Anthem Blue Cross and Blue Shield of Indiana Health Insurance in INDIANA – Health Plan Options

Anthem Blue Cross and Blue Shield of Indiana — Blue Access Value

A comparison of the Blue Access Value offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	70%	60%
Office Visit	Visits 1 and 2- member pays $30 copayment. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.	Visits 1 and 2- member pays coinsurance. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.
Copay	$30 for first 2 Office Visits.	N/A
Deductible	$10,000 Individual, $20,000 Family	$20,000 Individual, $40,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Blue Access Value

A comparison of the Blue Access Value offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	70%	60%
Office Visit	Visits 1 and 2- member pays $30 copayment. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.	Visits 1 and 2- member pays coinsurance. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.
Copay	$30 for first 2 Office Visits.	N/A
Deductible	$10,000 Individual, $20,000 Family	$20,000 Individual, $40,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Blue Access Value

A comparison of the Blue Access Value offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	70%	60%
Office Visit	Visits 1 and 2- member pays $30 copayment. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.	Visits 1 and 2- member pays coinsurance. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.
Copay	$30 for first 2 Office Visits.	N/A
Deductible	$10,000 Individual, $20,000 Family	$20,000 Individual, $40,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Blue Access Value

A comparison of the Blue Access Value offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	70%	60%
Office Visit	Visits 1 and 2- member pays $30 copayment. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.	Visits 1 and 2- member pays coinsurance. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.
Copay	$30 for first 2 Office Visits.	N/A
Deductible	$10,000 Individual, $20,000 Family	$20,000 Individual, $40,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Lumenos Health Incentive Account Plan 1

A comparison of the Lumenos Health Incentive Account Plan 1 offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	100% after deductible	60% after deductible
Deductible	see brochure	see brochure

Anthem Blue Cross and Blue Shield of Indiana — Lumenos Health Incentive Account Plan 2

A comparison of the Lumenos Health Incentive Account Plan 2 offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	80% after deductible	60% after deductible
Deductible	$1,000 Individual, $2,000 Family	$2,000 Individual, $4,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Lumenos Health Incentive Account Plan 1

A comparison of the Lumenos Health Incentive Account Plan 1 offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	100% after deductible	60% after deductible
Deductible	see brochure	see brochure

Anthem Blue Cross and Blue Shield of Indiana — Lumenos Health Incentive Account Plan 2

A comparison of the Lumenos Health Incentive Account Plan 2 offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	80% after deductible	60% after deductible
Deductible	$2,500 Individual, $5,000 Family	$5,000 Individual, $10,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Lumenos Health Incentive Account Plus Plan 1

A comparison of the Lumenos Health Incentive Account Plus Plan 1 offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	100% after deductible	60% after deductible
Deductible	$2,500 Individual, $5,000 Family	$5,000 Individual, $10,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Lumenos Health Incentive Account Plus Plan 2

A comparison of the Lumenos Health Incentive Account Plus Plan 2 offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	80% after deductible	60% after deducible
Deductible	$2,500 Individual, $5,000 Family	$5,000 Individual, $10,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Lumenos Health Incentive Account Plan 1

A comparison of the Lumenos Health Incentive Account Plan 1 offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	100% after deductible	60% after deductible
Deductible	see brochure	see brochure

Anthem Blue Cross and Blue Shield of Indiana — Lumenos Health Incentive Account Plus Plan 1

A comparison of the Lumenos Health Incentive Account Plus Plan 1 offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	100% after deductible	60% after deductible
Deductible	$5,000 Individual, $10,000 Family	$10,000 Individual, $20,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Lumenos Health Incentive Account Plus Plan 1

A comparison of the Lumenos Health Incentive Account Plus Plan 1 offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	100% after deductible	60% after deductible
Deductible	$10,000 Individual, $20,000 Family	$20,000 Individual, $40,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Premier 80% Std Rx

A comparison of the Premier 80% Std Rx offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 80% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$500 Individual, $1,000 Family	(Includes deductible)$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Premier 80% BuyUp Rx

