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Company:
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Plan:
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Lumenos
HIA and HIA Plus
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Blue
Cross Blue Shield
is one of the most known and trusted names in the health insurance
industry. With the Lumenos Health Incentive Account
(HIA) plans you get exclusive health tools and personalized
services designed to improve and maintain your health and
enhanced control over your health care dollars.
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There are two
plans to choose from:
The basic Health
Incentive Account (HIA) Plan and the Health Incentive Account
Plus (HIA Plus) Plan. With both plans you can earn money
to apply towards eligible medical expenses by participating in the
healthy rewards programs. This is money that can be applied
towards your yearly deductible if desired. In addition, the
HIA Plus plan will allocate up to $1,000 towards your account each
year, to be used in the same capacity. Any money not used
in either HIA will rollover to the next year and is available to
apply towards eligible medical expenses.
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| Lumenos
HIA Plans at a Glance: |
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Features
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Lumenos
HIA
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Lumenos
HIA Plus
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| Lifetime
Maximum Benefit |
$5
million
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| Doctor
Office Visits |
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100%,
80%, or 70%
after deductible
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100%
or 80%
after deductible
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| Wellness
Benefit
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100%
All approved preventive care covered **
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Prescription
Drugs
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100%,
80%, or 70%
after deductible
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100%
or 80%
after deductible
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| Hospital
Services |
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100%,
80%, or 70%
after deductible
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100%
or 80%
after deductible
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Plan
Deductible
This is the amount you pay
each calendar
year before benefits are paid. |
Please run an instant
quote for deductibles in your area
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| Chiropractic
Care |
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100%,
80%, or 70%
after deductible
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100%
or 80%
after deductible
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Network
Coinsurance
This is the percentage of covered medical
expenses Anthem pays after the deductible
is met. |
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100%,
80%, or 70%
after deductible
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100%
or 80%
after deductible
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Non-network
Coinsurance
If you go out of network, this is the
limit of
covered medical expenses you pay after
the deductible is met. |
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70%,
60%, or 50%
after deductible
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70%
or 60%
after deductible
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All
Other Services
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All
Covered Services, including prescription drugs,
are subject to deductible and coinsurance
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Children
services are not subject to deductible for age appropriate visits
and routine immunizations, and are subject to the coinsurance
limits of your plan. Age specific mammogram screening
and prostate screening are covered and are not subject to deductible
or coinsurance. Maximum payment of $500 per year. |
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When
you use providers in the network, nationally recommended preventive
care services are paid for by Anthem, at zero cost to you. |
This information
is presented only as a very brief overview of some of the benefits
of this plan, and is intended only for general education.
The amount of benefits provided depends on the plan selected.
Premium will vary with the type of benefits selected. These
plans contain exclusions from and limitations of coverage.
Please see the product brochure for more complete information,
as well as information about terms of renew ability, preexisting
conditions, out-of-network penalties, and notification requirements.
Plans are subject to health underwriting. To be considered
for reimbursement, expenses must qualify as covered expenses.
Expenses are also subject to reasonable and customary limits,
unless you use a network, and all other policy provisions, including
determinations of medical necessity.
Coverage
Synopsis:
Lumenos
HIA:
The Lumenos
HIA plan is available in a 100%, 80/20 or 70/30 version.
100% Plan:
This option pays 100% of all covered expenses up to the lifetime
maximum after your deductible has been met.
80/20 Plan:
This option pays 80% of all covered expenses up to $25,000 for
individuals and $50,000 for families, after the deductible has
been met, then 100% up to the lifetime maximum. Your out
of pocket maximum is $5,000 for individuals and $10,000 for families.
70/30 Plan:
This option pays 70% of all covered expenses up to $15,000 for
individuals and $30,000 for families, after the deductible has
been met, then 100% up to the lifetime maximum. Your out
of pocket maximum is $4,500 for individuals and $9,000 for families.
Lumenos
HIA Plus:
The Lumenos
HIA plan is available in a 100% or 80/20 version.
Anthem will
allocate $1,000 for families and $500 for individuals towards
your HIA each year. This is money that can be applied towards
your deductible for eligible medical expenses. If you cancel
the plan, any money left in your account is forfeited.
100% Plan:
This option pays 100% of all covered expenses up to the lifetime
maximum after your deductible has been met.
80/20 Plan:
This option pays 80% of all covered expenses up to $25,000 for
individuals and $50,000 for families, after the deductible has
been met, then 100% up to the lifetime maximum. Your out
of pocket maximum is $5,000 for individuals and $10,000 for families.
Both
Plans:
The deductible
for each of these plans needs to be met only once for the entire
family. Please run an instant
quote for deductibles in your area.
All nationally
recommended preventive care services are 100% covered, as listed
on the Lumenos
Preventive Services list.
You choose
your own doctor and you never need referrals-but when you use
Anthem's network providers, you can save money by receiving Anthem's
negotiated discounts on services and prescriptions.
Healthy
Rewards: Anthem will contribute dollars to your HIA
for taking any of the following steps to improve and maintain
your health:
- $50 per
year for completing or updating a Health Assessment
- $100 for
enrolling and another $100 for graduating from the Personal
Health Coach program
- $50 each
for you and your spouse for completing the Smoking Cessation
Program
- $50 each
for you and your spouse for completing the Weight Management
Program
You'll have
access to these exclusive Health Tools and Personalized Services:
- An online
Health Assessment designed to help you measure your overall
health.
