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Anthem Blue Cross and Blue Shield of Colorado Lumenos HSA 1500 3000 70 Plan Information

Plan Name: Lumenos HSA 1500 3000 70

Plan Type: HSA

Financial/Tax Incentive: Yes

Physician Choice: You choose specialist(s)

Annual Deductible: $1500 single/$3000 family in-network $3000 single/$6000 family out-of-network

Coinsurance: You pay 30% in-network/50% out-of-network

Annual Out-of-Pocket Maximum (includes deductible): $5000 single/$10000 family in-network $10000 single/$20000 family out-of-network

Lifetime Maximum: $2,000,000

Office Visits: You pay 30% in-network/50% out-of-network

Professional Service Includes X-ray and lab charges: You pay 30% in-network/50% out-of-network

Emergency Care: After deductible, You pay 0% in network/0% out-of-network

Ambulance: After deductible, You pay 30% in network/30% out-of-network

Hospital Inpatient Services: You pay 30% in-network/50% out-of-network

Outpatient Services: You pay 30% in-network/50% out-of-network

Preventive Care- Children: You pay 0% deductible waived in-network/50% out-of-network

Preventive Care- Adult: You pay 0% deductible waived in-network/50% out-of-network

Prescription Drug Benefits: You pay 30% in-network/50% out-of-network

Maternity: Benefits are paid for complications of pregnancy only, Routine maternity care is not covered

Significant Additional Services: You pay 30% in-network/50% out-of-network

Other Anthem Blue Cross and Blue Shield of Colorado health insurance plans:

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