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Anthem Blue Cross and Blue Shield of Wisconsin Health Insurance in WISCONSIN – Health Plan Options

Anthem Blue Cross and Blue Shield of Wisconsin — Blue Access Value Rx Option Discount Only

A comparison of the Blue Access Value Rx Option Discount Only offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined). Deductible and coinsurance applies for other office services. Visits 3+ are not covered.	50% after deductible for first 2 office visits. Visits 3+ are not covered.
Copay	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined).	N/A
Deductible	$2,000 Individual, $6,000 Family	$4,000 Individual, $12,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — Blue Access Value Rx Option $15/$30/$60/25% ($500 deductible)

A comparison of the Blue Access Value Rx Option $15/$30/$60/25% ($500 deductible) offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined). Deductible and coinsurance applies for other office services. Visits 3+ are not covered.	50% after deductible for first 2 office visits. Visits 3+ are not covered.
Copay	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined).	N/A
Deductible	$2,000 Individual, $6,000 Family	$4,000 Individual, $12,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — Blue Access Value Rx Option $15 Generic only ($500 maximum)

A comparison of the Blue Access Value Rx Option $15 Generic only ($500 maximum) offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined). Deductible and coinsurance applies for other office services. Visits 3+ are not covered.	50% after deductible for first 2 office visits. Visits 3+ are not covered.
Copay	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined).	N/A
Deductible	$10,000 Individual, $30,000 Family	$20,000 Individual, $60,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — Blue Access Value Rx Option Discount Only

A comparison of the Blue Access Value Rx Option Discount Only offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined). Deductible and coinsurance applies for other office services. Visits 3+ are not covered.	50% after deductible for first 2 office visits. Visits 3+ are not covered.
Copay	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined).	N/A
Deductible	$2,000 Individual, $6,000 Family	$4,000 Individual, $12,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — Blue Access Value Rx Option $15/$30/$60/25% ($500 deductible)

A comparison of the Blue Access Value Rx Option $15/$30/$60/25% ($500 deductible) offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined). Deductible and coinsurance applies for other office services. Visits 3+ are not covered.	50% after deductible for first 2 office visits. Visits 3+ are not covered.
Copay	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined).	N/A
Deductible	$2,000 Individual, $6,000 Family	$4,000 Individual, $12,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — Blue Access Value Rx Option $15 Generic only ($500 maximum)

A comparison of the Blue Access Value Rx Option $15 Generic only ($500 maximum) offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined). Deductible and coinsurance applies for other office services. Visits 3+ are not covered.	50% after deductible for first 2 office visits. Visits 3+ are not covered.
Copay	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined).	N/A
Deductible	$10,000 Individual, $30,000 Family	$20,000 Individual, $60,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — Blue Access Value Rx Option Discount Only

A comparison of the Blue Access Value Rx Option Discount Only offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined). Deductible and coinsurance applies for other office services. Visits 3+ are not covered.	50% after deductible for first 2 office visits. Visits 3+ are not covered.
Copay	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined).	N/A
Deductible	$2,000 Individual, $6,000 Family	$4,000 Individual, $12,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — Blue Access Value Rx Option $15/$30/$60/25% ($500 deductible)

A comparison of the Blue Access Value Rx Option $15/$30/$60/25% ($500 deductible) offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined). Deductible and coinsurance applies for other office services. Visits 3+ are not covered.	50% after deductible for first 2 office visits. Visits 3+ are not covered.
Copay	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined).	N/A
Deductible	$2,000 Individual, $6,000 Family	$4,000 Individual, $12,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — Blue Access Value Rx Option $15 Generic only ($500 maximum)

A comparison of the Blue Access Value Rx Option $15 Generic only ($500 maximum) offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined). Deductible and coinsurance applies for other office services. Visits 3+ are not covered.	50% after deductible for first 2 office visits. Visits 3+ are not covered.
Copay	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined).	N/A
Deductible	$10,000 Individual, $30,000 Family	$20,000 Individual, $60,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — Blue Access Value Rx Option Discount Only

