Smart Sense Plans

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Introducing SmartSense. Smart health coverage with sensible savings. If you want reliable, essential protection at some of our lowest monthly rates, SmartSense could be the health plan you’re looking for. What makes SmartSense so smart is how it balances solid health coverage with opportunities to save money, including:

  • A wide range of annual deductible/monthly rate combinations. Just choose the one that fits your budget.
  • Lower rates on services when you use our network of more than 50,000 doctors and 400 hospitals. This means your share of medical costs will be lower, too.
  • Immediate benefits for your first three in-network doctor visits. You’ll just have copays with no deductible to meet.
  • A choice of prescription drug benefits (brand-name and generic drugs, or (generics only). This helps keep your out-of-pocket prescription costs to a minimum.
  • Health and wellness programs. The healthier you are, the more you’ll save on health care.
  • Out-of-state coverage. This protects you from the high cost of unexpected emergencies when you travel.

For a total benefit solution, we also offer a wide range of dental and term life coverage options. Want to know more? See the following benefits-at-a-glance for a detailed look at the benefits SmartSense offers. If you have any questions, you can:

Get a Quote and Apply Now

 

Benefits-at-a-glance for SmartSense

       
Plan Benefits SmartSense®
In-Network Out-of-Network
Annual Deductible Choices Individual $500/$1,500/$2,500/$5,000 $5,000
Family $1,000/$3,000/$5,000/$10,000 $10,000
  After one family member’s individual deductible is satisfied, the remainder of the family deductible can be met by one or more other members.
Annual Out-of-Pocket Limit1
(in addition to deductible, if any)		 $2,500 $2,500 $10,000
$5,000 $5,000 aggregate* $20,000 aggregate*
Lifetime Maximum Plan pays up to $7 Million per member
 
Covered Services
The amounts shown are your share of costs after any deductible		 In-Network Out-of-Network
Doctors’ Office Visits 30% copay for first 3 visits per member per year (deductible waived); after 3 visits and once deductible is met, then 30% of negotiated fee 50% of negotiated fee plus all excess charges
Professional Services
(x-ray, lab, anesthesia, surgeon, etc.)		 30% of negotiated fee 50% of negotiated fee plus all excess charges
Hospital Inpatient
(overnight hospital stays)		 30% of negotiated fee All charges except $650 per day
Hospital Outpatient
(if you don’t stay overnight)		 30% of negotiated fee All charges except $380 per day
Emergency Room Services
($100 copay applies for each visit; waived if admitted as inpatient)		 30% of negotiated fee 50% of customary and reasonable fees plus all excess charges
Maternity Not covered Not covered
Preventive Care
(tests ordered by physician are covered, including appropriate screening for breast, cervical, ovarian, and prostate cancer)		 Adult Services Annual Physical exam(s): 30% of negotiated fee Routine mammogram,
Pap and PSA tests:
30% of negotiated fee		 50% of negotiated fee plus all excess charges.
Children's Services 30% of negotiated fee
Acupuncture / Acupressure Not covered
Chiropractic Services 30% of negotiated fee 50% of negotiated fee plus all excess charges
Plan covers up to $500 per year
 
Prescription Drug Coverage Options In-Network Out-of-Network
Comprehensive Prescription Drug Coverage Generic: $15 copay (or 40%, whichever is greater) Generic: $15 copay (or 40%, whichever is greater)
Brand-name/Specialty $500 annual deductible (2 member max) applies before the following: Brand-name: $15 copay (or 40%, whichever is greater, not to exceed $500 per prescription) Specialty: 40% $4,500 Annual Out-of-Pocket Maximum (the most you’ll have to pay)
In-Network only and in addition to brand name/specialty deductible		 $500 annual deductible (2 member max) applies before the following: Brand-name: $15 copay (or 40%, whichever is greater) Specialty: Not covered
Generic Prescription Drug Coverage $15 copay (or 40%, whichever is greater)
No Prescription Drug Coverage Not applicable

*When one or more family members’ eligible expenses (combined) meet the aggregate amount, the requirement is satisfied for all covered family members.
1. Excludes non-participating charges in excess of the Anthem Blue Cross negotiated fee and non-participating charges in excess of customary and reasonable fees for emergency care. Copays/coinsurance to participating and non-participating providers apply to annual calendar year out-of-pocket limit except where specifically noted in the policy.

 

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