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Anthem Blue Cross and Blue Shield of Indiana – Lumenos Health Incentive Account Plan 2 – INDIANA
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 |
| Application | Lumenos Health Incentive Account Plan 2 Application | Lumenos Health Incentive Account Plan 2 Application |
| Brochure | Lumenos Health Incentive Account Plan 2 Brochure | Lumenos Health Incentive Account Plan 2 Brochure |
| Copay | 80% after deductible | 60% after deductible |
| Office Visit | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
| Deductible | Lumenos Health Incentive Account Plan 2 | Lumenos Health Incentive Account Plan 2 |
| Coinsurance | 80% after deductible | 60% after deductible |
| Coinsurance Limit | SEE OOP Maximum | SEE OOP Maximum |
| Out-of-Pocket Maximum | Lumenos Health Incentive Account Plan 2 | Lumenos Health Incentive Account Plan 2 |
| Lifetime Maximum | Unlimited | Unlimited |
| Prescription Drugs | Subject to deductible and coinsurance(Specialty injectable drugs are limited to 30-day supply, not covered out-of-network) | Subject to deductible and coinsurance(Specialty injectable drugs are limited to 30-day supply, not covered out-of-network) |
| Emergency Room | 80% after deductible | 80% after deductible |
| Adult Preventative Care | 100% covered (deductible waived) | Subject to deductible and coinsurance |
| Child Preventative Care | 100% covered (deductible waived) | Subject to deductible and coinsurance |
| Lab / X-Ray | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
| Maternity | Not covered (Optional Rider available; subject to 12-month waiting period) | Not covered (Optional Rider available; subject to 12-month waiting period) |
| Physical Therapy | Physical/Occupational/Speech Thearpy- Subject to deductible and coinsurance | Physical/Occupational/Speech Thearpy- Subject to deductible and coinsurance |
| Skilled Nursing | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
| Home Health Care | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
| Mental Health | Mental Health and Substance Abuse- Subject to deductible and coinsurance | Mental Health and Substance Abuse- Subject to deductible and coinsurance |
| Hospital Care | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
| Optional Benefits | ||