A comparison of the Blue Access Value Rx Option Discount Only offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined). Deductible and coinsurance applies for other office services. Visits 3+ are not covered.	50% after deductible for first 2 office visits. Visits 3+ are not covered.
Copay	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined).	N/A
Deductible	$2,000 Individual, $6,000 Family	$4,000 Individual, $12,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — Blue Access Value Rx Option $15/$30/$60/25% ($500 deductible)

A comparison of the Blue Access Value Rx Option $15/$30/$60/25% ($500 deductible) offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined). Deductible and coinsurance applies for other office services. Visits 3+ are not covered.	50% after deductible for first 2 office visits. Visits 3+ are not covered.
Copay	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined).	N/A
Deductible	$2,000 Individual, $6,000 Family	$4,000 Individual, $12,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — Blue Access Value Rx Option $15 Generic only ($500 maximum)

A comparison of the Blue Access Value Rx Option $15 Generic only ($500 maximum) offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined). Deductible and coinsurance applies for other office services. Visits 3+ are not covered.	50% after deductible for first 2 office visits. Visits 3+ are not covered.
Copay	Physician Office Services: $35 for first 2 visits only (includes physician and outpatient therapy office visits combined).	N/A
Deductible	$10,000 Individual, $30,000 Family	$20,000 Individual, $60,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — 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 Wisconsin is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
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 Wisconsin — 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 Wisconsin is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
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 Wisconsin — 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 Wisconsin is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
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 Wisconsin — 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 Wisconsin is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
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 Wisconsin — 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 Wisconsin is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
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 Wisconsin — 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 Wisconsin is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$2,500 Individual, $5,000 Family	$5,000 Individual, $10,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — 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 Wisconsin is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
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 Wisconsin — 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 Wisconsin is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
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 Wisconsin — 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 Wisconsin is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
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 Wisconsin — SmartSense PPO Premier Rx

A comparison of the SmartSense PPO Premier Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense PPO Generic Rx

A comparison of the SmartSense PPO Generic Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Office Visit: $35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits Other Services- 70% after deductible	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$10,000 Individual, $20,000 Family	$10,000 Individual, $20,000 Family

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

A comparison of the Premier POS 80% Std Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	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	$1,500 Individual, $3,000 Family	$1,500 Individual, $3,000 Family

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

A comparison of the Premier POS 80% BuyUp Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	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	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense POS Premier Rx

A comparison of the SmartSense POS Premier Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense POS Generic Rx

A comparison of the SmartSense POS Generic Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Office Visit: $35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits Other Services- 70% after deductible	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

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

A comparison of the Premier PPO 80% Std Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	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	$1,000 Individual, $2,000 Family	$1,000 Individual, $2,000 Family

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

A comparison of the Premier PPO 80% BuyUp Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	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	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense PPO Premier Rx

A comparison of the SmartSense PPO Premier Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense PPO Generic Rx

A comparison of the SmartSense PPO Generic Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Office Visit: $35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits Other Services- 70% after deductible	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$10,000 Individual, $20,000 Family	$10,000 Individual, $20,000 Family

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

A comparison of the Premier POS 80% Std Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	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	$1,500 Individual, $3,000 Family	$1,500 Individual, $3,000 Family

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

A comparison of the Premier POS 80% BuyUp Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	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	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense POS Premier Rx

A comparison of the SmartSense POS Premier Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense POS Generic Rx

A comparison of the SmartSense POS Generic Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Office Visit: $35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits Other Services- 70% after deductible	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

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

A comparison of the Premier PPO 80% Std Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	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	$1,000 Individual, $2,000 Family	$1,000 Individual, $2,000 Family

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

A comparison of the Premier PPO 80% BuyUp Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	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	$1,000 Individual, $2,000 Family	$1,000 Individual, $2,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense PPO Premier Rx

A comparison of the SmartSense PPO Premier Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense PPO Generic Rx

A comparison of the SmartSense PPO Generic Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Office Visit: $35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits Other Services- 70% after deductible	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$10,000 Individual, $20,000 Family	$10,000 Individual, $20,000 Family

