except $650/day
OP: All charges except $380/day
Emergency Care additional $100 co-pay per ER visit (waived if admitted)
30% coinsurance after in-network deductible
50% coinsurance after out-of-network
deductible plus all excess charges
Maternity Not Covered Not Covered
SmartSense Benefits
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SmartSense Benefits
In-Network Out-of-Network
Routine Care
Routine Mammogram
Routine Pap Smear & PSA
Routine Colorectal Cancer Screenings
Preventive Care & Immunizations for Children (Birth to 6 years)
30% coinsurance after in-network
deductible
50% coinsurance after out-of-networkDeductible plus all
excess charges
• 3 office visits before deductible
• HealthyCheck not available
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SmartSense Benefits
In-Network Out-of-Network
Ambulance Services30% coinsurance after in-network deductible
50% coinsurance* after out-of-network deductible
Acupuncture/Acupressure
Not Covered Not Covered
Chiropractic Care30% coinsurance after in-network deductible,
$500 limit
50% coinsurance* after out-of-network deductible,
$500 limit
Outpatient Speech/Physical/
Occupational Therapy
30% coinsurance after in-network deductible,
$2,500 limit
50% coinsurance* after out-of-network deductible,
$2,500 limit
*Plus all excess charges
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SmartSense BenefitsPharmacy Benefits
In-Network Out-of-Network
GenericDrugs on
Generic Rx Formulary Only
$15 co-payment or 40% coinsurance
(member pays whichever is greater)
$15 co-payment or 40% coinsurance
(member pays whichever is greater)
Brand NameNot Covered
Discount AvailableNot Covered
Generic Rx Only
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In-Network Out-of-Network
Generic $15 co-payment or 40% coinsurance
(member pays whichever is greater)
$15 co-payment or 40% coinsurance
(member pays whichever is greater)
Brand Name $500 annual brand-name/ specialty deductible, then
$15 co-payment or 40% coinsurance
(whichever is greater)
$500 annual brand-name deductible, then
$15 co-payment or 40% coinsurance
(whichever is greater)
SmartSense BenefitsPharmacy Benefits
Comprehensive Rx
2-member maximum on
deductible
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In-Network Out-of-Network
Generic $15 co-payment or 40% coinsurance
(member pays whichever is greater)
$15 co-payment or 40% coinsurance
(member pays whichever is greater)
Brand Name $500 annual brand-name/ specialty deductible, then
$15 co-payment or 40% coinsurance
(whichever is greater)
40% of negotiated fee for Specialty Drugs and
self-administered injectables, except insulin
$4,500 annual OOP Maximum
$500 annual brand-name deductible, then
$15 co-payment or 40% coinsurance
(whichever is greater)
40% of negotiated fee for self-administered injectables,
except insulin
No Specialty Drug Coverage
SmartSense BenefitsPharmacy Benefits
Comprehensive Rx
Specialty Drugs include injected, infused, oral
and inhaled medications that generally need
to be closely monitored by the member’s doctor.
The most a member would have to pay. This is in addition to the deductible.
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Selling SmartSense
One of our lowest priced plans with solid protection
that covers the essentials
In-network office visits available before deductible
$500 - $5,000 range of deductibles
Embedded deductible
Choice of annual deductible/monthly rates to fit any budget
Choice of prescription drug benefits (comprehensive or generic only)
Lifetime maximum benefits of $7,000,000
4th Quarter deductible carry-over
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Gender Rating
• Allows us to more appropriately and accurately rate by gender
Single Age Bands
• Smaller age-related increases than for plans with multi-year age bands
Rates by Number of Members
• For one-member contracts, there is one set of rates
• For two or more SmartSense members on a contract, there is a discounted rate
Rating Differences
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Questions?
Thank you!
The SmartSense plans are offered by Anthem Blue Cross Life and Health Insurance Company. Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ® ANTHEM is a registered trademark. ® The Blue Cross name and symbol are registered marks of the Blue Cross Association.