March 19, 2010

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Anthem Blue Cross and Blue Shield of Missouri – Blue Access Choice Value RX Option Discount Only – MISSOURI

A comparison of the Blue Access Choice Value RX Option Discount Only offered by Anthem Blue Cross and Blue Shield of Missouri 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 Access Choice Value RX Option Discount Only Application Blue Access Choice Value RX Option Discount Only Application
Brochure Blue Access Choice Value RX Option Discount Only Brochure Blue Access Choice Value RX Option Discount Only Brochure
Copay
  • Physician Office Services: $30 for office visit charge (for first 2 visits only).
    		•  N/A
    Office Visit
  • Physician Office Services: $30 for office visit charge (for first 2 visits only).
  • 70% after deductible for other services.
  • Visits 3+ are not covered.
    		•
  • 50% after deductible for first 2 office visits.
  • Visits 3+ are not covered.
    		•
    Deductible
  • $2,000 Individual, $6,000 Family
  • Network and Non-network deductibles are separate and do not accumulate towards each other.
    		•
  • $4,000 Individual, $12,000 Family
  • Network and Non-network deductibles are separate and do not accumulate towards each other.
    		•
    Coinsurance 70% after deductible 50% after deductible
    Coinsurance Limit See OOP Maximum See OOP Maximum
    Out-of-Pocket Maximum
  • $6,000 Individual, $12,000 Family
  • Includes deductible
    		•
  • $12,000 Individual, $24,000 Family
  • Includes deductible
    		•
    Lifetime Maximum Unlimited Unlimited
    Prescription Drugs Prescription drugs are not covered. However, you can get discounts on prescription drugs with your Anthem Blue Cross and Blue Shield ID card. Prescription drugs are not covered. Prescription discounts are not applicable if the provider is non-network.
    Emergency Room 70% after deductible 70% after deductible
    Adult Preventative Care 70% after deductible
  • Childhood immunizations through age 5 only- 100% (not subject to deductible)
  • Other well child care services are not covered.
    		•
    Child Preventative Care
  • Childhood immunizations through age 5 only- 100% (not subject to deductible)
  • Other well child care services are not covered.
    		•
  • Childhood immunizations through age 5 only- 100% (not subject to deductible)
  • Other well child care services are not covered.
    		•
    Lab / X-Ray
  • Diagnostic Services- $300 maximum per member, per calendar-year, network and non-network combined. Includes lab work, X-rays, and Outpatient Diagnostic Services. Preventive services are excluded from the $300 limit.
  • Covered at 70% (not subject to deductible)
    		•
  • Diagnostic Services- $300 maximum per member, per calendar-year, network and non-network combined. Includes lab work, X-rays, and Outpatient Diagnostic Services. Preventive services are excluded from the $300 limit.
  • Covered at 50% (not subject to deductible)
    		•
    Maternity Not Covered Not Covered
    Physical Therapy Not Covered Not Covered
    Skilled Nursing Blue Access Choice Value RX Option Discount Only Blue Access Choice Value RX Option Discount Only
    Home Health Care
  • Maximum visits per benefit period- 40 visits
  • 70% after deductible
    		•
  • Maximum visits per benefit period- 40 visits
  • 50% after deductible
    		•
    Mental Health Not Covered Not Covered
    Hospital Care 70% after deductible 50% after deductible
    Optional Benefits Blue Access Choice Value RX Option Discount Only Blue Access Choice Value RX Option Discount Only