Anthem Blue Cross Blue Shield Colorado - Lumenos HIA Plan
Anthem Lumenos HIA Plans Overview
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The Lumenos HIA Plans are innovative plan designs that give you more control of your health care expenses while promoting your health and well-being. They are very similar to the Lumenos HSA Plan, but with specific incentives to encourage you to improve and maintain your health.
The Lumenos HIA Plan gives you an account to pay for any covered medical expenses and prescriptions you choose. This account (referred to as the HIA) allows you to earn credits through the Anthem rewards program. The Health Incentive Account (HIA) funds are used to offset your deductible expense and rollover into the next calendar year if unused (NOT "use it or lose it" funds). However, the HIA plans are not HSA-compatible, meaning you could not open an HSA account and receive any tax-advantages.
Some of the activities Anthem provides financial incentives for include:
- Completing an Online Health Assessment ($50)
- Participating in a personal health coach program ($150)
- Completing a Smoking Cessation Program ($50)
- Completing a Weight Management Program ($50)
There are two HIA plans to choose from: The basic Health Incentive Account (HIA) Plan and the Health Incentive Account Plus (HIA Plus) Plan. With both plans you can earn money to apply towards eligible medical expenses by participating in the healthy rewards programs (described in more detail below). This is money that can be applied towards your yearly deductible if desired. Payments are automatically made from your account so you don't have to deal with it, and any money not used in either HIA will rollover to the next year and is available to apply towards eligible medical expenses.
The only difference between the HIA and Health Incentive Account Plus
Like the Lumenos HSA Plan, both the Lumenos HIA and HIA Plus Plans include:
- 100% coverage for recommended preventive care services (including annual physicals) when you see an in-network provider (deductible waived)
- Traditional Health Coverage to help cover additional health care expenses
- Immediate $500 coverage (deductible waived) for accident-related injuries
- A single customer service organization for both the health insurance and the health account components of Lumenos plans
Lumenos HIA Plan Benefits
Lumenos HIA Plan - 100% Coinsurance
Lumenos HIA 100% highlights include:
- Access to BlueCard PPO nationwide network
- 100% coverage for extensive preventive care services without needing to satisfy the deductible
- 100% coverage after satisfaction of deductible
Lumenos HIA 100% Plan Benefits
| Plan Feature | In-Network You Pay | Out-of-Network You Pay |
| Lifetime Maximum Benefit | $5,000,000 per person | |
| Deductible Options Per individual, per calendar year. |
$2,500 individual / $5,000 family $5,000 individual / $10,000 family |
$5,000 individual / $10,000 family $10,000 individual / $20,000 family |
| Out-of-Pocket Expense Limit After deductible. |
$0 individual / $0 family $0 individual / $0 family |
$2,500 individual / $5,000 family $5,000 individual / $10,000 family |
| Doctor's Office Visits | 0% | 30% |
| Professional Services X-rays, lab, anesthesia, surgery, etc. |
0% | 30% |
| Hospital Inpatient (Overnight stays) |
0% | 30% |
| Hospital Outpatient (Non-overnight stays) |
0% | 30% |
| Emergency Room Services | 0% | 30% |
| Maternity | Not covered | |
| Preventive Care (Deductible waived) See List |
0% | 30% |
| Ambulance | 0% | 30% |
| Physical, Occupational, and Speech Therapy | 0% | 30% |
| Prescription Drug Coverage | 0% | 30% |
Lumenos HIA Plan - 70% Coinsurance
Lumenos HIA 70% highlights include:
- Access to Blue Access PPO network
- 100% coverage for extensive preventive care services without needing to satisfy the deductible
- $1500 individual / $3000 family deductible
Lumenos HIA Plan 70% Coinsurance - Plan Benefits
| Plan Feature | In-Network You Pay | Out-of-Network You Pay |
| Lifetime Maximum Benefit | $5,000,000 per person | |
| Deductible Options Per individual, per calendar year. |
$1,500 individual / $3,000 family |
$3,000 individual / $6,000 family |
| Out-of-Pocket Expense Limit After deductible. |
$5,000 individual / $10,000 family |
$10,000 individual / $20,000 family |
| Doctor's Office Visits | 30% | 50% |
| Professional Services X-rays, lab, anesthesia, surgery, etc. |
30% | 50% |
| Hospital Inpatient (Overnight stays) |
0% | 30% |
| Hospital Outpatient (Non-overnight stays) |
30% | 50% |
| Emergency Room Services | 30% | 50% |
| Maternity | Not covered | |
| Preventive Care (Deductible waived) See List |
20% | 50% |
| Ambulance | 30% | 50% |
| Physical, Occupational, and Speech Therapy | 30% | 50% |
| Prescription Drug Coverage | 30% | 50% |
Lumenos HIA Plus Plan
The HIA Plus Plan works like the regular HIA Plan, but Anthem Blue Cross chips in an extra $125 per individual and $250 per family to the health account each quarter, for a calendar year total of $500 per individual and $1,000 per family. Like the standard HIA Plan, any unused funds rollover from year to year.
