Message from Wiley Long
President - ColoHealth
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Health Incentive Account (HIA) Plans

 

Plans: Lumenos HIA and HIA Plus

 

 

Coverage synopsis Plan Options Rate Information PPO Network Underwriting Effective Dates About Anthem BCBS

 

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.

here 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. 

 

Lumenos HIA Plans at a Glance:
View the Outline of Coverage brochures: HIA - HIA Plus Lumenos HIA Adobe Acrobat Reader Information

Features

Lumenos HIA

Lumenos HIA Plus

Lifetime Maximum Benefit $5 million
Doctor Office Visits 100%, 80%, or 70% after deductible 100% or 80% after deductible
Wellness Benefit * 100% All approved preventive care covered **
Prescription Drugs 100%, 80%, or 70% after deductible 100% or 80% after deductible
Hospital Services 100%, 80%, or 70% after deductible 100% or 80% after deductible
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 
Chiropractic Care 100%, 80%, or 70% after deductible 100% or 80% after deductible
Network Coinsurance
This is the percentage of covered medical expenses Assurant pays after the deductible is met.
100%, 80%, or 70% after deductible 100% or 80% after deductible
Non-network Coinsurance
If you go out of network, this is the limit of covered medical expenses you pay after the deductible is met.
70%, 60%, or 50% after deductible 70% or 60% after deductible
All Other Services All Covered Services, including prescription drugs, are subject to deductible and coinsurance

       *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.

    **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:

Use the Best Individual Plan for You
Deductible Coinsurance
amount plan pays in-network/out-of-network after deductible is met
Annual Out-of-pocket Maximum
$1,500 100% / 70% $1,500
$1,500 70% / 50% $4,500
$2,500 100% / 70% $2,500
$2,500 80% / 60% $5,000
$3,000 100% / 70% $3,000
$3,000 80% / 60% $5,000
$5,000 100% / 70% $5,000
Choose the Best Family Plan for You 
Deductible Coinsurance
amount plan pays in-network/out-of-network after deductible is met
Annual Out-of-pocket Maximum
$3,000 100% / 70% $3,000
$3,000 70% / 50% $9,000
$5,000 100% / 70% $5,000
$5,000 80% / 60% $10,000
$6,000 100% / 70% $6,000
$6,000 80% / 60% $10,000
$10,000 100% / 70% $10,000

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.

 

 

 

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.