SmartSense Plus Health Insurance Information

Anthem Blue Cross of California, Affordable Individual and Family Health Care Plans

SmartSense Plus - Affordable Health insurance Plans

Is SmartSense Plus Right For You?

• Reliable, comprehensive protection with some of the lowest monthly rates make these plans affordable
• Choose the annual deductible/monthly rate combination that works for you
• Immediate benefits for first three visits to a doctor before deductible (all other visits covered after deductible)
• Choice of two prescription drug coverage options (Upgrade Rx or Standard Rx) Drug formulary applies
• No need for maternity benefits

What else do you get?

• Access to over 80,000 California PPO network doctors and specialists and nearly
315 hospitals so chances are your doctor is one of ours
• Money in your pocket because of negotiated lower fees with network
doctors and hospitals. Your share of costs is less (a lot less)
• Optional Preventive Care screenings at HealthyCheck Centers at no cost to you (ages 7 and above)
• Out-of-state coverage so you’ll feel better wherever you are
• Optional Dental Insurance and Life Insurance benefits (available for additional premium)

SmartSense Plus - Prescription Drug Coverage

The cost of prescription drug coverage is overwhelming. Here's how to help manage those costs. SmartSense Plus Prescription Drug coverage includes tiers which represent a cost level within the generic and brand name prescription drug categories.

• Drug Formulary - This is a special list of drugs the SmartSense plan covers. Anthem Blue Cross has negotiated lower prices on these drugs so you'll save when your doctor prescribes drugs for the plan formulary.
• Tier 1: Drugs that have the lowest copay and include generic medications.
• Tier 2: Drugs that have a higher copay than those in Tier 1 and include formulary brand name medications.
• Tier 3: Drugs that have a higher copay than those in Tier 2 and include non-formulary brand name medications.
• Specialty: Drugs are typically high-cost scientifically engineered drugs and are paid at a coinsurance level instead of a copay.

Additional Information: No Obligation Review Period

After you enroll in a plan offered by Anthem Blue Cross or Anthem Blue Cross Life & Health Insurance Company, you will receive a Policy/EOC booklet that explains the exact terms and conditions of coverage, including the plan's exclusions and limitations. You have 10 full days to examine your plan's features. During that time, if you are not fully satisfied, you may decline by returning your Policy/EOC booklet along with a letter notifying Anthem Blue Cross of California that you wish to discontinue coverage. Policy/EOC booklets are available for you to examine prior to enrolling. Ask your Agent or Anthem Blue Cross.

Auto Premium Payment
Save time with Auto Premium Payment from a bank account. After your initial payment, you can have future payments withdrawn right out of your bank account. You won't have to worry about a lapse in coverage because you forgot to mail your payment. Fill out the billing section of the enrollment application to begin Auto Premium Payment right away or ask your Agent or Anthem Blue Cross for assistance.

Enrollment Guidelines
To enroll, you and your dependents must be:
• Age 64 3/4 or younger;
• A permanent legal resident of California;
• A U.S. resident for at least the last 3 months;
• The applicant's spouse or domestic partner, age 64 3/4 or younger;
• The applicant's children (under 26 years of age), or the children (under 26 years of age) of the applicant's enrolling spouse or qualified domestic partner;
• The applicant's child (of any age) who is incapable of self-sustaining employment by reason of a physically or mentally disabling injury, illness or condition and is chiefly dependent upon the applicant for support and maintenance.

Medical Underwriting Requirement
We believe that the cost of the plans should be consistent with a member's expected health care needs and risk factors. That's why Anthem Blue Cross offers various levels of coverage. To determine individual medical risk factors, all applications are subject to medical underwriting. Depending on the results of the underwriting review, a number of
things may happen:
• You may be offered coverage at the standard premium charge, or
• You may be offered the plan you selected at a higher rate, or
• You may not qualify for the plan, or
• You may be offered an alternate plan.
If you have a significant medical condition and do not qualify for this plan or if you have discontinued group coverage, please contact your Agent or Anthem Blue Cross Representative for information regarding other Individual coverage options.

Waiting Periods
For applicants age nineteen (19) and older, there is a specific six-month waiting period for coverage of any condition, disease or ailment for which medical advice or treatment was recommended or received within six months preceding the effective date of coverage. If you apply for coverage within 63 days of terminating your membership with another “creditable” health care plan, then you can use your prior coverage for credit toward the six-month waiting period. Anthem Blue Cross will credit the time you were enrolled in the previous plan. Consult with your Anthem Blue Cross Agent or Representative if you have a question about the underwriting process.

Anthem Blue Cross is the trade name of Blue Cross of California, Anthem Blue Cross, Anthem Life Insurance Company (BCL&H) are Independent Licensees of the Blue Cross Association (BCA). ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name & symbol are registered marks of the Blue Cross Association

Apply for Anthem Blue Cross of California Affordable Smartsense plans today at www.californiahealthinsurancenow.com

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