Blue Cross of California Lumenos HIA 5000 California Health Insurance Plan Details

Insurance Plan Summary
Company
Blue Cross of California
Plan Name
Lumenos HIA 5000
Plan Type
PPO
Primary Care Physician Required
No 
Specialist Referrals Required
No 
HSA Eligible
No 
Out-of-Network Coverage
Yes
In-Network Coverage
Coinsurance
0% after deductible 
Office Visit
 
Primary Doctor
No Charge after deductible 
Specialist
No Charge after deductible 
Periodic Health Exam
No Charge (deductible waived) 
Periodic OB-GYN Exam
No Charge (deductible waived) 
Well Baby Care
No Charge (deductible waived) 
Chiropractic
No Charge after deductible 
Mental Health
No Charge after deductible 
Prescription Drugs
 
Generic
No Charge after deductible 
Brand
No Charge after deductible 
Non-Formulary
No Charge after deductible 
Separate Rx Deductible
Medical Plan Deductible Applies 
Mail Order
Available
Outpatient Lab/X-Ray
No Charge after deductible 
Emergency Room
No Charge after deductible 
Outpatient Surgery
No Charge after deductible 
Hospitalization
No Charge after deductible 
Maternity
 
Pre & Postnatal Office Visit
No Charge after deductible 
Labor & Delivery Hospital Stay
No Charge after deductible 
Additional Information
Will insurance company obtain and pay for medical records?
Yes
eSign
(electronic signature)
Yes
A.M. Best Rating
A
as of 11/06/2006
More Insurance Plan Details
Details
Exclusions and Limitations
Exclusions and Limitations
Actions
Company
Blue Cross of California
Plan Name
Lumenos HIA 5000
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