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Lumenos HSA 5950 Plus 1 MemberAnthem Logo

The Lumenos HSA 5950 Plus 1 Member plan from Blue Cross of California (Anthem Blue Cross) features the following:

Plan Type: PPO
Deductible: $5,950
In-Patient Hospital Co-Payment/Coinsurance: 0%
Prescription Drug Coverage (Out Patient): Yes
Maternity Coverage Included: No Charge After Ded.
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Lumenos HSA 5950 Plus 1 Member Summary:

In Network Out of Network
Annual Deductible Individual: $5,950 Individual: $5,950
Annual Out-Of-Pocket Limit Individual: $5,950 Individual: $5,950 (Deductible not Included)
Lifetime Maximum Unlimited Unlimited
Office Visits No Charge after Deductible 40%
Prescription Drugs No Charge after Medical/Rx Deductible 40%
Laboratory and Radiology No Charge after Deductible 40%
Annual Physical Exam No Charge 40%
Annual OB-GYN Exam No Charge 40%
Well Baby Care No Charge 40%
Outpatient Surgery No Charge after Deductible 40%
Emergency Room No Charge after Deductible No Charge after Deductible
Ambulance See Brochure See Brochure
Home Health Care See Brochure See Brochure
Mental Health Services - Outpatient No Charge after Deductible 40%
Chiropractic Care See Brochure See Brochure
Acupuncture / Acupressure See Brochure See Brochure
Inpatient Hospital See Brochure See Brochure
Maternity Care No Charge after Deductible 40%
Mental Health - Inpatient No Charge after Deductible 40%
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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