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Anthem Health Insurance Colorado

Rocky Mountain Hospital and Medical Service, Inc.
700 Broadway, 1st Floor Lobby, Denver, CO 80273 

Anthem Blue Cross and Blue Shield of Colorado provides health coverage to more than 450,000 members
Health insurance and health insurance quotes for Colorado on this site are available
from Anthem
for individuals and  families.      
    

 They also boast a positive credit rating from the four largest carrier ratings companies.
    
Rocky Mountain Hospital and Medical Service, Inc. Executives

  • Larry C. Glasscock  Chairman, President & CEO

  • Marjorie Dorr President, Anthem East

  • Thomas Snead President, Anthem Southeast

  • Caroline S. Matthews COO

  • David R. Frick Executive Vice President, Chief Administrative


Anthem Blue Cross and Blue Shield RightPlan PPO 40 With Prescription Drug Coverage

PART A: TYPE OF COVERAGE
 

. TYPE OF PLAN

Preferred provider plan

. OUT-OF-NETWORK CARE COVERED?

Yes, but the patient pays more for out-of-network care

. AREAS OF COLORADO WHERE PLAN IS
      AVAILABLE

Plan is available throughout Colorado


PART B: SUMMARY OF BENEFITS

Important Note: This form is not a contract, it is only a summary. The contents of this form are subject to the provisions of the policy, which contains all terms, covenants and conditions of coverage.

Your plan may exclude coverage for certain treatments, diagnoses, or services not noted below. The benefits shown in this summary may only be available if required plan procedures are followed (e.g., plans may require prior authorization, a referral from your primary care physician, or use of specified providers or facilities). Consult the actual policy to determine the exact terms and conditions of coverage. Coinsurance and co-payment options reflect the amount the covered person will pay.

IN-NETWORK

OUT-OF-NETWORK

4. ANNUAL DEDUCTIBLE 2

a) Individual

b) Family

$0

Family coverage not provided

$0

Family coverage not provided

5. OUT-OF-POCKET ANNUAL MAXIMUM3

a) Individual

b) Family

c) Is deductible included in the out-of-pocket maximum?

$3,500

Family coverage not provided

No

The out-of-pocket annual maximum does not include coinsurance for Other Mental Health Care.

Copayment amounts do not apply to out-of-pocket cost sharing requirements, except for inpatient and outpatient hospital copayments (see lines 12 and 13).

$10,000

Family coverage not provided

No

The out-of-pocket annual maximum does not include coinsurance for Other Mental Health Care or member costs for not obtaining required preauthorizations. Member cost sharing for visiting a non-participating provider for physical, occupational or speech therapies does not apply to the out-of-pocket cost sharing requirements.

Copayment amounts do not apply to out-of-pocket cost sharing requirements, except for inpatient and outpatient hospital copayments (see lines 12 and 13).

6. LIFETIME OR BENEFIT MAXIMUM PAID BY THE PLAN FOR ALL CARE

$5,000,000 per member in- and out-of-network combined for all covered services. Morbid obesity surgery has a lifetime maximum Anthem payment of $7,500 for services received from a Center of Excellence facility or a lifetime Anthem maximum payment of $1,500 for services received from a facility that has not been designated as a Center of Excellence; total lifetime maximum payment by the carrier shall not exceed $7,500 per member in- and out-of-network combined. Major organ transplants have a lifetime maximum Anthem payment of $1,000,000 per transplant in- and out-of-network combined.

$5,000,000 per member in- and out-of-network combined for all covered services. Morbid obesity surgery has a lifetime maximum Anthem payment of $1,500 for services received from a facility that has not been designated as a Center of Excellence; total lifetime Anthem maximum payment shall not exceed $7,500 in- and out-of-network combined. Major organ transplants have a lifetime maximum Anthem payment of $1,000,000 per transplant in- and out-of-network combined.

Independent licensees of the Blue Cross and Blue Shield Association. Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. ® Registered marks Blue Cross and Blue Shield Association 05-73 CIM (4-06) v1 DL95 05-73 CIM (4-06) v1 DL95 2

 IN-NETWORK OUT-OF-NETWORK

7A. COVERED PROVIDERS

Anthem Blue Cross and Blue Shield PPO Provider Network. See provider directory for complete list of current providers.

All providers licensed or certified to provide covered benefits.

7B. With respect to network plans, are all the providers listed in 7A accessible to me through my primary care physician?

Yes

Yes

8. ROUTINE MEDICAL OFFICE VISITS4

a) Primary Care Providers

$40 co-payment per office visit plus 40% coinsurance for services other than an office visit.

