ANTHEM LUMENOS HRA + PPO

This plan is not open to new retiree enrollment.

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.

Plan Changes for 2012

• Notice regarding Walgreens and prescription benefit
• Currently enrolled retirees will now be able to continue using their Health Reimbursement Account (HRA) balance when they lose eligibility for the plan because they become eligible for Medicare.
  
  A stand-alone Health Reimbursement Account (HRA) will be available to these.
  
  Medicare-eligible members are required to enroll in another plan when they become eligible for Medicare. 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.

Please note: This plan is not open for new retiree enrollments.

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.