We don’t accept health insurance at our office, but for ourselves we could benefit from some health coverage.  What we selected was based on recommendations from a Direct Sales Agent of Blue Cross.

Below are some notes to myself about health insurance and perhaps they may be of help to you too.

1-855-383-7247 to make payment over the phone

Mirita Dorsey, direct phone number 1-844-470-6571.  Email Mirita.dorsey (at) wellpoint.com

http://www.anthemdirectca.com/mdorsey – to apply for California

Anthem Bronze 60 D Health Savings Account PPO

$465.10 per month for 2 people

Deductable $9,000 for family
Out of Pocket Max	$12,500 for family (includes deductible)
Primary Care Visit to Treat an Injury or Illness	You pay 40% after deductible
Specialist Visit	You pay 40% after deductible
Tier 1 Drugs	30 day Retail: You Pay 40% after deductible 90 day Mail Order: You Pay 40% after deductible
Tier 2 Drugs	30 day Retail: You Pay 40% after deductible 90 day Mail Order: You pay 40% after deductible
Tier 3 Drugs	30 day Retail: You pay 40% after deductible 90 day Mail Order: You Pay 40% after deductible
Tier 4 Drugs	30 day Retail or Mail Order: You Pay 40% after deductible
Total Monthly Premium	465.10
Subsidized Premium	0.00
Total Member Responsibility	465.10
Dental
Total Monthly Premium
TOTAL	$465.10
Disclaimers

 

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Benefit	Benefit details
Monthly Cost	$465.10 a month Monthly Cost Breakdown Total Plan Cost $465.10 Subsidy Applied $0.00 Total Member Responsibility$465.10
Issued By	Anthem Blue Cross
Deductible (s)	$9,000 for family
Primary Care Visit to Treat an Injury or Illness	You pay 40% after deductible
Out of Pocket Max	$12,500 for family (includes deductible)
Specialist Visit	You pay 40% after deductible
Most Generic Drugs (Tier 1)	30 day Retail: You Pay 40% after deductible 90 day Mail Order: You Pay 40% after deductible
Most Preferred Brand Drugs (Tier 2)	30 day Retail: You Pay 40% after deductible 90 day Mail Order: You pay 40% after deductible
Most Non-Preferred Brand Drugs (Tier 3)	30 day Retail: You pay 40% after deductible 90 day Mail Order: You Pay 40% after deductible
Most Specialty Drugs (Tier 4)	30 day Retail or Mail Order: You Pay 40% after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	You pay 40% after deductible
Outpatient Surgery Physician/Surgical Services	You pay 40% after deductible
Emergency Room Services	You pay 40% after deductible
HSA Compatible	Yes
Live Health Online	You pay 40% after deductible
Pediatric Dental and vision	This product includes the required coverage for the Pediatric Essential Health Benefits which does not provide adult vision or dental benefits. Please review the Summary of Benefits for details
Mental/Behavioral Health Outpatient Services	You pay 40% after deductible
Urgent Care Centers or Facilities	You pay 40% after deductible
X-rays and Diagnostic Imaging	You pay 40% after deductible
Chiropractic Care	Benefit is not covered
Preventive Care/Screening/Immunization	You pay 0% – not subject to deductible
Prenatal and Postnatal Care	Prenatal Care: You pay 0% – not subject to deductible Postpartum Care: You pay 40% – not subject to deductible
Imaging (CT/PET Scans, MRIs)	You pay 40% after deductible
Laboratory Outpatient and Professional Services	You pay 40% after deductible
Mental/Behavioral Health Inpatient Services	You pay 40% after deductible
Delivery and All Inpatient Services for Maternity Care	You pay 40% after deductible
Inpatient Physician and Surgical Services	You pay 40% after deductible
Emergency Transportation/Ambulance	You pay 40% after deductible
Allergy Testing	You pay 40% after deductible
Durable Medical Equipment	You pay 40% after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	You pay 40% after deductible
Diabetes Care Management	You pay 40% after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)	You pay 40% after deductible
Outpatient Rehabilitation Services	Occupational Therapy: You pay 40% after deductible Physical Therapy: You pay 40% after deductible Speech Therapy: You pay 40% after deductible

 

calvinleeinsurance-t E21421087986843 Application Control Number

http://file.anthem.com/2015/OFF_HIX_CA_KIT6_2015.pdf

 

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REQUIREMENT FOR BINDING ARBITRATION

 

YOU AND ANTHEM BLUE CROSS AGREE TO BINDING ARBITRATION TO SETTLE ALL DISPUTES INCLUDING BUT NOT LIMITED TO DISPUTES RELATING TO THE DELIVERY OF SERVICE UNDER THE PLAN/POLICY AND/OR ANY OTHER ISSUES RELATED TO THE PLAN /POLICY AND CLAIMS OF MEDICAL MALPRACTICE, IF THE AMOUNT IN DISPUTE EXCEEDS THE JURISDICTIONAL LIMIT OF SMALL CLAIMS COURT AND THE DISPUTE CAN BE SUBMITTED TO BINDING ARBITRATION UNDER APPLICABLE FEDERAL AND STATE LAW, INCLUDING BUT NOT LIMITED TO, THE PATIENT PROTECTION AND AFFORDABLE CARE ACT. IT IS UNDERSTOOD THAT ANY DISPUTE INCLUDING DISPUTES RELATING TO THE DELIVERY OF SERVICES UNDER THE PLAN/POLICY AND/OR ANY OTHER ISSUES RELATED TO THE PLAN/POLICY, INCLUDING ANY DISPUTE AS TO MEDICAL MALPRACTICE, THAT IS AS TO WHETHER ANY MEDICAL SERVICES RENDERED UNDER THIS CONTRACT WERE UNNECESSARY OR UNAUTHORIZED OR WERE IMPROPERLY, NEGLIGENTLY OR INCOMPETENTLY RENDERED, WILL BE DETERMINED BY SUBMISSION TO ARBITRATION AS PERMITTED AND PROVIDED BY FEDERAL AND CALIFORNIA LAW, INCLUDING BUT NOT LIMITED TO, THE PATIENT PROTECTION AND AFFORDABLE CARE ACT AND NOT BY A LAWSUIT OR RESORT TO COURT PROCESS EXCEPT AS CALIFORNIA LAW PROVIDES FOR JUDICIAL REVIEW OF ARBITRATION PROCEEDINGS. BOTH PARTIES TO THIS CONTRACT, BY ENTERING INTO IT, ARE GIVING UP THEIR CONSTITUTIONAL RIGHT TO HAVE ANY SUCH DISPUTE DECIDED IN A COURT OF
LAW BEFORE A JURY, AND INSTEAD ARE ACCEPTING THE USE OF ARBITRATION. YOU, ANTHEM BLUE CROSS AGREE THAT EACH MAY BRING CLAIMS AGAINST THE OTHER ONLY IN YOUR OR ITS INDIVIDUAL CAPACITY, AND NOT AS A PLAINTIFF OR CLASS MEMBER IN ANY PURPORTED CLASS OR REPRESENTATIVE PROCEEDING. THIS MEANS THAT YOU AND ANTHEM BLUE CROSS ARE WAIVING THE RIGHT TO A JURY TRIAL AND/OR TO PARTICIPATE IN A CLASS ACTION FOR BOTH MEDICAL MALPRACTICE CLAIMS, AND ANY OTHER
DISPUTES INCLUDING DISPUTES RELATING TO THE DELIVERY OF SERVICE UNDER THE PLAN/POLICY OR ANY OTHER ISSUES RELATED TO THE PLAN/POLICY.