50% coinsurance

b) Specialists

$40 co-payment per office visit plus 40% coinsurance for services other than an office visit.

Only limited services are covered as part of an office visit; all other covered services are subject to applicable coinsurance or cost sharing.

See line 9 for preventive services, which are limited.

50% coinsurance

9. PREVENTIVE CARE

a) Children’s services

$40 co-payment for office visit plus 40% coinsurance for services other than an office visit for age-appropriate visits and routine immunizations.

50% coinsurance, for age-appropriate visits and routine immunizations.

b) Adults’ services

Not covered except for:

  1. 􀁺 One annual pap test. $40 co-payment for office visit plus 40% coinsurance. Maximum $75 Anthem payment for laboratory test;
  2. 􀁺 Mammogram screening and prostate screening, which are not subject to coinsurance.

Not covered except for:

  1. 􀁺 Mammogram screening and prostate screening, which are not subject to coinsurance.

10. MATERNITY

a) Prenatal care

b) Delivery & inpatient well baby care 5

Not covered

Delivery not covered. 40% coinsurance plus $500 co-payment per day up to 4 days for inpatient well baby care for up to 31-days following birth, adoption or placement for adoption.

Not covered

Delivery not covered. 50% coinsurance plus $500 hospital co-payment per day up to 4 days for inpatient well baby care for up to 31-days following birth, adoption or placement for adoption.

See certificate for complications of pregnancy coverage.

05-73 CIM (4-06) v1 DL95 3

11. PRESCRIPTION DRUGS6

Level of coverage and restrictions on prescriptions

a) Inpatient care

Included with inpatient hospital (see line 12)

Included with inpatient hospital (see line 12)

b) Outpatient care

Tier 1 generic formulary $10 co-payment; Tier 2 brand formulary $30 co-payment;

Tier 3 non-formulary 50% coinsurance;

Tier 4 30% coinsurance for self-administered injectables;

At a participating pharmacy up to a 34-day supply.

Not covered

c) Prescription Mail Service

Tier 1 generic formulary $20 co-payment; Tier 2 brand formulary $60 co-payment;

Tier 3 non-formulary 50% coinsurance;

Tier 4 30% coinsurance for self-administered injectables;

Through the mail order service up to a 90-day supply.

All brand name prescription drugs are subject to an annual $500 brand deductible. The $500 brand deductible does not apply to the out-of-pocket annual maximum.

In addition to the cost sharing described above, if you purchase a brand-name drug when there is a FDA rated equivalent drug available, you are responsible for the Tier-2 or Tier-3 Co-payment for brand-name drugs and you will pay the difference between the cost of the brand-name and the cost of the generic.

For example: a Tier-3 brand-name prescription costs $100; a generic Tier-1 substitution is available, the generic prescription costs $60, you pay the $40 difference plus the Tier-3 (50% coinsurance) for a total member cost of $90. The $40 difference is not applied toward any other cost-sharing requirement.

See certificate for details.

For drugs on our approved list, contact Customer Service at 888-231-5046. Covered only when received from a participating pharmacy.

Not covered


05-73 CIM (4-06) v1 DL95 4

12. INPATIENT HOSPITAL

$500 co-payment per day up to 4 days, plus 40% coinsurance. Hospital co-payment amounts will be applied to out-of-pocket cost sharing requirements.

$500 co-payment per day up to 4 days plus 50% coinsurance. Hospital co-payment amounts will be applied to out-of-pocket cost sharing requirements.

13. OUTPATIENT/AMBULATORY SURGERY

$500 co-payment per surgical admission, plus 40% coinsurance. Hospital co-payment amounts will be applied to out-of-pocket cost sharing requirements.

$500 co-payment per surgical admission plus 50% coinsurance. Hospital co-payment amounts will be applied to out-of-pocket cost sharing requirements.

14. DIAGNOSTICS

a) Laboratory & x-ray

b) MRI, nuclear medicine and other high-tech services

40% coinsurance

40% coinsurance

50% coinsurance

50% coinsurance

15. EMERGENCY CARE7,8

$100 emergency room co-payment (waived if admitted), plus 40% coinsurance

$100 emergency room co-payment (waived if admitted), plus 50% coinsurance

16. AMBULANCE

$100 co-payment

$100 co-payment

17. URGENT, NON-ROUTINE, AFTER HOURS CARE

$40 office visit co-payment plus 40% coinsurance for services other than an office visit

See line 15 for emergency room care

50% coinsurance

See line 15 for emergency room care

18. BIOLOGICALLY-BASED MENTAL ILLNESS CARE9

Biologically-Based Mental Illness Care is paid as Other Mental Health Care, see line 19.

