Anthem Blue Cross of California
Lumenos HSA 5000 100% Health Insurance Plan
A plan summary of the Anthem Blue Cross of California Lumenos HSA 5000 - 100% Plan is detailed out below for both In Network and Out of Network coverage.
| In Network |
Out of Network |
Copay |
No Charge after Deductible
|
30% |
Office Visits |
No Charge after Deductible
|
30% |
| Annual Deductible |
Individual: $5,000 |
Individual: $5,000 |
| Annual Out-Of-Pocket Limit |
Individual: $5,000 |
Individual: $5,000 (Deductible not Included) |
| Lifetime Maximum |
Unlimited |
Unlimited |
| Prescription Drugs |
No Charge after Medical / Rx Deductible
|
30% |
| Laboratory & X-Ray |
No Charge after Deductible
|
30% |
| Annual Physical Exam |
No Charge |
30% |
| Annual OB-GYN Exam |
No Charge |
30% |
Well Baby Care |
No Charge |
30% |
| Outpatient Surgery |
No Charge after Deductible |
All Charges except $380/day after Deductible
|
| Emergency Room |
No Charge after Deductible |
No Charge after Deductible |
| Inpatient Hospital |
No Charge after Deductible |
All Charges Except $650/day after Deductible
|
| Ambulance |
See Brochure |
See Brochure |
| Home Health Care |
See Brochure |
See Brochure |
| Mental Health - Outpatient |
See Brochure |
See Brochure |
| Chiropractic Care |
See Brochure |
See Brochure |
Acupuncture |
See Brochure |
See Brochure |
| Mental Health - Inpatient |
See Brochure |
See Brochure |
| Chemical Dependency |
See Brochure |
See Brochure |
| Maternity Care |
No Charge after Deductible |
30% |
To learn more about your
individual and family
California health insurance options, the price of each plan and/or a detailed benefit summary of the plans, visit us here.
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