Anthem Blue Cross and Blue Shield of Virginia SmartSense with Enhanced Drug – Virginia Health Insurance Plan
A detailed comparison of the Anthem Blue Cross and Blue Shield of Virginia SmartSense with Enhanced Drug health insurance plan as offered in Virginia 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 Virginia 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 Virginia health insurance quote for Virginia now or view all of our Anthem Blue Cross and Blue Shield of Virginia health insurance quotes.
| Network | Non-Network | |
|---|---|---|
| Copay | $35 | $35 |
| OfficeVisit | Office Visits: Office Visit Copay for the first 3 yearly visits: $35 copay deductible waived, for primary care physician or specialist visits; Office Visit Coinsurance for remaining visits: 30% after deductible | Office Visits: 50% after deductible |
| Deductible false | Individual: $2,500, Family: $5,000 | Individual: $2,500, Family: $5,000 |
| Coinsurance | 30% | 50% |
| Coinsurance Limit | ||
| Out-of-Pocket Maximum | ||
| Lifetime Maximum | Unlimited | Unlimited |
| Prescription Drugs | Retail Drugs and Mail Order Drugs when available; For Generic and Brand Name Drugs: $15 copay or 40% coinsurance, whichever is greater; For Specialty Drugs: 40% coinsurance | Retail Drugs and Mail Order Drugs when available; For Generic and Brand Name Drugs: $15 copay or 40% coinsurance, whichever is greater; For Specialty Drugs: 40% coinsurance; Member is responsible for filing the claim and for the difference between the pha |
| Emergency Room | Emergency Room (Medical Emergency or Accident): 30% after deductible; Emergency Room (Non-Medical Emergency or Non-Serious Accidental Injury): 30% after deductible; Ambulance Services: 30% after deductible | Emergency Room (Medical Emergency or Accident): 30% after deductible; Emergency Room (Non-Medical Emergency or Non-Serious Accidental Injury): 50% after deductible; Ambulance Services: 50% after deductible |
| Adult Preventative Care | Member pays 0% (Deductible waived); Routine Mammmogram Screenings - 1 per year per member for ages 35 & older (in and out of network combined); Routine Office Visits (office visit only) - Unlimited visits; Routine Pap Test - 1 per year per member (in and | Member pays 50%; Routine Mammmogram Screenings - 1 per year per member for ages 35 & older (in and out of network combined); Routine Office Visits (office visit only) - Unlimited visits; Routine Pap Test - 1 per year per member (in and out of network comb |
| Child Preventative Care | Preventive Care Services - Preventive Care and Immunizations for Children age 6 and under (Includes coverage for office visits, lab tests, vision and hearing screenings and immunizations): 0% copay and deductible waived | Preventive Care Services - Preventive Care and Immunizations for Children age 6 and under (Includes coverage for office visits, lab tests, vision and hearing screenings and immunizations): 0% copay and deductible waived |
| Lab / X-Ray | Professional and Diagnostic Services (X-ray, lab, anesthesia, surgeon, etc.): 30% after deductible | Professional and Diagnostic Services (X-ray, lab, anesthesia, surgeon, etc.): 50% after deductible |
| Maternity | Complications of Pregnancy Only | Complications of Pregnancy Only |
| Physical Therapy | Outpatient Physical/Occupational Therapy: Member pays 30% after deductible; Limitations (in and out of network combined) - 20 visits per member, per calendar year | Outpatient Physical/Occupational Therapy: Member pays 50% after deductible; Limitations (in and out of network combined) - 20 visits per member, per calendar year |
| Home Health Care | Home Health Care: 30% after deductible (90 visit limit per year per person); Hospice: 30% after deductible | Home Health Care: 50% after deductible (90 visit limit per year per person); Hospice: 50% after deductible |
| Mental Health | Mental Health and Substance Abuse - Inpatient: 30% after deductible (25 day limit per year per person; 10 Inpatient days can converted to 15 partial days); Outpatient: Visits 1-3: Member pays $35 copay or 30% after deductible (deductible waived when there | Mental Health and Substance Abuse - Inpatient: 50% after deductible (25 day limit per year per person; 10 Inpatient days can converted to 15 partial days); Outpatient: 50% after deductible |
| Hospital Care | Inpatient Services (overnight hospital/facility stays): 30% after deductible; Outpatient Services (overnight hospital/facility stays): 30% after deductible | Inpatient Services (overnight hospital/facility stays): 50% after deductible; Outpatient Services (overnight hospital/facility stays): 50% after deductible |
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