Biologically-Based Mental Illness Care is paid as Other Mental Health Care, see line 19.

19. 0THER MENTAL HEALTH CARE

a) Inpatient care

b) Outpatient care

All charges except $175 per day. Limited to 30 days in each benefit year in- and out-of-network combined.

All charges except $25 per visit. Limited to 20 visits in each benefit year, in-and out-of-network combined. Maximum Anthem payment for inpatient and outpatient care is limited to $10,000 per lifetime, in-and out-of-network combined.

All charges except $175 per day. Limited to 30 days in each benefit year in- and out-of-network combined.

All charges except $25 per visit. Limited to 20 visits in each benefit year, in-and out-of-network combined. Maximum Anthem payment for inpatient and outpatient care is limited to $10,000 per lifetime, in-and out-of-network combined.

20. ALCOHOL & SUBSTANCE ABUSE

a) Inpatient Care

b) Outpatient care

Not covered

Not covered

Not covered

Not covered


05-73 CIM (4-06) v1 DL95 5
 

21. PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY

a) Inpatient

40% coinsurance. Covered when received as part of an inpatient hospital admission for acute care and for rehabilitation therapy for up to 30 days per illness or injury, in- and out-of-network combined.

50% coinsurance. Covered when received as part of an inpatient hospital admission for acute care and for rehabilitation therapy for up to 30 days per illness or injury, in- and out-of-network combined.

b) Outpatient

40% coinsurance

Physical and occupational therapy is limited to a combination of 12 visits in each benefit year in- and out-of-network combined, except for children to age 5 (see certificate for details).

Speech therapy is limited to 50 visits in each benefit year, in- and out-of-network combined, except for children to age 5 (see certificate for details).

Participating Providers: 50% coinsurance

Non-Participating Providers: All charges except $25 per visit

Physical and occupational therapy is limited to a combination of 12 visits in each benefit year in- and out-of-network combined, except for children to age 5 (see certificate for details).

Speech therapy is limited to 50 visits in each benefit year, in- and out-of-network combined, except for children to age 5 (see certificate for details).

22. DURABLE MEDICAL EQUIPMENT

40% coinsurance. See certificate for types and circumstances of coverage. For prosthetic devices (arms and legs), benefits are provided with the same deductible and coinsurance as provided by Medicare.

Footwear is limited to a $400 maximum Anthem payment per member’s benefit year, in- and out-of-network combined.

Wigs are limited to a $400 maximum Anthem payment per member’s year, in- and out-of-network combined.

50% coinsurance. See certificate for types and circumstances of coverage.

Footwear is limited to a $400 maximum Anthem payment per member’s benefit year, in- and out-of-network combined.

Wigs are limited to a $400 maximum Anthem payment per member’s benefit year, in- and out-of-network combined.

23. OXYGEN

40% coinsurance

50% coinsurance

24. ORGAN TRANSPLANTS

40% coinsurance. See certificate for details.

50% coinsurance. See certificate for details.

25. HOME HEALTH CARE

40% coinsurance. Limited to 60 visits in each benefit year, in-and out-of-network combined.

50% coinsurance. Limited to 60 visits in each benefit year, in-and out-of-network combined.

26. HOSPICE CARE

a) Inpatient Care

b) Outpatient care

40% coinsurance

40% coinsurance. Limited to $100 maximum Anthem payment per day with a maximum benefit of 91 days in each benefit period, in-and out-of-network combined.

See certificate for details.

50% coinsurance

50% coinsurance. Limited to $100 maximum Anthem payment per day with a maximum benefit of 91 days in each benefit period, in-and out-of-network combined.

See certificate for details.

05-73 CIM (4-06) v1 DL95 6

27. SKILLED NURSING FACILITY CARE

Not covered

Not covered

28. DENTAL CARE

Not covered

Not covered

29. VISION CARE

Not covered

Not covered

30. CHIROPRACTIC CARE

Not covered

Not covered

31. SIGNIFICANT ADDITIONAL COVERED SERVICES (list up to 5)

Dental injury – 40% coinsurance

Smoking cessation program – All charges except $50 per lifetime, in-and out-of-network combined.

When a member desires another professional opinion, they may obtain a second surgical opinion.

Dental injury – 50% coinsurance

Smoking cessation program – All charges except $50 per lifetime, in-and out-of-network combined.

