California Health Insurance

Anthem Blue Cross of California Individual HMO

Lifetime Maximum

Unlimited
Annual Out-of-Pocket Maximum
(includes deductible)

$3,000/single (2-member maximum)
Annual Deductible

No deductible
Office Visits

You pay $10
Professional Services
(other office visits, X-ray, lab, anesthesia, surgeon, etc.)

Unlimited office visits: you pay $10 per visit
Inpatient hospital — no charge
Hospital Inpatient/Outpatient

Inpatient — no charge
Outpatient — you pay 20% of negotiated fee
(for non-emergency services)
Emergency Services

Inpatient and professional services — no
harge when authorized by a medical group
wthin 48 hours of emergency care
Outpatient — you pay $100 emergency room
copayment plus 20% Office Visit you pay $10 Inpatient Hospital no charge Outpatient Hospital you pay 20% of Negotiated Fee
Maternity

You pay 20% of the Negotiated Fee
Preventive Care

You pay a $10 copayment for specific health
maintenance services
Ambulance

You pay a $50 copayment unless admitted to
the hospital
Physical and Occupational Therapy; Chiropractic Services

You pay $10 per visit; limited to 60 consecutive days following illness or injury; no charge for inpatient services Chiropractic benefits with medical group referral
Drug Benefits
(retail or mail order: 30-day supply)
Participating Provider
You pay $10 for generic and $30 for Brand drugs, plus a $250 deductible for Brand drugs

Non-Formulary:
Participating Provider: Generic 50%; Brand 100% of negotiated Fee Rate for Brand Name Drugs until the Brand Name Prescription Drug Deductible is s
Non-participating Provider
You pay a $250 Brand deductible; then 50% of drug Limited Fee Schedule within California

 


Here at Santa Barbara Health Insurance Services we know that no web site can substitute for courteous service from an experienced professional. Our staff is always happy to help with your California health insurance, California dental insurance, or term life insurance needs. Feel free to call us any time at (800) 765-1540.