March 19, 2010

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Blue Cross Blue Shield of Georgia – SmartSense with Comprehensive Rx – GEORGIA

A comparison of the SmartSense with Comprehensive Rx offered by Blue Cross Blue Shield of Georgia is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application SmartSense with Comprehensive Rx Application SmartSense with Comprehensive Rx Application
Brochure SmartSense with Comprehensive Rx Brochure SmartSense with Comprehensive Rx Brochure
Copay Physician Office Visit- $30 Copay for first 3 visits per person per calendar year, then Plan pays 70% after deductible. Plan pays 60% (subject to deductible except for child wellness)
Office Visit $30 Copay for first 3 visits per person per calendar year, then Plan pays 70% after deductible. Plan pays 60% (subject to deductible except for child wellness)
Deductible Individual: $750, Family: $1,500 Individual: $750, Family: $1,500
Coinsurance Plan pays 70% after deductible (Plan pays 100% after OOP Max is met) Plan pays 60% after deductible (Plan pays 100% after OOP Max is met)
Coinsurance Limit See OOP Maximum See OOP Maximum
Out-of-Pocket Maximum Individual: $3,750, Family: $7,500 Individual: $8,250, Family: $16,500
Lifetime Maximum $7,000,000 $7,000,000
Prescription Drugs
  • Separate $250 per person deductible for Brands & Specialty drugs (Drug deductible does not apply to Generic drugs).
  • Greater of $15 or 40% coinsurance.
  • If a brand name drug is purchased, the member will be responsible for the difference in allowable charge between the brand and generic, plus the copayment or coinsurance. 40% coinsurance up to an out-of-pocket maximum of $300 per script; $4,000 annual out-of-pocket maximum per person.
    		•
  • Separate $250 per person deductible for Brands & Specialty drugs (Drug deductible does not apply to Generic drugs).
  • Greater of $15 or 40% coinsurance.
  • If a brand name drug is purchased, the member will be responsible for the difference in allowable charge between the brand and generic, plus the copayment or coinsurance. 40% coinsurance up to an out-of-pocket maximum of $300 per script; $4,000 annual out-of-pocket maximum per person.
    		•
    Emergency Room
  • Medical Emergency or Accident- Plan pays 70% after deductible
  • Non-Medical Emergency or Non-Serious Accidental Injury- Plan pays 70% after deductible
    		•
  • Medical Emergency or Accident- Plan pays 70% after deductible
  • Non-Medical Emergency or Non-Serious Accidental Injury- Plan pays 60% after deductible
    		•
    Adult Preventative Care
  • Preventive Care 6 & older (to include services like PSA, Colorectal screening, mammograms, pap smear, and chlamydia screening)- Plan pays 70% after deductible
  • Routine office Visits- $30 Copay when included in the first 3 visits per person per calendar year, then Plan pays 70% after deductible.
    		•
  • Preventive Care Children thru age 5- Plan pays 60% (not subject to deductible)
  • Routine office Visits- $30 Copay when included in the first 3 visits per person per calendar year, then Plan pays 60%.
    		•
    Child Preventative Care
  • Preventive Care Children thru age 5- Plan pays 70% (not subject to deductible)
  • Routine office Visits- $30 Copay when included in the first 3 visits per person per calendar year, then Plan pays 70%.
    		•
  • Preventive Care Children thru age 5- Plan pays 60% (not subject to deductible)
  • Routine office Visits- $30 Copay when included in the first 3 visits per person per calendar year, then Plan pays 60%.
    		•
    Lab / X-Ray Plan pays 70% after deductible Plan pays 60% after deductible
    Maternity Not Covered (except for complications) Not Covered (except for complications)
    Physical Therapy
  • Plan pays 70% after deductible
  • 30 Visits per year, combined specialties (in and out of network)
    		•
  • Plan pays 60% after deductible
  • 30 Visits per year, combined specialties (in and out of network)
    		•
    Skilled Nursing
  • Plan pays 70% after deductible
  • 30 Visits per year, combined specialties (in and out of network)
    		•
  • Plan pays 60% after deductible
  • 30 Visits per year, combined specialties (in and out of network)
    		•
    Home Health Care
  • Plan pays 70% after deductible
  • 100 Visits per year, combined specialties (in and out of network)
    		•
  • Plan pays 60% after deductible
  • 100 Visits per year, combined specialties (in and out of network)
    		•
    Mental Health
  • Plan pays 70% after deductible
  • Inpatient- 30 Visits per year (in and out of network)
  • Outpatient- 48 Visits per year (in and out of network)
    		•
  • Plan pays 60% after deductible
  • Inpatient- 30 Visits per year (in and out of network)
  • Outpatient- 48 Visits per year (in and out of network)
    		•
    Hospital Care Plan pays 70% after deductible Plan pays 60% after deductible
    Optional Benefits
  • Drug Buy-up
  • Preventive, Restorative & Complex Dental Services (Dental Blue Plans)
  • Term Life
    		•
  • Drug Buy-up
  • Preventive, Restorative & Complex Dental Services (Dental Blue Plans)
  • Term Life
    		•