SmartSense PPO Plans

New Plan DesignLaunched December 2007

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SmartSense

Smar tSenseFrom Anthem Blue Cross Life and Health Insurance Company

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SmartSense Highlights

Reliable protection with some of our lowest monthly rates

Choice of annual deductible/monthly rate combination

In-network office visits available before deductible

Choice of prescription drug benefits (Generic Only or Comprehensive)

$7 million lifetime maximum benefit

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SmartSense Benefits

In-Network Out-of-Network

DeductibleIndividual/Family $5,000/$10,000

• Separate in-network and out-of-network deductibles

• Embedded (family) deductiblesOnce a member meets their single deductible, their deductible is satisfied. After any one family member meets the single deductible, then two or more family members can meet the family deductible.

• 4th Quarter carry-over deductible feature

4 OPTIONS

$500/$1,000

$1,500/$3,000

$2,500/$5,000

$5,000/$10,000

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SmartSense Benefits

In-Network Out-of-Network

Coinsurance 30% 50%

Annual OOP MaximumIndividual/Family

$2,500/$5,000 $10,000/$20,000

Lifetime Maximum $7 million

• Separate in-network and out-of-network OOP Maximum

• OOP maximum amount shown is in addition to deductible

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In-Network Out-of-Network

Physician Office Visits

$30 copay for first 3 visits

then in-network deductible and 30% coinsurance

50% coinsurance after out-of-network

deductible plus all excess charges

In/Outpatient Hospital Care

30% coinsurance after in-network deductible

IP: All charges except $650/day

OP: All charges except $380/day

Emergency Care additional $100 co-pay per ER visit (waived if admitted)

30% coinsurance after in-network deductible

50% coinsurance after out-of-network

deductible plus all excess charges

Maternity Not Covered Not Covered

SmartSense Benefits

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SmartSense Benefits

In-Network Out-of-Network

Routine Care

Routine Mammogram

Routine Pap Smear & PSA

Routine Colorectal Cancer Screenings

Preventive Care & Immunizations for Children (Birth to 6 years)

30% coinsurance after in-network

deductible

50% coinsurance after out-of-networkDeductible plus all

excess charges

• 3 office visits before deductible

• HealthyCheck not available

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SmartSense Benefits

In-Network Out-of-Network

Ambulance Services30% coinsurance after in-network deductible

50% coinsurance* after out-of-network deductible

Acupuncture/Acupressure

Not Covered Not Covered

Chiropractic Care30% coinsurance after in-network deductible,

$500 limit

50% coinsurance* after out-of-network deductible,

$500 limit

Outpatient Speech/Physical/

Occupational Therapy

30% coinsurance after in-network deductible,

$2,500 limit

50% coinsurance* after out-of-network deductible,

$2,500 limit

*Plus all excess charges

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SmartSense Benefits

Choose your Pharmacy Benefit!

Generic Rx Only

Comprehensive Rx

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SmartSense BenefitsPharmacy Benefits

In-Network Out-of-Network

GenericDrugs on

Generic Rx Formulary Only

$15 co-payment or 40% coinsurance

(member pays whichever is greater)

$15 co-payment or 40% coinsurance

(member pays whichever is greater)

Brand NameNot Covered

Discount AvailableNot Covered

Generic Rx Only

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In-Network Out-of-Network

Generic $15 co-payment or 40% coinsurance

(member pays whichever is greater)

$15 co-payment or 40% coinsurance

(member pays whichever is greater)

Brand Name $500 annual brand-name/ specialty deductible, then

$15 co-payment or 40% coinsurance

(whichever is greater)

$500 annual brand-name deductible, then

$15 co-payment or 40% coinsurance

(whichever is greater)

SmartSense BenefitsPharmacy Benefits

Comprehensive Rx

2-member maximum on

deductible

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In-Network Out-of-Network

Generic $15 co-payment or 40% coinsurance

(member pays whichever is greater)

$15 co-payment or 40% coinsurance

(member pays whichever is greater)

Brand Name $500 annual brand-name/ specialty deductible, then

$15 co-payment or 40% coinsurance

(whichever is greater)

40% of negotiated fee for Specialty Drugs and

self-administered injectables, except insulin

$4,500 annual OOP Maximum

$500 annual brand-name deductible, then

$15 co-payment or 40% coinsurance

(whichever is greater)

40% of negotiated fee for self-administered injectables,

except insulin

No Specialty Drug Coverage

SmartSense BenefitsPharmacy Benefits

Comprehensive Rx

Specialty Drugs include injected, infused, oral

and inhaled medications that generally need

to be closely monitored by the member’s doctor.

The most a member would have to pay. This is in addition to the deductible.

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Selling SmartSense

One of our lowest priced plans with solid protection

that covers the essentials

In-network office visits available before deductible

$500 - $5,000 range of deductibles

Embedded deductible

Choice of annual deductible/monthly rates to fit any budget

Choice of prescription drug benefits (comprehensive or generic only)

Lifetime maximum benefits of $7,000,000

4th Quarter deductible carry-over

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Rating Differences

• Gender Rating

• Single Age Bands

• Rates by Number of Members

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Gender Rating

• Allows us to more appropriately and accurately rate by gender

Single Age Bands

• Smaller age-related increases than for plans with multi-year age bands

Rates by Number of Members

• For one-member contracts, there is one set of rates

• For two or more SmartSense members on a contract, there is a discounted rate

Rating Differences

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Questions?

Thank you!

The SmartSense plans are offered by Anthem Blue Cross Life and Health Insurance Company. Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ® ANTHEM is a registered trademark. ® The Blue Cross name and symbol are registered marks of the Blue Cross Association.