Introducing SmartSense.
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Smart health coverage with sensible savings.
If you want reliable coverage at some of our lowest monthly rates, a SmartSense health plan could be exactly what you’re looking for. What makes SmartSense so smart?
How it balances solid protection with opportunities to save money, including:
 | A wide range of annual deductible/monthly rate combinations. Just choose the plan that best fits your budget. |
| Lower rates on services from our network providers. With more than 6,500 doctors and 80 hospitals, chances are your favorite doctors are in our network. |
| Simple copays for your first three in-network doctor visits. You don’t have to meet your plan’s deductible first. |
| A choice of prescription drug plans. Choose from brand-name/generic or generic-only coverage to reduce your out-of-pocket drug costs. |
| Out-of-state coverage. Protects you from the high cost of unexpected emergencies when you travel. |
For extra security, we offer dental and life insurance plans that you can add to your medical coverage.
If you have any questions:
| Call 1-866-293-2892, Monday through Friday, 6:30 a.m. to 5:30 p.m. (PST) to speak to a licensed agent. |
| Or contact your local Anthem Blue Cross and Blue Shield agent. |
SmartSense benefits-at-a-glance
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SmartSense Plan
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Plan Benefits
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In-Network
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Out-of-Network
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Annual Deductible Choices
(separate for In-Network and
Out-of-Network)
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Individual
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$500 / $1,500 / $2,500 / $5,000 / $7,500
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$5,000 / $5,000 / $5,000/ $5,000 / $7,500
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Family
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$1,000 / $3,000 / $5,000 / $10,000 /$15,000
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$10,000 / $10,000 / $10,000 /$10,000 /$15,000
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Each family member has an individual deductible.
The family deductible can be satisfied by 2 or more members.
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Annual
Out-of-Pocket
Maximum1
(includes deductible)
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Individual Maximum
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$3,000/$4,000/$5,000/$7,500/$10,000
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$15,000/$15,000/$15,000/$15,000/$17,500
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Family Maximum
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$6,000/$8,000/$10,000/$15,000/$20,000
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$30,000/$30,000/$30,000/$30,000/$35,000
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Each family member has an individual out-of-pocket maximum. The family out-of-pocket maximum can be satisfied by 2 or more members.
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Lifetime Maximum
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Plan pays up to $7 Million per member
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Covered Services
The amounts shown are your share of
costs after any deductible
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In-Network
Coinsurance amounts are
percentage of negotiated fee
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Out-of-Network
Coinsurance amounts are
percentage of negotiated fee, plus any amounts charged over that fee
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Doctors’ Office Visits
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$30 copay for first 3 visits
per member per year
(deductible waived);
after 3 visits and once deductible is met, then 30%
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50%
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Professional Services
(x-ray, lab, anesthesia, surgeon, etc.)
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30%
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50%
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Hospital Inpatient
(overnight hospital stays)
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30%
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50%
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Hospital Outpatient
(if you don’t stay overnight)
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30%
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50%
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Emergency Room Services
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30%
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30%
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Maternity
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not covered
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Preventive Care
(Including appropriate screening for breast, cervical, ovarian, and prostate cancer)
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Routine mammogram, and PSA tests:
no cost to member
Colorectal screenings: 30% (deductible waived)
Childhood immunizations (under age 13): 30% (deductible waived)
Other Preventive Services: 30% after deductible
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50%
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Physical Therapy, Occupational Therapy and Chiropractic Services
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30%
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50%
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Plan covers up to a total of 24 visits per year.
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Prescription Drug Coverage
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In-Network
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Out-of-Network
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Comprehensive
Prescription Drug Coverage
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Generic: $15 copay
(or 40%, whichever is greater)
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not covered
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Brand-name/Specialty
$500 annual deductible applies before the following:
Brand-name: $15 copay
(or 40%, whichever is greater, not
to exceed $500 per prescription)
Specialty: 40%
$5,000 annual out-of-pocket maximum
(the most you'll have to pay)
In-network only and in addition to
brand-name/specialty deductible
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Generic Prescription Drug Coverage
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Generic Coverage ONLY
$15 copay (or 40%, whichever is greater)
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