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Company:
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Plan:
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SmartSense
Plan
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newest plan available for individuals and families is called SmartSense.
It offers reliable, standard protection with low monthly rates. SmartSense
gives members a choice of prescription drug benefits and immediate benefits for
your first three doctor visits all at a low co-payment that works for you. Specific
financial benefits apply to both families and individuals with the SmartSense
plan. Members can choose the deductible rate that accommodates their personal
budget anywhere from $500 to $7,500 for individuals and up to $15,000 for families.
Each family member has an individual deductible. A family deductible can
be satisfied by 2 or more members. | | | | | | | | |
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Coverage
Synopsis: View
the
Outline
of Coverage
brochure 
Annual
Deductible Choices (In-Network rates):
Individual
- $500 / $1,500 / $2,500 / $5,000 / $7,500 Family
- $1,000 / $3,000 / $5,000 / $10,000 /$15,000
Annual
Out-of-Pocket Maximum (In-Network rates):
Individual
Maximum - $3,000 / $4,000 / $5,000 / $7,500 / $10,000 Family
Maximum - $6,000 / $8,000 / $10,000 / $15,000 / $20,000
Like the deductible, each
family member has an individual out-of-pocket maximum. Family out-of-pocket
maximums can be satisfied by 2 or more members. The SmartSense plan can
pay up to $7 million per member. SmartSense
offers many covered services for members for a fraction of coinsurance payouts.
In-Network coinsurance amounts are a percentage of the negotiated fee. - Pay
only 30% coinsurance on all professional services, inpatient and outpatient
costs, emergency room services, preventive care services, and therapy costs.
- $30 dollar
copay for first 3 visits per member per year after deductible is waived. After
the first three visits and the deductible is satisfied co-insurance rates are
30%
Your
prescription drug coverage has two options:
The Comprehensive
Prescription Drug Plan (In-Network only): - $15
copay on both generic and brand-name prescription drugs, as well as a 40%
coinsurance rate for all specialty prescriptions
- Annual
out-of-pocket maximum is $5,000
The
Generic Prescription Drug Plan: - Covers
only generic brands with a $15 copay or 40% coinsurance - whichever is greater
Taking a plan with just
generic prescription coverage can save you up to 50% per month on your insurance
premium. Exclusions
and Limitations Applicable to the SmartSense Plan: - Maternity
and pregnancy care
- Experimental
and investigative services
- Conditions
covered by workers' compensation
- Services
provided by a local, state, federal or foreign government
- Services
received before your effective date
- Any services
received by Medicare benefits without payment of additional premium
- Services
or supplies that are not medically necessary
- Cosmetic
surgery
- Infertility
services
- Private duty
nursing
- Services
received for mental and nervous disorders and substance abuse
- Vision care
including certain eye surgeries to replace glasses
Other
exclusions and limitation apply. View the Health
Plan Description Form
for a complete list.
Rate
Information:
Rates are available
through our instant quote
system. 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.
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. 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).
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 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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