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SmartSense 2000 Plus Upgrade Rx 1 MemberAnthem Logo

The SmartSense 2000 Plus Upgrade Rx 1 Member plan from Blue Cross of California (Anthem Blue Cross) features the following:

Plan Type: PPO
Deductible: $2,000
In-Patient Hospital Co-Payment/Coinsurance: 30%
Prescription Drug Coverage (Out Patient): Yes
Maternity Coverage Included: 30%
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SmartSense 2000 Plus Upgrade Rx 1 Member Summary:

In Network Out of Network
Annual Deductible Individual: $2,000 Family: $4,000 Individual: $2,000 Family: $4,000
Annual Out-Of-Pocket Limit Individual: $3,500 Family: $7,000 (Deductible not Included) Individual: $7,500 Family: $15,000 (Deductible not Included)
Lifetime Maximum Unlimited Unlimited
Office Visits $30 first 3 visits/member/year then 30% 50%
Prescription Drugs Generic: $15 Brand: $40 Non-Formulary Brand: $60 ($500 Brand Deductible, see brochure for details) 50%
Laboratory and Radiology 30% 50%
Annual Physical Exam No Charge 50%
Annual OB-GYN Exam No Charge 50%
Well Baby Care No Charge 50%
Outpatient Surgery 30% All Charges Except $380/day after Deductible
Emergency Room 30% plus $100 (Waived if admitted) 30% plus $100 (Waived if admitted)
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 See Brochure See Brochure
Maternity Care 30% 50%
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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Copyright © 2017 Dave Terpening Insurance Agency, Inc. |  CA Lic# 0G47857
Blue Cross of California is an independent licensee of the Blue Cross Association. The Blue Cross name and symbol are registered service marks of the Blue Cross Association.

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