March 20, 2010

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Anthem Blue Cross and Blue Shield of Connecticut – BlueCare Direct with $500 Rx Max – CONNECTICUT

A comparison of the BlueCare Direct with $500 Rx Max offered by Anthem Blue Cross and Blue Shield of Connecticut is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application BlueCare Direct with $500 Rx Max Application BlueCare Direct with $500 Rx Max Application
Brochure BlueCare Direct with $500 Rx Max Brochure BlueCare Direct with $500 Rx Max Brochure
Copay
  • $20 for PCP and $30 for specialist.
    		•
  • $20 for PCP and $30 for specialist.
    		•
    Office Visit
  • $20 for PCP and $30 for specialist.
  • No deductible.
    		•
  • $20 for PCP and $30 for specialist.
  • No deductible.
    		•
    Deductible $1,500 Individual/$3,000 Family $1,500 Individual/$3,000 Family
    Coinsurance N/A N/A
    Coinsurance Limit N/A N/A
    Out-of-Pocket Maximum N/A N/A
    Lifetime Maximum $5,000,000 $5,000,000
    Prescription Drugs
  • Prescription card: You pay $10 copayment on Generic Drugs, $25 copayment on Formulary Brand-Name Drugs and $40 copayment on Non-Formulary Brand-Name Drugs
  • $500 annual maximum
    		•
  • Prescription card: You pay $10 copayment on Generic Drugs, $25 copayment on Formulary Brand-Name Drugs and $40 copayment on Non-Formulary Brand-Name Drugs
  • $500 annual maximum
    		•
    Emergency Room
  • $75 copayment after deductible (copayment waived if admitted)
  • Urgent Care- $50 copayment
    		•
  • $75 copayment after deductible (copayment waived if admitted)
  • Urgent Care- $50 copayment
    		•
    Adult Preventative Care
  • Adult Physical Examinations- $20 per visit based on age schedule:
    • 1 exam every 5 Calendar Years 22 through 29 years of age
    • 1 exam every 3 Calendar Years 30 through 39 years of age
    • 1 exam every 2 Calendar Years 40 through 49 years of age
    • 1 exam per Calendar Year 50 years of age and older
  • No deductible
    		•
  • Up to age 13: No cost share
  • Age 13+: $20 copayment
  • Age schedule:
    • 6 exams from birth to 1 year of age
    • 6 exams from 1 through 5 years of age
    • 1 exam every 2 Calendar Years 6 through 10 years of age
    • 1 exam every Calendar Year 11 through 21 years of age
    		•
    Child Preventative Care
  • Up to age 13: No cost share
  • Age 13+: $20 copayment
  • Age schedule:
    • 6 exams from birth to 1 year of age
    • 6 exams from 1 through 5 years of age
    • 1 exam every 2 Calendar Years 6 through 10 years of age
    • 1 exam every Calendar Year 11 through 21 years of age
    		•
  • Up to age 13: No cost share
  • Age 13+: $20 copayment
  • Age schedule:
    • 6 exams from birth to 1 year of age
    • 6 exams from 1 through 5 years of age
    • 1 exam every 2 Calendar Years 6 through 10 years of age
    • 1 exam every Calendar Year 11 through 21 years of age
    		•
    Lab / X-Ray
  • Outpatient Diagnostic Services- $75 copayment after deductible (max. of $375 per member per calendar year)
    		•
  • Outpatient Diagnostic Services- $75 copayment after deductible (max. of $375 per member per calendar year)
    		•
    Maternity
  • Physician: $30 copay for initial visit after deductible
  • Hospital: No charge after deductible
    		•
  • Physician: $30 copay for initial visit after deductible
  • Hospital: No charge after deductible
    		•
    Physical Therapy
  • Outpatient rehabilitative and restorative physical, occupational, speech therapy (30 visit max.)- $30 per visit after deductible
    		•
  • Outpatient rehabilitative and restorative physical, occupational, speech therapy (30 visit max.)- $30 per visit after deductible
    		•
    Skilled Nursing
  • Covered in full after payment of deductible
  • up to 120 days per Calendar Year
    		•
  • Covered in full after payment of deductible
  • up to 120 days per Calendar Year
    		•
    Home Health Care
  • No cost share ($50 deductible and 20% coinsurance)
  • Unlimited nursing and therapeutic services and home health aide services
    		•
  • No cost share ($50 deductible and 20% coinsurance)
  • Unlimited nursing and therapeutic services and home health aide services
    		•
    Mental Health
  • Inpatient Hospital Services- Covered in full after payment of deductible
  • Outpatient treatment for Mental Health Care and Substance Abuse Care- $30 per visit after deductible
    		•
  • Inpatient Hospital Services- Covered in full after payment of deductible
  • Outpatient treatment for Mental Health Care and Substance Abuse Care- $30 per visit after deductible
    		•
    Hospital Care
  • Hospital Inpatient Services- No charge after deductible
  • Outpatient Services- $20 copayment per visit
  • Outpatient surgery (In a hospital or surgi-center)- No charge after deductible
    		•
  • Hospital Inpatient Services- No charge after deductible
  • Outpatient Services- $20 copayment per visit
  • Outpatient surgery (In a hospital or surgi-center)- No charge after deductible
    		•
    Optional Benefits BlueCare Direct with $500 Rx Max BlueCare Direct with $500 Rx Max