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

A comparison of the Premier POS 80% Std Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	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	$1,500 Individual, $3,000 Family	$1,500 Individual, $3,000 Family

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

A comparison of the Premier POS 80% BuyUp Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	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	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense POS Premier Rx

A comparison of the SmartSense POS Premier Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense POS Generic Rx

A comparison of the SmartSense POS Generic Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Office Visit: $35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits Other Services- 70% after deductible	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

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

A comparison of the Premier PPO 80% Std Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	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	$1,000 Individual, $2,000 Family	$1,000 Individual, $2,000 Family

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

A comparison of the Premier PPO 80% BuyUp Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	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	$1,500 Individual, $3,000 Family	$1,500 Individual, $3,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense PPO Premier Rx

A comparison of the SmartSense PPO Premier Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense PPO Generic Rx

A comparison of the SmartSense PPO Generic Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Office Visit: $35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits Other Services- 70% after deductible	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$10,000 Individual, $20,000 Family	$10,000 Individual, $20,000 Family

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

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	70% after deductible
Office Visit	Office Visit: Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	70% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	70% after deductible
Deductible	$2,500 Individual, $5,000 Family	$2,500 Individual, $5,000 Family

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

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	70% after deductible
Office Visit	Office Visit: Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	70% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	70% after deductible
Deductible	$3,500 Individual, $7,000 Family	$3,500 Individual, $7,000 Family

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

A comparison of the Premier POS 80% Std Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	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	$1,500 Individual, $3,000 Family	$1,500 Individual, $3,000 Family

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

A comparison of the Premier POS 80% BuyUp Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	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	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense POS Premier Rx

A comparison of the SmartSense POS Premier Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense POS Generic Rx

A comparison of the SmartSense POS Generic Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Office Visit: $35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits Other Services- 70% after deductible	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

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

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	70% after deductible
Office Visit	Office Visit: Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	70% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	70% after deductible
Deductible	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 Family

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

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	70% after deductible
Office Visit	Office Visit: Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	70% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	70% after deductible
Deductible	$3,500 Individual, $7,000 Family	$3,500 Individual, $7,000 Family

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

A comparison of the Premier PPO 80% Std Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	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	$1,000 Individual, $2,000 Family	$1,000 Individual, $2,000 Family

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

A comparison of the Premier PPO 80% BuyUp Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	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	$2,500 Individual, $5,000 Family	$2,500 Individual, $5,000 Family

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

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	70% after deductible
Office Visit	Office Visit: Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	70% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	70% after deductible
Deductible	$2,500 Individual, $5,000 Family	$2,500 Individual, $5,000 Family

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

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	70% after deductible
Office Visit	Office Visit: Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	70% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	70% after deductible
Deductible	$3,500 Individual, $7,000 Family	$3,500 Individual, $7,000 Family

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

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	70% after deductible
Office Visit	Office Visit: Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	70% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	70% after deductible
Deductible	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 Family

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

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	70% after deductible
Office Visit	Office Visit: Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	70% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	70% after deductible
Deductible	$3,500 Individual, $7,000 Family	$3,500 Individual, $7,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense PPO Premier Rx

A comparison of the SmartSense PPO Premier Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense PPO Generic Rx

A comparison of the SmartSense PPO Generic Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Office Visit: $35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits Other Services- 70% after deductible	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$10,000 Individual, $20,000 Family	$10,000 Individual, $20,000 Family

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

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	70% after deductible
Office Visit	Office Visit: Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	70% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	70% after deductible
Deductible	$2,500 Individual, $5,000 Family	$2,500 Individual, $5,000 Family

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

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	70% after deductible
Office Visit	Office Visit: Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	70% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	70% after deductible
Deductible	$3,500 Individual, $7,000 Family	$3,500 Individual, $7,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense POS Premier Rx

A comparison of the SmartSense POS Premier Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense POS Generic Rx

A comparison of the SmartSense POS Generic Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Office Visit: $35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits Other Services- 70% after deductible	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

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

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	70% after deductible
Office Visit	Office Visit: Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	70% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	70% after deductible
Deductible	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 Family