A comparison of the Premier 80% BuyUp Rx offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 80% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$500 Individual, $1,000 Family	(Includes deductible)$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Premier 80% Std Rx

A comparison of the Premier 80% Std Rx offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 80% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$1,000 Individual, $2,000 Family	(Includes deductible)$1,000 Individual, $2,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Premier 80% BuyUp Rx

A comparison of the Premier 80% BuyUp Rx offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 80% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$500 Individual, $1,000 Family	(Includes deductible)$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Premier 80% Std Rx

A comparison of the Premier 80% Std Rx offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 80% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$1,500 Individual, $3,000 Family	(Includes deductible)$1,500 Individual, $3,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Premier 80% BuyUp Rx

A comparison of the Premier 80% BuyUp Rx offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 80% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$500 Individual, $1,000 Family	(Includes deductible)$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Premier 100% Std Rx

A comparison of the Premier 100% Std Rx offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$3,500 Individual, $7,000 Family	(Includes deductible)$3,500 Individual, $7,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Premier 100% BuyUp Rx

A comparison of the Premier 100% BuyUp Rx offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$2,500 Individual, $5,000 Family	(Includes deductible)$2,500 Individual, $5,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Premier 80% Std Rx

A comparison of the Premier 80% Std Rx offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 80% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$2,500 Individual, $5,000 Family	(Includes deductible)$2,500 Individual, $5,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Premier 80% BuyUp Rx

A comparison of the Premier 80% BuyUp Rx offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 80% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$500 Individual, $1,000 Family	(Includes deductible)$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Premier 100% Std Rx

A comparison of the Premier 100% Std Rx offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$3,500 Individual, $7,000 Family	(Includes deductible)$3,500 Individual, $7,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Premier 100% BuyUp Rx

A comparison of the Premier 100% BuyUp Rx offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$2,500 Individual, $5,000 Family	(Includes deductible)$2,500 Individual, $5,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Premier 100% Std Rx

A comparison of the Premier 100% Std Rx offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$3,500 Individual, $7,000 Family	(Includes deductible)$3,500 Individual, $7,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Premier 100% BuyUp Rx

A comparison of the Premier 100% BuyUp Rx offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$2,500 Individual, $5,000 Family	(Includes deductible)$2,500 Individual, $5,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Premier 100% Std Rx

A comparison of the Premier 100% Std Rx offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$3,500 Individual, $7,000 Family	(Includes deductible)$3,500 Individual, $7,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Premier 100% BuyUp Rx

A comparison of the Premier 100% BuyUp Rx offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$2,500 Individual, $5,000 Family	(Includes deductible)$2,500 Individual, $5,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Lumenos Health Savings Account Plan 3

A comparison of the Lumenos Health Savings Account Plan 3 offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	N/A	N/A
Deductible	see brochure	see brochure

Anthem Blue Cross and Blue Shield of Indiana — Lumenos Health Savings Account Plan 3

A comparison of the Lumenos Health Savings Account Plan 3 offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	N/A	N/A
Deductible	see brochure	see brochure

Anthem Blue Cross and Blue Shield of Indiana — Lumenos Health Savings Account Plan 5

A comparison of the Lumenos Health Savings Account Plan 5 offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	N/A	N/A
Deductible	$3,500 Individual, $7,000 Family	$3,500 Individual, $7,000 Family

Anthem Blue Cross and Blue Shield of Indiana — Lumenos Health Savings Account Plan 3

A comparison of the Lumenos Health Savings Account Plan 3 offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	N/A	N/A
Deductible	see brochure	see brochure

Anthem Blue Cross and Blue Shield of Indiana — SmartSense Premier Rx

A comparison of the SmartSense Premier Rx offered by Anthem Blue Cross and Blue Shield of Indiana is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	70% after deductible	50% after deductible
Office Visit	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Copay	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Deductible	$1,500 Individual, $3,000 Family	$1,500 Individual, $3,000 Family