1. SmartSense PPO Plans
POPULAR PLANS!
March 2009

2. SmartSense Highlights
Reliable protection with some of our lowest monthly rates
In-network office visits available before deductible
Choice of prescription drug benefits (Generic Only or Comprehensive)
4TH quarter deductible carry-over
$7 million lifetime maximum benefit
2-year anniversary date rate guarantee on $5000 deductibles

3. SmartSense Benefits In-Network Out-of-Network
Deductible Individual/Family
$5,000/$10,000
4 OPTIONS
$500/$1,000
$1,500/$3,000
$2,500/$5,000
$5,000/$10,000
Separate in-network and out-of-network deductibles
Embedded (family) deductible
A member may meet the individual deductible before the rest of the family and go into coinsurance, OR two or more family members can meet the family deductible.
4th Quarter deductible carry-over feature

4. SmartSense Benefits In-Network Out-of-Network Coinsurance 30% 50%
Annual OOP Maximum Individual/Family
(in addition to deductible)
$2,500/$5,000
$10,000/$20,000
Lifetime Benefit Maximum
$7 million
Separate in-network and out-of-network OOP Maximum
Embedded (family) OOP maximum
A member may meet the individual OOP maximum before the rest of the family and move into full coverage, OR two or more family members can meet the family OOP maximum.

5. SmartSense Benefits In-Network Out-of-Network Physician Office Visits
$30 copay for first 3 visits
then in-network deductible and 30% coinsurance
50% coinsurance after out-of-network deductible plus all excess charges
In/Outpatient Hospital Care
30% coinsurance after in-network deductible
IP: All charges except $650/day
OP: All charges except $380/day
Emergency Care additional $100 co-pay per ER visit (waived if admitted)
Maternity
Not Covered

6. SmartSense Benefits Out-of-Network In-Network OR
Annual Physical Exam OR
HealthyCheck Center
30% coinsurance after in-network deductible
$27/$75 copay for basic/premium screening (deductible waived)
Routine Mammogram
Routine Pap Smear & PSA
Routine Colorectal Cancer Screenings
Preventive Care & Immunizations for Children (Birth to 6 years)
50% coinsurance after out-of-network
deductible plus all excess charges
30% coinsurance after in-network deductible
3 office visits before deductible

7. SmartSense Benefits In-Network Out-of-Network Ambulance Services
30% coinsurance after in-network deductible
50% coinsurance* after out-of-network deductible
Acupuncture/ Acupressure
Not Covered
Chiropractic Care
30% coinsurance after in-network deductible, $500 limit
50% coinsurance* after out-of-network deductible, $500 limit
Outpatient Speech/Physical/ Occupational Therapy
30% coinsurance after in-network deductible, $2,500 limit
50% coinsurance* after out-of-network deductible, $2,500 limit
*Plus all excess charges

8. SmartSense Benefits Choose your Pharmacy Benefit! Generic Rx Only
Comprehensive Rx

9. SmartSense Benefits Pharmacy Benefits
Generic Rx Only
In-Network
Out-of-Network
Generic Drugs on Generic Rx Formulary Only
$15 co-payment or 40% coinsurance (member pays whichever is greater)
Brand Name
Not Covered
Discount Available

10. SmartSense Benefits Pharmacy Benefits
Comprehensive Rx
In-Network
Out-of-Network
Generic
$15 co-payment or 40% coinsurance (member pays whichever is greater)
Brand Name
$500 annual brand-name/ specialty deductible, then
$15 co-payment or 40% coinsurance (whichever is greater)
$500 annual brand-name deductible, then
2-member maximum on deductible

11. SmartSense Benefits Pharmacy Benefits
Comprehensive Rx
In-Network
Out-of-Network
Generic
$15 co-payment or 40% coinsurance (member pays whichever is greater)
Brand Name
$500 annual brand-name/ specialty deductible, then
$15 co-payment or 40% coinsurance (whichever is greater)
40% of negotiated fee for Specialty Drugs and self-administered injectables, except insulin
$4,500 annual OOP Maximum
$500 annual brand-name deductible, then
40% of negotiated fee for self-administered injectables, except insulin
No Specialty Drug Coverage
Specialty Drugs include injected, infused, oral and inhaled medications that generally need to be closely monitored by the member’s doctor.
The most a member would have to pay.
This is in addition to the brand deductible.

12. Selling SmartSense
One of our lowest priced plans with solid protection that covers the essentials
In-network office visits available before deductible
$500 - $5,000 range of deductibles
Embedded deductible and OOP maximum
Choice of prescription drug benefits (comprehensive or generic only)
Lifetime maximum benefits of $7,000,000
4th Quarter deductible carry-over
2-year anniversary date rate guarantee on $5000 deductibles

13. Questions?
Thank you!
The SmartSense plans are offered by Anthem Blue Cross Life and Health Insurance Company. 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 a registered trademark. ® The Blue Cross name and symbol are registered marks of the Blue Cross Association.