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Anthem Blue Cross and Blue Shield of Indiana Premier Plus 100% Upgrade Rx – Indiana Health Insurance Plan

A detailed comparison of the Anthem Blue Cross and Blue Shield of Indiana Premier Plus 100% Upgrade Rx health insurance plan as offered in Indiana is listed below for both Network and Non-Network coverage. This is a review of the coverage for this specific Anthem Blue Cross and Blue Shield of Indiana plan. However, GoHealthInsurance offers a large variety of health insurance options to fit your needs. If you wish, get a new Anthem Blue Cross and Blue Shield of Indiana health insurance quote for Indiana now or view all of our Anthem Blue Cross and Blue Shield of Indiana health insurance quotes.

  Network Non-Network
Copay $30 PCP / $40 Specialist N/A
OfficeVisit
  • $30 PCP / $40 Specialist
  • Other Services: 0% after deductible
    		•  40% after deductible
    Deductible false Individual: $2,500, Family: $5,000 Individual: $2,500, Family: $5,000
    Coinsurance 0% 40%
    Coinsurance Limit
    Out-of-Pocket Maximum N/A N/A
    Lifetime Maximum Unlimited Unlimited
    Prescription Drugs Retail (30 day supply) -
    • Tier 1 - $15 per prescription
    • Tier 2 - $30 per prescription
    • Tier 3 - $60 per prescription
    • Tier 4 - Member pays 25% per prescription ($2,500 OOP max.)
    Mail Service (90 day supply) -
    • Tier 1 - $3
    		 Retail (30 day supply) -
    • Tier 1 - 50% with a minimum of $60, no maximum
    • Tier 2 - 50% with a minimum of $60, no maximum
    • Tier 3 - 50% with a minimum of $60, no maximum
    • Tier 4 - 50% with a minimum of $60, no maximum
  • Member i
    		•
    Emergency Room 0% after deductible 0% after deductible (Member is responsible for charged amount that exceeds Anthem's maximum allowable amount.)
    Adult Preventative Care Includes all nationally recommended preventive services including immunizations, PSA screenings, Pap tests, mammograms etc.: No deductible, copay, or coinsurance Includes all nationally recommended preventive services including immunizations, PSA screenings, Pap tests, mammograms etc.: 40% after deductible
    Child Preventative Care Includes all nationally recommended preventive services including well-child care, immunizations, etc.: No deductible, copay, or coinsurance Includes all nationally recommended preventive services including well-child care, immunizations, etc.: 40% after deductible
    Lab / X-Ray 0% after deductible 40% after deductible
    Maternity Optional Benefit Optional Benefit
    Physical Therapy 0% after deductible (PT/Spinal Manipulation Therapy - 20 visits combined) 40% after deductible (PT/Spinal Manipulation Therapy - 20 visits combined)
    Home Health Care 0% after deductible (Home Health Care Limited to 60 visits. Infusion Therapy does not count toward the limit.) 40% after deductible (Home Health Care Limited to 60 visits. Infusion Therapy does not count toward the limit.)
    Mental Health 0% after deductible 40% after deductible
    Hospital Care 0% after deductible 40% after deductible
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