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ANTHEM LUMENOS PPO + HRA

Plan Highlights

Anthem Lumenos is a high-deductible PPO plan with UC-provided health reimbursement account (HRA):

• Choose any doctor or hospital you wish, but providers in the Anthem Blue Cross network cost less
• You pay 100 percent of the cost of services, including prescription drugs
• Costs are automatically deducted from your HRA first; if you use all of the HRA, then you pay all costs until you meet the deductible amount
• Once you meet the deductible, you pay 20 percent for in-network services and 40 percent for out-of-network services
• Preventive care from in-network providers has no charge
• If you don’t use all of your HRA funds in a year, they roll over to the next year.
• Annual out-of-pocket maximums limit what you pay. If you reach the annual maximum, the plan pays 100 percent of your medical and prescription drug costs for the rest of the year. The maximums are different for in-network and out-of-network services.
• Behavioral health benefits are provided by United Behavioral Health. You can use your HRA to pay for these services, and costs are included in your deductible and out-of-pocket maximums.

The Lumenos plan requires enrollees to take greater control of their health care spending. Anthem provides online tools, including cost calculators and a care comparison tool, to help manage health decisions and health care spending.

For details, see the Anthem Lumenos plan brochure and FAQ, available on the Anthem website http://www.anthem.com/ca/uc/

Read more about how the plan works >>

Plan Changes for 2012

• Notice regarding Walgreens and prescription benefit
• Now available to faculty and staff who live outside the U.S.
• New Stand-alone Health Reimbursement Account
  A stand-alone Health Reimbursement Account (HRA) will be available to Anthem Lumenos PPO members who lose eligibility for the plan because they become eligible for Medicare.
  
  Employees enrolled in the Anthem Lumenos plan may continue in the plan when they retire until they become eligible for Medicare.  Once they become Medicare-eligible, they are required to enroll in another plan. If they continue enrollment in another UC-sponsored retiree plan and have an HRA balance of $100 or more, the balance will be transferred to the Lumenos StandAlone HRA and can be used for reimbursable expenses.  Those expenses include deductibles, coinsurance and copays for covered medical, behavioral health and pharmacy expenses, medical premiums and Medicare Part B premiums not reimbursed by UC.

2012 Anthem Lumenos Plan Costs
Pay Band (per annum)		Self	Self + Child	Self + Adult	Family
Under $48,000	Employee Cost	$8.07	$14.53	$16.95	$23.40
	UC Contribution	513.02	923.43	1,077.34	1,487.76
$48,001 - $96,000	Employee Cost	$44.12	$79.42	$99.25	$134.54
	UC Contribution	476.97	858.54	995.04	1,376.62
$96,001 to $144,000	Employee Cost	$81.12	$146.02	$173.01	$237.90
	UC Contribution	439.97	791.94	921.28	1,273.26
$144,001 and above	Employee Cost	$119.43	$214.98	$249.43	$344.97
	UC Contribution	401.66	722.98	844.86	1,166.19

 

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 registered trademark of Anthem Insurance Companies, Inc. The Blue Cross names and symbols are registered marks of the Blue Cross Association.