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 |
|
|
|
| Total Monthly Premium | |
| TOTAL | $465.10 |
| Disclaimers |
Dental
| Benefit | Benefit details |
|---|---|
|
Monthly Cost |
$465.10 a month
Monthly Cost Breakdown
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
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.