March 18, 2010

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Anthem Blue Cross and Blue Shield of Ohio – Blue Traditional Plan 2 – OHIO

A comparison of the Blue Traditional Plan 2 offered by Anthem Blue Cross and Blue Shield of Ohio 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 Traditional Plan 2 Application Blue Traditional Plan 2 Application
Brochure Blue Traditional Plan 2 Brochure Blue Traditional Plan 2 Brochure
Copay N/A N/A
Office Visit
  • Subject to deductible and coinsurance.
  • Subject to deductible and coinsurance.
  • Deductible $500 Individual, $1,000 Family $500 Individual, $1,000 Family
    Coinsurance 80% 80%
    Coinsurance Limit Includes deductible:$2,500 Individual, $5,000 Family Includes deductible:$2,500 Individual, $5,000 Family
    Out-of-Pocket Maximum Includes deductible:$2,500 Individual, $5,000 Family Includes deductible:$2,500 Individual, $5,000 Family
    Lifetime Maximum $5,000,000 maximum per member $5,000,000 maximum per member
    Prescription Drugs
  • Retail (30-day supply):
    • Tier 1 - $15 per prescription.
    • Tier 2 - $30 per prescription.
    • Tier 3 - $60 per prescription.
    • Tier 4 - 25% per prescription ($2,500 out-of-pocket maximum).
  • Mail Service (90-day supply):
    • Tier 1 - $30 per prescription.
    • Tier 2 - $75 per prescription.
    • Tier 3 - $150 per prescription.
    • Tier 4 - 25% per prescription ($2,500 out-of-pocket maximum).
  • Retail (30-day supply):
    • Tier 1 - 50% with a minimum of $60, no maximum
    • Tier 2 - 50% with a minimum of $60, no maximum
    • Tier 3 - 50% with a minimum of $60, no maximum
    • Tier 4 - 50% with a minimum of $60, no maximum
  • Mail Service (90-day supply): Not covered.
  • Emergency Room
  • Subject to deductible and coinsurance.
  • Subject to deductible and coinsurance.
  • Adult Preventative Care
  • Subject to deductible and coinsurance.
  • $300 calendar-year maximum.
  • $500 maximum from birth to 12 months, $150 maximum from age 1 to age 9 per calendar year.
  • Child Preventative Care
  • $500 maximum from birth to 12 months, $150 maximum from age 1 to age 9 per calendar year.
  • $500 maximum from birth to 12 months, $150 maximum from age 1 to age 9 per calendar year.
  • Lab / X-Ray
  • Subject to deductible and coinsurance.
  • Subject to deductible and coinsurance.
  • Maternity Not Covered. You may purchase benefits for maternity at an additional cost. See Brochure for Optional Maternity Rider. Not Covered. You may purchase benefits for maternity at an additional cost. See Brochure for Optional Maternity Rider.
    Physical Therapy
  • Subject to deductible and coinsurance; Physical Therapy and Manipulation Therapy limited to 20 visits per person per calendar year.
  • Subject to deductible and coinsurance; Physical Therapy and Manipulation Therapy limited to 20 visits per person per calendar year.
  • Skilled Nursing
  • Subject to deductible and coinsurance; limited to 90 days per person per calendar year.
  • Subject to deductible and coinsurance; limited to 90 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
  • Behavioral Health - Non-Biologically Based Mental Illness and Substance Abuse limits apply.
  • Biologically based Mental Illnesses are covered the same as any other illness and limits do not apply.
  • Behavioral Health - Non-Biologically Based Mental Illness and Substance Abuse limits apply.
  • Biologically based Mental Illnesses are covered the same as any other illness and limits do not apply.
  • Hospital Care
  • Subject to deductible and coinsurance.
  • Subject to deductible and coinsurance.
  • Optional Benefits Blue Traditional Plan 2 Blue Traditional Plan 2