March 20, 2010

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Anthem Blue Cross and Blue Shield of Missouri – Lumenos Health Incentive Account Plan 1 – MISSOURI

A comparison of the Lumenos Health Incentive Account Plan 1 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 Lumenos Health Incentive Account Plan 1 Application Lumenos Health Incentive Account Plan 1 Application
Brochure Lumenos Health Incentive Account Plan 1 Brochure Lumenos Health Incentive Account Plan 1 Brochure
Copay N/A N/A
Office Visit Subject to deductible and coinsurance. Subject to deductible and coinsurance.
Deductible see brochure see brochure
Coinsurance 100% after deductible 60% after deductible
Coinsurance Limit see brochure see brochure
Out-of-Pocket Maximum Includes deductible: Includes deductible:
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 Covered 100% after deductible. Covered 100% after deductible.
Adult Preventative Care Covered 100% (deductible waived). Covered 60% after deductible.
Child Preventative Care Covered 100% (deductible waived). Covered 60% after deductible.
Lab / X-Ray Subject to deductible and coinsurance. Subject to deductible and coinsurance.
Maternity Not Covered (optional maternity rider available; subject to 12-month waiting period). Not Covered (optional maternity rider available; subject to 12-month waiting period).
Physical Therapy
  • Outpatient Physical/Speech/Occupational Therapy- Subject to deductible and coinsurance (Maximum 20 visits per benefit period, in and out-of-network combined).
  • Manipulation Therapy- Subject to deductible and coinsurance (Limited to 12 visits per benefit period).
    		•
  • Outpatient Physical/Speech/Occupational Therapy- Subject to deductible and coinsurance (Maximum 20 visits per benefit period, in and out-of-network combined).
  • Manipulation Therapy- Subject to deductible and coinsurance (Limited to 12 visits per benefit period).
    		•
    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 Subject to deductible and coinsurance. Subject to deductible and coinsurance.
    Hospital Care Subject to deductible and coinsurance. Subject to deductible and coinsurance.
    Optional Benefits see brochure see brochure