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Anthem Right Plan PPO 440
 
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Company: 
Anthem Blue Cross Blue Shield of Colorado
Plan: 
Right Plan PPO 440  
   
  Right Plan is designed for consumer that want more of a choice in their health insurance, including control over how much if any outpatient coverage they want in their policy.  This is also the only PPO plan on the market in Colorado that offers you NO DEDUCTIBLE, meaning that you can enjoy first-dollar benefits for not only doctor visits and prescriptions (if you choose), but for all of your other medical services as well.

 
Anthem BCBS

Plans at a Glance:           View the Outline of Coverage brochure Adobe Acrobat Reader Information

Plan Names: 
PPO 40 No Rx   -   PPO 40 Generic Rx   -   PPO 40 Comprehensive Rx
Features
Network
Non-Network
  Copay
$40
N/A
  Deductible
$0 (Family coverage not provided)
$0 (Family coverage not provided)
  Co-insurance (% Paid by Insurance Company)
60%
50%
  Co-insurance Limit
$8,750
$20,000
  Out-of-Pocket Maximum
$3,500
$10,000
  Lifetime Maximum
$5,000,000 per member in- and out- network combined for all covered services
$5,000,000 per member in- and out- network combined for all covered services
  Office Visits
- Primary Care Providers - You pay $40 co-payment per office visit plus 40% co-insurance for services other than an office visit.
- Specialists - You pay $40 co-payment per office visit plus 40% co-insurance for services other than on office visit.
- Only limited services are covered as part of an office visit; all other covered services are subject to applicable co-insurance or cost sharing.

50% co-insurance
  Prescription Drugs
  Emergency Room
You pay $100 emergency room co-payment (waived if admitted), plus 40% co-insurance
You pay $100 emergency room co-payment (waived if admitted), plus 50% co-insurance
  Adult Preventive Care
 Not Covered except for:
- One annual pap test. $40 co-payment for office visit plus 40% co-insurance. Maximum $75 Anthem payment for laboratory test;
- Mammogram screening and prostate screening, which are not subject to co-insurance.
 Not Covered except for:
- Mammogram screening and prostate screening, which are not subject to co-insurance.
  Child Preventive Care
$40 co-payment for office visit plus you pay 40% co-insurance for services other than an office visit for age-appropriate visits and routine immunizations.
You pay 50% co-insurance, for age-appropriate visits and routine immunizations.
  Lab / X-ray
You pay 40%
You pay 50%
  Maternity
- Prenatal care - Not covered.
- Delivery and Inpatient well baby care - Delivery not covered.  You pay 40% co-insurance plus $500 co-payment per day up to 4 days for inpatient well baby care for up to 31-days following birth, adoption or placement for adoption.
- Prenatal care - Not covered.
- Delivery and Inpatient well baby care - Delivery not covered.  You pay 50% co-insurance plus $500 co-payment per day up to 4 days for inpatient well baby care for up to 31-days following birth, adoption or placement for adoption.
  Physical Therapy
- Inpatient - You pay 40% co-insurance.  Covered when received as part of an inpatient hospital admission for acute care and for rehabilitation therapy for up to 30 days per illness or injury, in and out-of-network combined.
- Outpatient - You pay 40%.  Physical and occupational therapy is limited to a combination of 12 visits in each benefit year in- and out-of-network combined, except for children to age 5.
- Inpatient - You pay 50% co-insurance.  Covered when received as part of an inpatient hospital admission for acute care and for rehabilitation therapy for up to 30 days per illness or injury, in and out-of-network combined.
- Outpatient - For Participating Providers, you pay 50%.  For Non-Participating Providers, you pay all charges except $25 per visit.  Physical and occupational therapy is limited to a combination of 12 visits in each benefit year in- and out-of-network combined, except for children to age 5.
  Skilled Nursing
Not Covered
Not Covered
  Home Health Care
- You pay 40% co-insurance
- Limited to 60 visits in each benefit year, in- and out-of-network combined.
- You pay 50% co-insurance
- Limited to 60 visits in each benefit year, in- and out-of-network combined.
  Mental Health
- Inpatient care - You pay all charges except $175 per day.  Limited to 30 days in each benefit year, in- and out-of-network combined.
- Outpatient care - You pay all charges except $25 per visit.  Limited to 20 visits in each benefit year, in- and out-of-network combined.  Maximum Anthem payment for inpatient and outpatient care is limited to $10,000 per lifetime, in- and out-of-network combined.
<= Same as In-Network
  Hospital Care
- Inpatient hospital - You pay $500 co-payment per day up to 4 days, plus 40% co-insurance.  Hospital co-payment amounts will be applied to out-of-pocket cost sharing requirements.
- Inpatient hospital - You pay $500 co-payment per day up to 4 days, plus 50% co-insurance.  Hospital co-payment amounts will be applied to out-of-pocket cost sharing requirements.

