March 19, 2010

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Anthem Blue Cross and Blue Shield of Kentucky – Lumenos Health Incentive Account Plus Plan 1 – KENTUCKY

A comparison of the Lumenos Health Incentive Account Plus Plan 1 offered by Anthem Blue Cross and Blue Shield of Kentucky is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application Lumenos Health Incentive Account Plus Plan 1 Application Lumenos Health Incentive Account Plus Plan 1 Application
Brochure Lumenos Health Incentive Account Plus Plan 1 Brochure Lumenos Health Incentive Account Plus Plan 1 Brochure
Copay N/A N/A
Office Visit Subject to deductible and coinsurance. Subject to deductible and coinsurance.
Deductible Lumenos Health Incentive Account Plus Plan 1 Lumenos Health Incentive Account Plus Plan 1
Coinsurance 100% 70%
Coinsurance Limit Lumenos Health Incentive Account Plus Plan 1 Lumenos Health Incentive Account Plus Plan 1
Out-of-Pocket Maximum Lumenos Health Incentive Account Plus Plan 1 Lumenos Health Incentive Account Plus Plan 1
Lifetime Maximum Unlimited Unlimited
Prescription Drugs
  • Subject to deductible and coinsurance.
  • Retail: 30-day supply.
  • Mail service: 90-day supply.
  • Mail order and prescription drug benefits administered by WellPoint NextRx, a division of WellPoint, Inc.
    		•
  • Subject to deductible and coinsurance.
  • Retail: 30-day supply.
  • Mail service: 90-day supply.
  • Mail order and prescription drug benefits administered by WellPoint NextRx, a division of WellPoint, Inc.
    		•
    Emergency Room Covered 100% after deductible. Covered 100% after deductible.
    Adult Preventative Care
  • Covered 100% (not subject to deductible).
    		•
  • Covered 70% after deductible.
    		•
    Child Preventative Care
  • Covered 100% (not subject to deductible).
    		•
  • Covered 70% after deductible.
    		•
    Lab / X-Ray
  • Subject to deductible and coinsurance.
    		•
  • Subject to deductible and coinsurance.
    		•
    Maternity Not Covered. You may purchase maternity at an additional cost. See Brochure for Optional Maternity Rider. Not Covered. You may purchase maternity at an additional cost. See Brochure for Optional Maternity Rider.
    Physical Therapy
  • Outpatient- Subject to deductible and coinsurance.
  • Maximum visits per benefit period for network and non-network combined: 20 visits maximum.
    		•
  • Outpatient- Subject to deductible and coinsurance.
  • Maximum visits per benefit period for network and non-network combined: 20 visits maximum.
    		•
    Skilled Nursing
  • Subject to deductible and coinsurance; limited to 180 days per person per calendar year.
    		•
  • Subject to deductible and coinsurance; limited to 180 days per person per calendar year.
    		•
    Home Health Care
  • Subject to deductible and coinsurance.
  • Maximum visits per benefit period: 60 visits.
    		•
  • Subject to deductible and coinsurance.
  • Maximum visits per benefit period: 60 visits.
    		•
    Mental Health
  • Mental Health and Substance Abuse- Subject to deductible and coinsurance.
  • Inpatient- 10 days maximum network and non-network combined.
  • Outpatient- 10 visits maximum network and non-network combined.
  • $550 combined maximum for non-network inpatient and outpatient substance abuse.
  • Inpatient and outpatient substance abuse is limited to 2 rehabilitation programs per lifetime.
    		•
  • Mental Health and Substance Abuse- Subject to deductible and coinsurance.
  • Inpatient- 10 days maximum network and non-network combined.
  • Outpatient- 10 visits maximum network and non-network combined.
  • $550 combined maximum for non-network inpatient and outpatient substance abuse.
  • Inpatient and outpatient substance abuse is limited to 2 rehabilitation programs per lifetime.
    		•
    Hospital Care
  • Subject to deductible and coinsurance.
    		•
  • Subject to deductible and coinsurance.
    		•
    Optional Benefits Lumenos Health Incentive Account Plus Plan 1 Lumenos Health Incentive Account Plus Plan 1