Anthem Blue Cross and Blue Shield of Nevada Lumenos HIA 1500 3000 100 Plan Information

Plan Name Lumenos HIA 1500 3000 100

Plan Type: HIA

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 0% in-network/30% out-of-network

Annual Out-of-Pocket Maximum (includes deductible): $1500 single/$3000 family in-network $4500 single/$9000 family out-of-network Lifetime Maximum: $2,000,000

Office Visits: After deductible, You pay 0% in-network/30% out-of-network

Professional Service Includes X-ray and lab charges: After deductible, You pay 0% in-network/30% out-of-network

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

Ambulance: After deductible, You pay 0% in network/0% out-of-network.

Hospital Inpatient Services: After deductible, You pay 0% in-network/30% out-of-network

Outpatient Services: After deductible, You pay 0% in-network/30% out-of-network

Preventive Care- Children: You pay 0% deductible waived in-network/30% out-of-network.

Preventive Care- Adult: You pay 0% deductible waived in-network/30% out-of-network.

Prescription Drug Benefits: After deductible, You pay 0% in-network/30% 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 0% in-network/30% out-of-network

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

• Lumenos HSA 5000 10000 100
• HSA Qualified High Ded Health Plan 5000 100
• Lumenos HIA 5000 10000 100
• Anthem BlueSaver 2000
• Lumenos HSA 3000 6000 80
• Lumenos HIA 3000 6000 80
• Lumenos HSA 2500 5000 80
• Anthem Blue High Ded HSA compatible 2600
• Lumenos HIA 2500 5000 80
• Anthem Blue 5000
• HSA Qualified High Ded Health Plan 3000 70
• HSA Qualified High Ded Health Plan 4000 100
• BluePreferred For Individuals 3000 Ded
• HSA Qualified High Ded Health Plan 2000 70
• Lumenos HIA Plus 5000 10000 100
• Lumenos HSA 3000 6000 100
• Lumenos HIA 3000 6000 100
• Lumenos HSA 1500 3000 70
• Lumenos HIA 1500 3000 70
• HSA Qualified High Ded Health Plan 3000 100
• HSA Qualified High Ded Health Plan 1500 70
• Lumenos HSA 2500 5000 100
• BluePreferred For Individuals 2000 Ded
• Lumenos HIA 2500 5000 100
• Lumenos HIA Plus 3000 6000 80
• Lumenos HIA Plus 2500 5000 80
• BluePreferred For Individuals 500 Ded No RX
• HSA Qualified High Ded Health Plan 2000 100
• Lumenos HIA Plus 3000 6000 100
• Lumenos HSA 1500 3000 100
• BluePreferred For Individuals 1000 Ded
• Lumenos HIA Plus 2500 5000 100
• HSA Qualified High Ded Health Plan 1500 100
• BluePreferred For Individuals 500 Ded