When a member desires another professional opinion, they may obtain a second surgical opinion.

PART C: LIMITATIONS AND EXCLUSIONS

32. PERIOD DURING WHICH PRE-EXISTING CONDITIONS ARE NOT COVERED. 10

12 months for all pre-existing conditions unless the covered person is a HIPAA-eligible individual as defined under federal and state law, in which case there are no pre-existing condition exclusions.

33. EXCLUSIONARY RIDERS. Can an individual’s specific, pre-existing condition be entirely excluded from the policy?

No

34. HOW DOES THE POLICY DEFINE A "PRE-EXISTING CONDITION"?

A pre-existing condition is an injury, sickness, or pregnancy for which a person incurred charges, received medical treatment, consulted a health-care professional, or took prescription drugs within 12 months immediately preceding the effective date of coverage.

35. WHAT TREATMENTS AND CONDITIONS ARE EXCLUDED UNDER THIS POLICY?

Exclusions vary by policy. List of exclusions is available immediately upon request from your carrier, agent, or plan, sponsor (e.g., employer). Review them to see if a service or treatment you may need is excluded from the policy.

PART D: USING THE PLAN

IN-NETWORK

OUT-OF-NETWORK

36. Does the enrollee have to obtain a referral and/or prior authorization for specialty care in most or all cases?

No

Yes, the member is responsible for obtaining preauthorization unless the provider participates with Anthem Blue Cross and Blue Shield.

37. Is prior authorization required for surgical procedures and hospital care (except in an emergency)?

Yes

Yes, the member is responsible for obtaining pre-certification unless the provider participates with Anthem Blue Cross and Blue Shield.

38. If the provider charges more for a covered service than the plan normally pays, does the enrollee have to pay the difference?

No

Yes, unless the provider participates with Anthem Blue Cross and Blue Shield.

39. What is the main customer service number?

888-231-5046

40. Whom do I write/call if I have a complaint or want to file a grievance?11

Anthem Blue Cross and Blue Shield Complaints and Appeals

700 Broadway, Denver, CO 80273

888-231-5046

41. Whom do I contact if I am not satisfied with the resolution of my complaint or grievance?

Write to: Colorado Division of Insurance ICARE Section

1560 Broadway, Suite 850, Denver, CO 80202

42. To assist in filing a grievance, indicate the form number of this policy; whether it is individual, small group, or large group; and if it is a short-term policy.

Policy form #’s 05-74, individual

43. Does the plan have a binding arbitration clause?

Yes


05-73 CIM (4-06) v1 DL95 7

1 "Network" refers to a specified group of physicians, hospitals, medical clinics and other health care providers that your plan may require you to use in order for you to get any coverage at all under the plan, or that the plan may encourage you to use because it may pay more of your bill if you use their network providers (i.e., go in-network) than if you don’t (i.e., go out-of-network).

2 "Deductible" means the amount you will have to pay for allowable covered expenses under a health plan during a specified time period (e.g., a calendar year) before the carrier will cover those expenses. The specific expenses that are subject to deductible may vary by policy. Expenses that are subject to deductible may be noted in boxes 8 through 31.

3 "Out-of-pocket maximum" means the maximum amount you will have to pay for allowable covered expenses under a health plan, which may or may not include the deductibles or co-payments, depending on the contract for that plan. The specific deductibles or co-payments included in the out-of-pocket maximum may vary by policy. Expenses that are applied toward the out-of-pocket maximum may be noted in boxes 8 through 31.

4 Routine medical office visits include physician, mid-level practitioner, and specialist visits.

5 Well baby care includes an in-hospital newborn pediatric visit and newborn hearing screening. The hospital co-payment applies to mother if complication of pregnancy and well-baby together: there are not separate co-payments.

6 Prescription drugs otherwise excluded are not covered, regardless of whether preferred generic, preferred brand name, or non-preferred.

7 "Emergency care" means services delivered by an emergency care facility which are necessary to screen and stabilize a covered person. The plan must cover this care if a prudent lay person having average knowledge of health services and medicine and acting reasonably would have believed that an emergency medical condition or life- or limb threatening emergency existed.

8 Non-emergency care delivered in an emergency room is covered only if the covered person receiving such care was referred to emergency room by his/her carrier or primary care physician. If emergency departments are used by the plan or non-emergency after-hours care, then urgent care co-payments apply.

9 "Biologically based mental illnesses" means schizophrenia, schizoaffective disorder, bipolar affective disorder, major depressive disorder, specific obsessive-compulsive disorder, and panic disorder.

