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Anthem Blue Cross and Blue Shield of Colorado Lumenos HSA 3000 6000 80 Plan Information

Plan Name: Lumenos HSA 3000 6000 80

Plan Type: HSA

Financial/Tax Incentive: Yes

Physician Choice: You choose specialist(s)

Annual Deductible: $3000 single/$6000 family in-network $6000 single/$12000 family out-of-network

Coinsurance: You pay 20% in-network/40% 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: After deductible, You pay 20% in-network/40% out-of-network

Professional Service Includes X-ray and lab charges: After deductible, You pay 20% in-network/40% out-of-network

Emergency Care: After deductible, You pay 20% in network/20% out-of-network

Ambulance: After deductible, You pay 20% in network/20% out-of-network

Hospital Inpatient Services: After deductible, You pay 20% in-network/40% out-of-network Outpatient Services: After deductible, You pay 20% in-network/40% out-of-network

Preventive Care- Children: You pay 0% deductible waived in-network/40% out-of-network

Preventive Care- Adult: You pay 0% deductible waived in-network/40% out-of-network

Prescription Drug Benefits: After deductible, You pay 20% in-network/40% out-of-network

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

Significant Additional Services: After deductible, You pay 20% in-network/40% out-of-network

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

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