- A Personal
Health Coach Program, Smoking Cessation Program, and Weight
Management Program.
- 24-Hour
Nurse Advice Line when you need a quick answer to a routine
health question or advice on a medical issue.
- An online
health site with tools and information, including network provider
listings, hospital quality ratings, prescription drug costs,
wellness articles, and much more.
Plan
Options :
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Choose
the Best Individual Plan for You
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Deductible
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Coinsurance
amount plan pays in-network/out-of-network
after deductible is met
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Annual
Out-of-pocket Maximum
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$1,500
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100%
/ 70%
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$1,500
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$1,500
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70%
/ 50%
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$4,500
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$2,500
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100%
/ 70%
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$2,500
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$2,500
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80%
/ 60%
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$5,000
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$3,000
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100%
/ 70%
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$3,000
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$3,000
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80%
/ 60%
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$5,000
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$5,000
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100%
/ 70%
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$5,000
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Choose
the Best Family Plan for You
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Deductible
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Coinsurance
amount plan pays in-network/out-of-network
after deductible is met
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Annual
Out-of-pocket Maximum
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$3,000
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100%
/ 70%
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$3,000
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$3,000
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70%
/ 50%
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$9,000
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$5,000
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100%
/ 70%
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$5,000
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$5,000
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80%
/ 60%
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$10,000
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$6,000
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100%
/ 70%
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$6,000
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$6,000
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80%
/ 60%
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$10,000
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$10,000
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100%
/ 70%
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$10,000
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Note:
Please run an instant
quote for exact deductibles in your area.
Rate
Information:
Current rates
are available on our instant quote
page. The premium can be paid monthly, quarterly, semi-annual,
or annual billing, or a monthly bank draft. The bank draft
will occur on either the first or the sixteenth of each month.
The initial premium can be paid with a check, credit card, or
bank draft.
All individual
Lumenos plans have a one year rate guarantee, based on the anniversary
date of the policy. Anniversary month will be assigned for
the first of the month if effective date is the first, or the
following first of the month for requested effective dates after
the first.
PPO
Network:
Anthem gives
you access to one of the largest networks in Colorado, with nearly
8,500 health care providers and over 60 hospitals throughout the
state. The large list of doctors and hospitals can be viewed
at the Anthem
PPO Online Provider Directory.
Make sure to choose the "BluePreferred PPO" plan.
Policyholders can go to Blue Cross doctors anywhere in the
country, and can even access a world-wide network.
Underwriting:
Anthem has
one of the easiest, most efficient underwriting teams in the industry.
The process is very fast if no medical records are needed.
While it is always a good idea to apply at least three weeks prior
to the time you need your new coverage to take effect, most applications
that are done online are approved by Anthem within 24 hours.
If medical records must be ordered, the application process will
take longer.
The company
does have the right to accept or decline any individual or family
application. Certain conditions may be waivered with a temporary
rider (usually for one to two years), or an indefinite rider.
If you are currently being treated for depression, anxiety,
or high cholesterol, please let us know before you apply so we
can avoid unnecessary delays in getting you covered.
For an infant
less than 6 months of age, Anthem requires nursery records from
the hospital where the infant was born, office records from the
infant’s pediatrician, and results of the newborn screening
laboratory tests (available from the hospital or pediatrician).
Anyone applying
for Anthem coverage that has any of the following pre-existing
conditions also needs to complete the appropriate form and return
it to our office via fax (toll-free
866-284-0082)
as promptly as possible.
Effective
dates:
The coverage
can go into effect in as quickly as 24 hours, though the applicant
risks being declined if claims are submitted before the underwriting
process is completed. You may request an effective date
any time after the date you sign the application and 60 days later. Please
note that you will be billed starting on your requested effective
date, even if you have not yet been notified that you have been
approved. This is very good for someone who does not have
any present coverage and would like for their benefits to begin
right away. For those who are already covered, it is suggested
that you maintain your current coverage in force until you have
received notice from either ColoHealth
or directly from Anthem that your policy has been approved
and is in force.
Your earliest
possible effective date will be the day after Anthem has received
all the necessary documents and information needed to process
your application.
About
Anthem:
The company
known today as Anthem is the outgrowth of two Indianapolis-based
corporations formed in 1944 and 1946 as mutual insurance companies.
Those two companies were created to provide health insurance
to residents of Indiana as Blue Cross of Indiana. In the
mid-1980s, Blue Cross and Blue Shield of Indiana began to diversify
and expand, primarily through Blue Cross and Blue Shield mergers
and acquisitions. The Anthem Blue Cross and Blue Shield
companies are independent licensees of the Blue Cross and Blue
Shield Association and currently serve more than 12.6 million
customers in nine different states.
Anthem is
listed on the New York Stock Exchange under the trading symbol
ATH, and is the fifth largest publicly traded health benefits
company in the United States.
Anthem
Blue Cross Blue Shield has been assigned a rating of
"A" (Excellent) from the A.M.
Best Company, an independent insurance rating organization.
ColoHealth
is an independent authorized Anthem Blue Cross Blue Shield
agent in Colorado.
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