10 Waiver of pre-existing condition exclusions. State law requires carriers to waive some or all of the pre-existing condition exclusion period based on other coverage you recently may have had. Ask your carrier or plan sponsor (e.g., employer) for details.

11 Grievances. Colorado law requires all plans to use consistent grievance procedures. Write the Colorado Division of Insurance for a copy of those procedures.

Anthem Blue Cross and Blue Shield & HMO Colorado Health Plan Description Form Disclosure Amendment

Colorado law requires carriers to make available a Colorado Health Plan Description Form, which is intended to facilitate comparison of health plans. The form must be provided automatically within three (3) business days to a potential policyholder who has expressed interest in a particular plan. The carrier also must provide the form, upon oral or written request, within three (3) business days, to any person who is interested in coverage under or who is covered by a health benefit plan of the carrier.

Pursuant to Colorado law (C.R.S. §10-16-107(7)(a), services or supplies for the treatment of Intractable Pain and/or Chronic Pain are not covered.

Individual Health Plans

This coverage is renewable at your option, except for the following reasons:

  1. 1. Non-payment of the required premium;

  2. 2. Fraud or intentional misrepresentation of material fact on the part of the plan sponsor;

  3. 3. The commissioner finds that the continuation of the coverage would not be in the best interest of the policyholders, the plan is obsolete, or would impair the carrier’s ability to meet its contractual obligations;

  4. 4. The carrier elects to discontinue offering and non-renew all of its individual plans delivered or issued for delivery in Colorado.

Group Health Plans

Pursuant to Colorado law (C.R.S. §10-16-105(5)(g)(I)), small employers purchasing any health benefit plan other than a Basic Health Benefit Plan, must pay for all benefits mandated by Colorado law, including non-waivable coverages for: newborn, maternity, pregnancy, childbirth, complications from pregnancy and childbirth, therapies for congenital defects and birth abnormalities, low-dose mammography, mental illness, biologically-based mental illness, the availability of alcoholism treatment, the availability of hospice care, prostate cancer screening, child health supervision services, hospitalization and general anesthesia for dental procedures for dependent children, diabetes, and prosthetic devices.

Pursuant to Colorado law (C.R.S. §10-16-105(5)(g)(II)), small employers purchasing a Basic Health Benefit Plan is waiving coverage for low-dose mammography screening, mental illness, prostate cancer screening, hospitalization and general anesthesia for dental procedures for children, the availability of treatment for alcoholism, and the availability of hospice care. All other state-mandated benefits are included in the Basic Health Benefit Plan.

This coverage is renewable at your option, except for the following reasons:

  1. 1. Non-payment of the required premium;

  2. 2. Fraud or intentional misrepresentation of material fact on the part of the plan sponsor;

  3. 3. The policyholder fails to comply with participation or contribution rules;

  4. 4. The carrier elects to discontinue offering and non-renew all of its small group or large group plans delivered or issued for delivery in Colorado;

  5. 5. An employer is no longer actively engaged in the business in which it was engaged on the effective date of the plan;

Independent licensees of the Blue Cross and Blue Shield Association. Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. ® Registered marks Blue Cross and Blue Shield Association 98868 (10-04) CO disclosure 8

  1. 6. With respect to group health benefit plans offered through a managed care plan, there are no longer any enrollees who live, reside or work in the service area; or

  2. 7. With respect to coverage of an employer that is made available only through one or more bona fide associations, the membership of an employer ceases.

Important Information for Employers with 50 or Fewer Employees and Business Groups of One: Rates are calculated based on allowable case characteristics – age bands, geographic location, family size, health status, and claims experience – and will be given within five working days of request. Rates for a specific employer cannot be adjusted due to the duration of coverage of employees or dependents of the small employer. Rates may change based on case characteristics, whenever benefits are changed, or upon giving written notice to the employer not less than 31 days prior to the effective date of the change. New applicants may be subject to pre-existing condition clauses, based on HIPAA requirements. Renewal of health insurance coverage in this class is guaranteed, assuming compliance with underwriting regulations. A Network Access Plan, which describes Anthem Blue Cross and Blue Shield’s or HMO Colorado’s network standards and evaluation procedures for ensuring provider access is available by calling our customer service department.

