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Anthem Blue Cross and Blue Shield of Ohio SmartSense Plus Upgrade Rx – Ohio Health Insurance Plan

A detailed comparison of the Anthem Blue Cross and Blue Shield of Ohio SmartSense Plus Upgrade Rx health insurance plan as offered in Ohio 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 Ohio 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 Ohio health insurance quote for Ohio now or view all of our Anthem Blue Cross and Blue Shield of Ohio health insurance quotes.

  Network Non-Network
Copay $35 N/A
OfficeVisit Office Visit Copayment for first 3 visits: $35 copayment, deductible waived, for first 3 visits per member per calendar year for primary care physician/specialist
  • Other Office Services: Subject to deductible and 30% coinsurance
Office Visit 		50% coinsurance after deductible
Deductible false Individual: $10,000, Family: $20,000 Individual: $10,000, Family: $20,000
Coinsurance 30% 50%
Coinsurance Limit
Out-of-Pocket Maximum N/A N/A
Lifetime Maximum Unlimited Unlimited
Prescription Drugs Upgrade Drug Coverage -
  • Separate $250 per member deductible for Tiers 2, 3 and 4. Member is also responsible for the difference in allowable charge between Brand and Generic, plus copayment or coinsurance
  • Retail (30-day supply) -
    • Ti
 Upgrade Drug Coverage - Retail (30-day supply only): 50% coinsurance (minimum $60) per prescription (Mail Order not covered)
Emergency Room 30% coinsurance after deductible 30% coinsurance after deductible
Adult Preventative Care Covers all nationally recommended preventive care services, including immunizations, PSA screenings, Pap tests, mammograms and more: 0% coinsurance, not subject to deductible Covers all nationally recommended preventive care services, including immunizations, PSA screenings, Pap tests, mammograms and more: 50% coinsurance after deductible
Child Preventative Care Covers all nationally recommended preventive care services, including well-child care, immunizations, and more: 0% coinsurance, not subject to deductible Covers all nationally recommended preventive care services, including well-child care, immunizations, and more: 50% coinsurance after deductible
Lab / X-Ray 30% coinsurance after deductible 50% coinsurance after deductible
Maternity Not Covered, except covered for complications of pregnancy only. Not Covered, except covered for complications of pregnancy only.
Physical Therapy 30% coinsurance after deductible (PT/Spinal Manipulation Therapy - 20 visits combined) 50% coinsurance after deductible (PT/Spinal Manipulation Therapy - 20 visits combined)
Home Health Care 30% coinsurance after deductible (Home Health Care Limited to 60 visits. Infusion Therapy does not count toward the limit.) 50% coinsurance after deductible (Home Health Care Limited to 60 visits. Infusion Therapy does not count toward the limit.)
Mental Health
Hospital Care
  • Professional and Diagnostic Services (X-ray, lab, anesthesia, surgeon, etc.): 30% coinsurance after deductible
  • Inpatient Services (overnight hospital/facility stays): 30% coinsurance after deductible
  • Outpatient Services (without overnight h
    		•
  • Professional and Diagnostic Services (X-ray, lab, anesthesia, surgeon, etc.): 50% coinsurance after deductible
  • Inpatient Services (overnight hospital/facility stays): 50% coinsurance after deductible
  • Outpatient Services (without overnight h
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