  * Children services are not subject to deductible for age appropriate visits and routine immunizations, and are subject to the co-insurance limits of your plan.  Age specific mammogram screening and prostate screening are covered and are not subject to deductible or co-insurance.  Maximum payment of $500 per year.

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.

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Coverage Synopsis:

This coverage will provide you with ZERO DEDUCTIBLE hospitalization coverage.  You simply pay a $500 per day confinement charge for your first four days of coverage, and none thereafter.  From there, Blue Cross Blue Shield will pay 60%, with you paying the remaining 40%.  After $8,750 in qualified expenses, the plan then kicks in at 100% up to a lifetime benefit of $2 million per person.  This means your maximum out of pocket exposure during the year (not including co-payments) would be $3,500.  Your $500 per day confinement charge DOES count towards your $3,500 out of pocket limit.

This coverage would also provide you with an unlimited number of doctor visits each year, with a $40 co-payment per visit.

Outpatient Prescriptions Drug coverage varies by policy, as follows:

RightPlan PPO 40 No Rx:  Not covered.

This is a good option if you have been turned down previously by other companies due to the cost of your prescriptions.  Since this plan does not offer any coverage for outpatient benefits, the underwrititing requirements are more leneient than Anthem plans offering prescription coverage.

RightPlan PPO 40 Generic Rx:

  • Tier 1 - You pay a generic formulary $10 co-payment
  • Brand name drugs are not covered

RightPlan PPO 40 Comprehensive Rx:

  • At a participating pharmacy up to a 34-day supply:

    • Tier 1 - You pay a generic formulary $10 co-payment
    • Tier 2 - You pay a brand formulary $30 co-payment
    • Tier 3 - You pay non-formulary 50% co-insurance
    • Tier 4 - You pay 30% co-insurance for self-administered injectables

  • Prescription Mail Service up to a 90-day supply:

    • Tier 1 - You pay a generic formulary $20 co-payment
    • Tier 2 - You pay a brand formulary $60 co-payment
    • Tier 3 - You pay non-formulary 50% co-insurance
    • Tier 4 - You pay 30% co-insurance for self-administered injectables

Note: All brand name prescription drugs are subject to an annual $500 brand deductibls.  The $500 brand deductible does not apply to the out-of-pocket annual maximum.


Right Plan is only available to individual policy holders.  If more than one person in your family is applying, you simply need to submit a separate application for each family member you would like to cover.

The coverage and rates are excellent, and they have what is probably the widest PPO network in the state of Colorado. Complete details can be seen by opening:

blue cross blue shield of colorado

Rate Information:

Rates are available through our instant quote system.

Rates are the same throughout Colorado, and don't change by zip code or effective date.  Though rates may change at any time, readjustments typically occur on January 1 of each year.  

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 or credit card.

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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.

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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.

Right Plan is the only policy offered by Blue Cross that may include a "rate up," or increase in your monthly premium due to a pre-existing health condition.  By offering coverage with a rate up, Anthem is able to approve policies for applicants who they would otherwise decline.

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).

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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.

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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 and Blue Shield of Indiana.

As the health care industry began rapidly consolidating 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.  Now going by the name Anthem Blue Cross and Blue Shield, they underwrite some of the most popular plans we offer at ColoHealth.

The Anthem Blue Cross and Blue Shield companies are independent licensees of the Blue Cross and Blue Shield Association and currently serves more than 12.6 million customers in nine different 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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