COLORADO INSURANCE LAW REQUIRES ALL CARRIERS IN THE SMALL GROUP MARKET TO ISSUE ANY HEALTH BENEFIT PLAN IT MARKETS IN COLORADO TO SMALL EMPLOYERS OF 2-50 EMPLOYEES, INCLUDING A BASIC OR STANDARD HEALTH BENEFIT PLAN, UPON REQUEST OF A SMALL EMPLOYER TO THE ENTIRE SMALL GROUP, REGARDLESS OF THE HEALTH STATUS OF ANY OF THE INDIVIDUALS IN THE GROUP. BUSINESS GROUPS OF ONE CANNOT BE REJECTED UNDER A BASIC OR STANDARD HEALTH BENEFIT PLAN DURING OPEN ENROLLMENT PERIODS SPECIFIED BY LAW.

98868 (10-04) CO disclosure Independent licensees of the Blue Cross and Blue Shield Association. Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. ® Registered marks Blue Cross and Blue Shield Association 98871 (7-04) v2 10

Cancer Screenings

At Anthem Blue Cross and Blue Shield and our subsidiary company, HMO Colorado, Inc., we believe cancer screenings provide important preventive care that supports our mission: to improve the health of the people we serve. We cover cancer screenings as described below.

Pap Tests

All plans except our BasicBlue PPO Plan provide coverage for an annual Pap test and the related office visit. The BasicBlue PPO Plan provides coverage for a Pap test and the related office visit once every three years. Payment for the Pap test is based on the plan’s laboratory services provisions, and payment for the related office visit is based on the plan’s preventive care provisions. With our BluePreferred for Individuals PPO Plan, laboratory services for a Pap test are limited to a maximum payment of $75.00. With our Colorado HSA-Qualified Plans for Individuals, all services related to a Pap test are subject to the maximum benefit as described on the Health Plan Description Form. Under most plans pap tests received out of-network are not covered.

Mammogram Screenings

All plans except our HMO and PPO Basic Health and BluePreferred for Individual Plans provide mammogram screening coverage for women 35 years of age and older. For BluePreferred for Individuals the following frequency guidelines apply: For women between the ages of 35 years and 40 years, a single baseline screening mammogram is covered. For women between 40 years of age and less than 50 years of age, a screening mammogram is covered once every two years, or it is covered annually if the member’s physician has determined that identified breast cancer risk factors are present. For women between the ages of 50 years and 65 years, a screening mammogram is covered annually. Payment for the mammogram screening benefit is based on the plan’s provisions for X-ray services. Our HMO and PPO Basic Health Plans do not provide coverage for mammogram screenings.

Prostate Cancer Screenings

All plans except our HMO and PPO Basic Health Plans provide prostate cancer screening coverage for men 40 years of age and older. The following frequency guidelines apply: For men between 40 years of age and less than 50 years of age, a prostate cancer screening is covered annually if the member’s physician has determined that identified prostate cancer risk factors are present. For men 50 years of age and older, a prostate cancer screening is covered annually. Payment for the prostate cancer screening benefit is based on the plan’s provisions for X-ray services. Our HMO and PPO Basic Health Plans do not provide coverage for prostate cancer screenings.

Colorectal Cancer Screenings

Several types of colorectal cancer screening methods exist. All plans except BluePreferred for Individual Plans provide coverage for colorectal cancer screenings, such as colonoscopies, sigmoidoscopies and fecal occult blood tests. Depending on the type of colorectal cancer screening received, payment for the benefit is based on the plan’s provisions for laboratory services, preventive care office visit services, or other medical or surgical services. Our plans do not provide coverage for preventive colorectal cancer screenings involving invasive surgical procedures and DNA analysis. Under most plans colorectal cancer screenings received out of-network are not covered.

The information above is only a summary of the benefits described. The certificate for each health plan includes important additional information about limitations, exclusions and covered benefits. The Health Plan Description Form for each health plan includes additional information about co-payments, deductibles and coinsurance. If you have any questions, please call our customer service department at the phone number on the Health Plan Description Form.

Which Anthem Colorado health plan Is right for you?

 
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Colorado Plan Comparison

 

  In Colorado:  
Rocky Mountain Hospital and Medical Service, Inc.
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  In Connecticut:  
Anthem Health Plans, Inc.
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  In Indiana: 
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  In Kentucky: 
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  In Nevada:  
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Independent licensees of the Blue Cross and Blue Shield Association

Serving residents and businesses in Indiana, Kentucky, Missouri, Ohio, Wisconsin, Colorado, Nevada, Connecticut, Maine, New Hampshire and Virginia (excluding the city of Fairfax, the town of Vienna and the area east of State Route 123)

  Learn More >>
 

  
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