March 20, 2010

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Anthem Blue Cross and Blue Shield of Connecticut – Century Preferred Direct with $2,000 Rx Max – CONNECTICUT

A comparison of the Century Preferred Direct with $2,000 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 Century Preferred Direct with $2,000 Rx Max Application Century Preferred Direct with $2,000 Rx Max Application
Brochure Century Preferred Direct with $2,000 Rx Max Brochure Century Preferred Direct with $2,000 Rx Max Brochure
Copay N/A N/A
Office Visit Subject to deductible and coinsurance Subject to deductible and coinsurance
Deductible $10,000 Individual/$20,000 Family $10,000 Individual/$20,000 Family
Coinsurance 100% 80%
Coinsurance Limit Member Cost-Share Maximum: $10,000 Individual/$20,000 Family Member Cost-Share Maximum: $15,000 Individual/$30,000 Family
Out-of-Pocket Maximum Member Cost-Share Maximum: $10,000 Individual/$20,000 Family Member Cost-Share Maximum: $15,000 Individual/$30,000 Family
Lifetime Maximum $5,000,000 $5,000,000
Prescription Drugs
  • You pay $10 copayment on Generic Drugs, $25 copayment on Formulary Brand Name Drugs and $40 copayment on Non-Formulary Brand Name Drugs
  • $2,000 annual maximum
    		•
  • You pay $10 copayment on Generic Drugs, $25 copayment on Formulary Brand Name Drugs and $40 copayment on Non-Formulary Brand Name Drugs
  • $2,000 annual maximum
    		•
    Emergency Room Subject to In-Network deductible and In-Network coinsurance Subject to In-Network deductible and In-Network coinsurance
    Adult Preventative Care
  • Subject to deductible and coinsurance:
    • 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
    		•
  • Subject to deductible and coinsurance:
    • 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
  • Subject to deductible and coinsurance:
    • 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
    		•
  • Subject to deductible and coinsurance:
    • 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 Subject to deductible and coinsurance Subject to deductible and coinsurance
    Maternity Century Preferred Direct with $2,000 Rx Max Century Preferred Direct with $2,000 Rx Max
    Physical Therapy
  • Outpatient rehabilitative and restorative physical, occupational, speech therapy (30 visit max.)- Subject to deductible and coinsurance
  • Chiropractic therapy (20 visit max.)- Subject to deductible and coinsurance
    		•
  • Outpatient rehabilitative and restorative physical, occupational, speech therapy (30 visit max.)- Subject to deductible and coinsurance
  • Chiropractic therapy (20 visit max.)- Subject to deductible and coinsurance
    		•
    Skilled Nursing
  • Subject to deductible
  • up to 120 days per Calendar Year
    		•
  • Subject to deductible and coinsurance
  • up to 120 days per Calendar Year
    		•
    Home Health Care
  • No cost share
    		•
  • $50 deductible and 80% coinsurance
    		•
    Mental Health
  • Outpatient Treatment for Mental Health Care and Substance Abuse Care- Subject to deductible
  • Inpatient Hospital Services- subject to deductible
    		•
  • Outpatient Treatment for Mental Health Care and Substance Abuse Care- subject to deductible and coinsurance
  • Inpatient Hospital Services- subject to deductible and coinsurance
    		•
    Hospital Care Subject to deductible Subject to deductible and coinsurance
    Optional Benefits Prescription card Prescription card