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

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	70% after deductible
Office Visit	Office Visit: Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	70% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	70% after deductible
Deductible	$3,500 Individual, $7,000 Family	$3,500 Individual, $7,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense PPO Premier Rx

A comparison of the SmartSense PPO Premier Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense PPO Generic Rx

A comparison of the SmartSense PPO Generic Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Office Visit: $35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits Other Services- 70% after deductible	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$10,000 Individual, $20,000 Family	$10,000 Individual, $20,000 Family

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

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	70% after deductible
Office Visit	Office Visit: Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	70% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	70% after deductible
Deductible	$2,500 Individual, $5,000 Family	$2,500 Individual, $5,000 Family

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

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	70% after deductible
Office Visit	Office Visit: Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	70% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	70% after deductible
Deductible	$3,500 Individual, $7,000 Family	$3,500 Individual, $7,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense POS Premier Rx

A comparison of the SmartSense POS Premier Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Anthem Blue Cross and Blue Shield of Wisconsin — SmartSense POS Generic Rx

A comparison of the SmartSense POS Generic Rx offered by Anthem Blue Cross and Blue Shield of Wisconsin 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	Office Visit: $35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits Other Services- 70% after deductible	50% after deductible
Copay	$35 copay for first 3 visits per person per calendar year for primary car physician/specialist (deductible waived); then 70% after deductible for 4+ office visits	50% after deductible
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

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

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	70% after deductible
Office Visit	Office Visit: Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	70% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	70% after deductible
Deductible	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 Family

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

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	70% after deductible
Office Visit	Office Visit: Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	70% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	70% after deductible
Deductible	$3,500 Individual, $7,000 Family	$3,500 Individual, $7,000 Family

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

A comparison of the Lumenos Health Savings Account PPO Plan 3 offered by Anthem Blue Cross and Blue Shield of Wisconsin 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 Wisconsin — Lumenos Health Savings Account POS Plan 3

A comparison of the Lumenos Health Savings Account POS Plan 3 offered by Anthem Blue Cross and Blue Shield of Wisconsin 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 Wisconsin — Lumenos Health Savings Account PPO Plan 5

A comparison of the Lumenos Health Savings Account PPO Plan 5 offered by Anthem Blue Cross and Blue Shield of Wisconsin 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 Wisconsin — Lumenos Health Savings Account POS Plan 3

A comparison of the Lumenos Health Savings Account POS Plan 3 offered by Anthem Blue Cross and Blue Shield of Wisconsin 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 Wisconsin — Lumenos Health Savings Account PPO Plan 3

A comparison of the Lumenos Health Savings Account PPO Plan 3 offered by Anthem Blue Cross and Blue Shield of Wisconsin 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 Wisconsin — Lumenos Health Savings Account POS Plan 3

A comparison of the Lumenos Health Savings Account POS Plan 3 offered by Anthem Blue Cross and Blue Shield of Wisconsin 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 Wisconsin — Blue Short Term

A comparison of the Blue Short Term offered by Anthem Blue Cross and Blue Shield of Wisconsin is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$250 Single/$750 Family	$250 Single/$750 Family

Anthem Blue Cross and Blue Shield of Wisconsin — Blue Short Term

A comparison of the Blue Short Term offered by Anthem Blue Cross and Blue Shield of Wisconsin is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$250 Single/$750 Family	$250 Single/$750 Family

Anthem Blue Cross and Blue Shield of Wisconsin — Blue Short Term

A comparison of the Blue Short Term offered by Anthem Blue Cross and Blue Shield of Wisconsin is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$250 Single/$750 Family	$250 Single/$750 Family

Anthem Blue Cross and Blue Shield of Wisconsin — Blue Short Term

A comparison of the Blue Short Term offered by Anthem Blue Cross and Blue Shield of Wisconsin is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$250 Single/$750 Family	$250 Single/$750 Family

Anthem Blue Cross and Blue Shield of Wisconsin — Blue Short Term

A comparison of the Blue Short Term offered by Anthem Blue Cross and Blue Shield of Wisconsin is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$250 Single/$750 Family	$250 Single/$750 Family