How Anthem Lumenos PPO with HRA differs from an HMO

• Provider Choice. Unlike an HMO, the Anthem Lumenos plan allows you to go to any doctor you choose. Your in-network services are available through the nationwide Anthem Blue Cross PPO provider network. Out-of-network services are available through any doctor you choose. You pay more for out-of-network services.
  
  
• No PCPs or Referrals. You do not have to designate a primary care physician (PCP), and you do not need a referral to see a specialist.
  
  
• Network. In an HMO, you must see a network doctor. Anthem Lumenos also offers a network, and you will save by using a network doctor or hospital. But there is also out-of-network coverage if you wish to see a doctor that doesn't participate in the network.
  
  
• No Copays. There are no copays with the Anthem Lumenos PPO with HRA. As long as you have a balance in the HRA available, you pay nothing out-of-pocket.
  
  
• Health Reimbursement Account Feature (HRA). The HRA, which UC funds, automatically pays first for 100% of eligible medical and pharmacy expenses until the balance is exhausted. If you use up your HRA dollars, you pay the full cost until you meet the deductible. Then the traditional PPO health plan features begin.
  
  Your HRA:
  employee $1,000
  employee + adult $1,500
  employee + child(ren) $1,500
  family $2,000
  
  
• Unused HRA Balances Roll Over. Any unused balance left in your HRA at the end of the plan year carries over to the next year - reducing the amount you may have to pay for future health care expenses.
  
  
• Deductible Isn't Upfront. The deductible works differently than with an HMO. When you use the plan, payment for services is deducted from the HRA. If you exhaust your HRA, then you pay the remaining share of the deductible. If you don't use all of your HRA, the deductible doesn't come into play and you pay nothing.
  
  
• Tools and Resources. Tools and Resources. Anthem Lumenos includes many tools and resources, such as the Coverage Advisor that estimates the cost of health care services, a 24-hour nurse line, a personal website to track your account, and Anthem’s specially trained customer service representatives.

How Anthem Lumenos PPO with HRA differs from a PPO

• Health Reimbursement Account Feature (HRA). The HRA, which UC funds, automatically pays first for 100% of eligible medical and pharmacy expenses until the balance is exhausted. If you use up your HRA dollars, you pay the full cost until you meet the deductible. Then the traditional PPO health plan features begin.
  
  Your HRA:
  employee $1,000
  employee + adult $1,500
  employee + child(ren) $1,500
  family $2,000
  
  
• Unused HRA Balances Roll Over. Any unused balances left in your HRA at the end of the plan year carries over to the next year - reducing the amount you may have to pay for future health care expenses.
  
  
• Deductible Isn't Upfront. The deductible works differently than with a PPO. When you use the plan, payment for services is deducted from the HRA. If you exhaust your HRA, then you pay the remaining share of the deductible. If you don't use all of your HRA, the deductible doesn't come into play and you pay nothing.
  
  
• No Copays. There are no copays with the Anthem Lumenos PPO with HRA. As long as you have a balance in the HRA available, you pay nothing out-of-pocket.
  
  
• Tools and Resources. Tools and Resources. Anthem Lumenos includes many tools and resources, such as the Coverage Advisor that estimates the cost of health care services, a 24-hour nurse line, a personal website to track your account, and Anthem’s specially trained customer service representatives.

How Anthem Lumenos PPO with HRA differs from a Point of Service Plan (POS)

• No PCPs or Referrals. You do not have to designate a primary care physician (PCP), and you do not need a referral to see a specialist with the Anthem Lumenos PPO with HRA .
  
  
• No Copays. There are no copays with the Anthem Lumenos plan. As long as you have a balance on the HRA available, you pay nothing out-of-pocket.
  
  
• Health Reimbursement Account Feature (HRA). The HRA, which UC funds, automatically pays first for 100% of eligible medical and pharmacy expenses until the balance is exhausted. If you use up your HRA dollars, you pay the full cost until you meet the deductible. Then the traditional PPO health plan features begin.
  
  Your HRA:
  employee $1,000
  employee + adult $1,500
  employee + child(ren) $1,500
  family $2,000
  
  
• Unused HRA Balances Roll Over. Any unused balance left in your HRA at the end of the plan year carries over to the next year - reducing the amount you may have to pay for future health care expenses. This is the only plan that lets you save your dollars for a year when you need them more.
  
  
• Deductible Isn't Upfront. The deductible works differently than with a POS. When you use the plan, payment for services is deducted from the HRA. If you exhaust your HRA, then you pay the remaining share of the deductible. If you don't use all of your HRA, the deductible doesn't come into play and you pay nothing.
  
  
• Tools and Resources. Anthem Lumenos includes many tools and resources, such as the Coverage Advisor that estimates the cost of health care services, a 24-hour nurse line, a personal website to track your account, and Anthem’s specially trained customer service representatives.

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.

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