Anthem BCBS SmartSense Health Plan

The SmartSense health insurance plans offered by Anthem Blue Cross Blue Shield offer some great options for Wisconsin residents.  The plan has individual and family plan options, along with pricing for network and non-network coinsurance options.

These health plans also have deductible options and out of pocket maximums for each calendar year.  For family deductibles, each family member has their own individual deductible and out of pocket maximum. The family deductible can by fulfilled by 2 or more members within the health policy. No member can contribute more than their individual deductible or out of pocket maximum.

A couple additional items to note is SmartSense does offer dental and life insurance coverage for an additional cost.  The plan however, does not offer maternity coverage.  There are also many covered benefits offered to Wisconsin policy holders such as home health care, organ transplants, ambulance, chiropractic, therapy services, and urgent care.

Smart Sense Plan Highlights for Wisconsin Residents:

Doctor Visits

– Network

  • The first 3 visits have a $35 copayment.
  • For primary care physicians, the deductible is waived for first 3 visits per person each calendar year.
  • Office visit coinsurance for 4 or more visits and other services is 30%-50%

– Non-Network

  • 50% coinsurance

Inpatient Services (overnight hospital stays) and Outpatient Services (without overnight hospital stay)

– Network

  • 30% or 50% coinsurance

– Non-Network

  • 50% Coinsurance

Emergency Room Services

– Network

  • 30% or 50% coinsurance

– Non-Network

  • 30% or 50% coinsurance

 

Preventive Care Services

– Network

  • 0% coinsurance
  • Not subject to deductible

– Non-Network

  • 30% or 50% coinsurance

Retail Drug Coverage

– Network

  • Drugs on formulary: the greater of $15 copayment or 40% coinsurance
  • Drugs not on formulary: member pays for entire cost of drug, after the anthem negotiated discount

– Non-Network

  • Drugs on formulary: the greater of $15 copayment or 40% coinsurance and member is responsible for the difference between the actual cost of drug and anthem’s allowable charge
  • Drugs not on formulary: member pays for entire cost of drugs

Plan benefits are subject to change at anytime.  To receive a free health insurance quote, please contact us today.

 

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