Lumenos HIA Plus highlights include:
- Access to BlueCard Nationwide PPO network
- 100% coverage for extensive preventive care services without needing to satisfy the deductible
- 100% coverage after satisfaction of deductible
- Choice of $2,500 or $5,000 deductible for individuals, or $5,000 or $10,000 for families
Lumenos HIA Plus Plan Benefits
| Plan Feature | In-Network You Pay | Out-of-Network You Pay |
| Lifetime Maximum Benefit | $5,000,000 per person | |
| Deductible Options Per individual, per calendar year. |
$2,500 individual / $5,000 family $5,000 individual / $10,000 family |
$5,000 individual / $10,000 family $10,000 individual / $20,000 family |
| Out-of-Pocket Expense Limit After deductible. |
$0 individual / $0 family $0 individual / $0 family |
$2,500 individual / $5,000 family $5,000 individual / $10,000 family |
| Doctor's Office Visits | 0% | 30% |
| Professional Services X-rays, lab, anesthesia, surgery, etc. |
0% | 30% |
| Hospital Inpatient (Overnight stays) |
0% | 30% |
| Hospital Outpatient (Non-overnight stays) |
0% | 30% |
| Emergency Room Services | 0% | 30% |
| Maternity | Not covered | |
| Preventive Care (Deductible waived) See List |
0% | 30% |
| Ambulance | 0% | 30% |
| Physical, Occupational, and Speech Therapy | 0% | 30% |
| Prescription Drug Coverage | 0% | 30% |
Lumenos HIA Plan Details
Preventive Care
Preventive care is covered with no deductible. The following is a list of covered preventive care services for adults included in all Lumenos Plans:
Office Visits (for preventive physical exams
Screening Tests including:
- Eye chart vision screening (Full vision exams not included)
- Hearing screening
- Cholesterol and Lipid level screening
- Blood Glucose test to screen for Type II Diabetes
- Prostate Cancer screenings including Digital Rectal Exam and PSA test
- Breast exam and Mammography screening
- Pelvic exam, Pap test and contraceptive management for females
- Colorectal Cancer screening including Fecal Occult Blood test, Barium Enema, Flexible Sigmoidoscopy and screening Colonoscopy
- Routine Blood and urine screenings
Immunizations for:
- Hepatitis A
- Hepatitis B
- Tetanus, Diphtheria (Td)
- Varicella (chicken pox)
- Influenza (flu shot)
- Pneumococcal Conjugate (pneumonia)
- Humana Papilloma Virus (HPV)
- Measles, Mumps, Rubella (MMR)
- Meningococcal Polysaccharide
- Herpes Zoster (shingles)
Child Preventive Care
Child Preventive Care is coverd with no deductible. The following is a list of covered preventive care services for babies and children included in all Lumenos Plans:
Office Visits (for preventive physical exams
Screening Tests including:
- Eye chart vision screening (Full vision exams not included)
- Hearing screening
- Screening for lead exposure
- Pelvic exam, Pap test and contraceptive management for females
Immunizations for:
- Hepatitis A
- Hepatitis B
- Diphtheria, Tetanus, Pertussis (DtaP)
- Varicella (chicken pox)
- Influenza (flu shot)
- Pneumococcal Conjugate (pneumonia)
- H.Influenza type b
- Polio
- Measles, Mumps, Rubella (MMR)
- Meningococcal Polysaccharide
- Rotavirus
How to Earn Reward Credits
Anthem will contribute reward credits into your health account for taking any of the following steps to improve and maintain your health:
- Completing or updating a MyHealth Assessment, an online tool for measuring your overall health. The Health Assessment is an online health profile that takes only a few minutes to complete. It helps you identify possible health risk factors, based on your current health, family history, lifestyle and other factors. And like all of the tools on the Anthem online health site, the Health Assessment is confidential. The information is protected by the highest level of online security available. You and your family members are eligible to complete their own Health Assessment. The Reward: one adult per family can earn a $50 reward credit per year.
- Enrolling in or graduating from one of the personal health coaching programs, one-on-one support programs for proactively managing your health. The Personal Health Coach Program teams consumers who have certain chronic medical conditions, such as asthma, diabetes, cancer or heart disease, with a specially trained nurse care manager to help them manage their health condition. The Reward: Members who qualify earn $100 for enrolling and $100 for acheiving you health goals and graduating from program. If you're enrolled in more than one health coaching program, you only get one reward. Not all health coaching programs qualify for reward credits, so check before signing up.
- Completing the Smoking Cessation Program, a proven program for kicking the habit for good. Manage withdrawal symptoms, identify triggers and learn new behaviors and skills. It features nine one-on-one telephone counseling sessions to help you develop your own tobacco cessation plan, including determining what nicotine-replacement products may work best for you. The program also includes coverage for nicotine-replacement products (gum or patch). You and your covered family members over 18 are eligible for this program. The Reward: You and your covered spouse or domestic partner can each earn $50 for completing the program (one reward per lifetime).
- Completing the Healthy Weight Program. The Healthy Weight Program includes nine one-on-one telephone counseling sessions designed to help you achieve a weight that supports good health. Working with a registered dietitian and health educator, you'll have confidential phone sessions to discuss topics like healthy eating, physical activity and exercise, stress management, maintenance and relapse. Anyone in your covered family who is 18 or older and has a Body Mass Index (BMI) of 25 or higher can participate. The Reward: You and your covered spouse or domestic partner can each earn $50 for completing the program (one reward per lifetime).
The weight management and tobacco cessation programs give you a one-time only reward. But you'll receive your reward every year that you take the online health assessment, stay enrolled in the health coach program, and meet your health coach goals. And money left over in your account at the end of the year stays in your account for the next year.
HIA Plans vs HIA Plus Plan
Because of the additional annual HIA "Plus" benefit of $500 for individuals and $1000 for families, the Health Incentive Account Plus Plans are about 25% higher than the standard HIA Plans. With this significant price difference, the standard HIA plan annual premiums can be more than $500 per indvidual or $1,000 less expensive than the HIA Plus annual premium, making the HIA Plus Plan an unwise financial option.
Disadvantages of HIA Plans vs HSA Plans
Because of the additional HIA benefit, the Health Incentive Account Plans are about 10% higher than the Lumenos HSA Plans. Additionally, the HIA plans are not HSA-compatible, meaning you could not open an HSA account and receive any tax-advantages.