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ClearProtection 1000 1 MemberAnthem Logo

The ClearProtection 1000 1 Member plan from Blue Cross of California (Anthem Blue Cross) features the following:

Plan Type: PPO
Deductible: $1,000
In-Patient Hospital Co-Payment/Coinsurance: 40%
Prescription Drug Coverage (Out Patient): Yes
Maternity Coverage Included: Yes
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ClearProtection 1000 1 Member Summary:

In Network Out of Network
Annual Deductible Individual: $1,000 Family: $2,000 Individual: $1,000 Family: $2,000
Annual Out-Of-Pocket Limit Individual: $3,500 Family: $7,000 (Deductible not Included) Individual: $3,500 Family: $7,000 (Deductible not Included)
Lifetime Maximum $4,000,000 (In and Out of Network combined) $4,000,000 (In and Out of Network combined)
Office Visits $40 first 2 visits then No Charge after OOP max is met No Charge after Deductible then 50% after OOP max is met
Prescription Drugs Tier 1: $15 Tier 2: $35 ($2,000 Deductible per member for Tier 2) Not Covered
Laboratory and Radiology 100% of negotiated fee then No Charge after OOP max is met 100% of negotiated fee then 50% after OOP max is met
Annual Physical Exam $25/$75 Co-Pay at HealthyCheck Centers for Basic/Premium Screening Not Covered
Annual OB-GYN Exam 40% See brochure for complete details 50% See brochure for complete details
Well Baby Care 40% See brochure for complete details 50% See brochure for complete details
Outpatient Surgery 40% All Charges Except $380/day after Deductible
Emergency Room $100 (Waived if admitted) plus 40% $100 (Waived if admitted) plus 40%
Ambulance See Brochure See Brochure
Home Health Care See Brochure See Brochure
Mental Health Services - Outpatient See Brochure See Brochure
Chiropractic Care See Brochure See Brochure
Acupuncture / Acupressure See Brochure See Brochure
Inpatient Hospital 40% All Charges Except $650/day after Deductible
Maternity Care Covered Covered
Mental Health - Inpatient See Brochure See Brochure
Chemical Dependency See Brochure See Brochure

 

IMPORTANT NOTICE: Coinsurance amounts represented with a "%" are payable after the plan deductibles are reached; Co-pay amounts represented with a "$" are not subject to plan deductibles (except where noted). Refer to contract for a detailed explanation of plan benefits, features, exclusions and limitations. Benefits subject to change without notice. Out of pocket maximum shown includes the plan deductible unless otherwise noted. Co-pays, Deductibles, and Coinsurance amounts listed above are your share of the costs for covered benefits.

Do Not Cancel your current coverage until a new policy is approved and you have received written confirmation of the policy's rates and benefits from the insurance company. Rate and Benefit Disclaimer Notification!

Information contained in this website is limited in scope, subject to change without notice, and does not contain all the terms, conditions, limitations, or exclusions of the referenced benefit plans. Only the insurance company Plan Documents and Policy's contain the exact terms and conditions of coverage.

 

 
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