March 18, 2010

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Anthem – Blue 5000 – NEVADA

A comparison of the Blue 5000 offered by Anthem is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application Blue 5000 Application Blue 5000 Application
Brochure Blue 5000 Brochure Blue 5000 Brochure
Copay
  • First 4 office visits per member per year: Deductible is waived (member pays a $30 copayment)
    		•
  • First 4 office visits per member per year: Deductible is waived (member pays a $30 copayment)
    		•
    Office Visit
  • First 4 office visits per member per year: Deductible is waived (member pays a $30 copayment)
  • 5+ office visits per member per year: Anthem pays 70%; office visits are subject to deductible
    		•
  • First 4 office visits per member per year: Deductible is waived (member pays a $30 copayment)
  • 5+ office visits per member per year: Anthem pays 70%; office visits are subject to deductible
    		•
    Deductible
  • $5,000 (2-member maximum)
    		•
  • $5,000 (2-member maximum)
    		•
    Coinsurance 70% 70%
    Coinsurance Limit Blue 5000 Blue 5000
    Out-of-Pocket Maximum
  • $3,500 plus deductible per member
  • $7,000 plus deductible per family
    		•
  • $3,500 plus deductible per member
  • $7,000 plus deductible per family
    		•
    Lifetime Maximum $5,000,000 per member $5,000,000 per member
    Prescription Drugs
  • Retail Pharmacy (Per prescription up to a 30-day supply)
  • Generic drugs: 100% (after member pays a $10 copayment)
  • Brand-name drugs: 100%(after member pays a $25 copayment; separate $500 deductible per member per year applies)
    		•
  • Retail Pharmacy (Per prescription up to a 30-day supply)
  • Generic drugs: 100% (after member pays a $10 copayment)
  • Brand-name drugs: 100%(after member pays a $25 copayment; separate $500 deductible per member per year applies)
    		•
    Emergency Room Blue 5000 Blue 5000
    Adult Preventative Care
  • Routine Pap tests, and annual mammograms, colorectal cancer screenings and PSA screenings: 70% after deductible
  • Other Preventive Care Services, such as flu shots and routine physical exams: 70% after deductible with a maximum covered expense of $200 per year
    		•
  • Preventive Care for Babies and Children (through age 6), Exams and lab tests: See office visits
  • Immunizations: 70% after deductible
    		•
    Child Preventative Care
  • Preventive Care for Babies and Children (through age 6), Exams and lab tests: See office visits
  • Immunizations: 70% after deductible
    		•
  • Preventive Care for Babies and Children (through age 6), Exams and lab tests: See office visits
  • Immunizations: 70% after deductible
    		•
    Lab / X-Ray 70% after deductible 70% after deductible
    Maternity Blue 5000 Blue 5000
    Physical Therapy Blue 5000 Blue 5000
    Skilled Nursing Blue 5000 Blue 5000
    Home Health Care Blue 5000 Blue 5000
    Mental Health Blue 5000 Blue 5000
    Hospital Care 70% after deductible 70% after deductible
    Optional Benefits Blue 5000 Blue 5000