Virginia Individual Health Insurance, Family Plans | MyLocalBroker.net

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Roberson Insurance Agency, Inc.
1945 Malbon Road
Virginia Beach, VA 23456
1-(888)-380-2505


Anthem KeyCare : HealthSmart with Enhanced Drug Benefit

Anthem HealthSmart w/Enhance Rx Health Insurance

HealthSmart is an affordable, high deductible health plan which includes prescription drug coverage. If you want solid protection with Anthem's lowest high-deductible premium option, Anthem HealthSmart may be the plan for you. Click Here to Sign Up for Anthem HealthSmart, or call us at (757) 426-9797 or 1-(888) 380-2505 to talk with a real person. We would be glad to help you.

  • Lowest high-deductible premium option, offering solid protection.
  • All covered services, except preventive care for children, are covered after the deductible is met.

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Choose an Anthem HealthSmart w/Rx Deductible


In-Network  
 Out of Network
Deductible Out-of-Pocket Maximum Coinsurance Deductible Out-of-Pocket Maximum
$2,250 Individual or Family $4,000 Individual or Family 20% $2,250 Individual or Family $6,000
$3,500 Individual or Family $5,000 Individual or Family 20% $3,500 Individual or Family $7,500
$5,000 Individual or Family $5,000 Individual or Family 0% $5,000 Individual or Family $7,500
         
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The deductible is the annual amount you as the member or family must pay before coverage begins. There are separate deductibles for in and out of network coverage. Anthem maintains a large network of doctors which can be found online. Doctors in Anthem's network are considered in-network, and offer significant cost savings benefits. You can usually lower your monthly premium by choosing a higher deductible.

 

Anthem HealthSmart w/Rx Benefits 


After Deductible means that after you have met your deductible, Anthem will pay a percent of the cost of covered services as coinsurance and you will pay the rest. Coinsurance is the percentage of costs that you pay after the deductible is met. In general, zero coinsurance options are found with higher deductible options.

Once the out of pocket maximum is reached, Anthem will pay 100% of most covered charges for the remaining year. There is a separate out of pocket maximum for in and out of network services. Prescription drug costs do not count towards the out-of-pocket maximum.  


Covered Services  In-Network Costs After Deductible  Out of Network Costs After Deductible
Doctor's Office Visits
Deductible Waived for Doctor's Visits.
$20 copay for primary care physician,
$30 copay for specialist
30% coinsurance
Preventive Care Services Deductible Waived for Preventive Care.
     Preventive Office Visits:
 $20 copay for primary care physician,
$30 copay for specialist
     Preventive Screenings, Labs, X-rays, Immunizations:
 20% coinsurance
     Well-Baby Care
 Childhood immunizations only to age 3,
Rider Available for complete well care
Professional & Diagnostic Services
(X-rays, labs, anesthesia, surgeons, etc.)		 0% or 20% coinsurance
Inpatient Services
(overnight hospital / facility stays)		 0% or 20% coinsurance
Outpatient Services
(without overnight hospital / facility stays)		 0% or 20% coinsurance, max 20 visits
Emergency Room Services 0% or 20% coinsurance
Maternity Coverage
 Add $71.00 monthly
Optional Coverage Options
     Preventive Dental
 Rider Available; add $23.00 monthly
     Preventive Vision / Laser Vision Correction
 Discount through Special Offers @ Anthem.com
     Well Child Care (Optional)
 Rider Available for complete well care
     Supplemental Accident Insurance Add $8.00 monthly
     Life Insurance
     
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The benefits listed below are also covered by this particular Anthem KeyCare plan.



Prescription Drugs & Other Benefits Anthem HealthSmart with Enhanced Drug Benefit
Prescription Retail Drugs
(and Mail Order when available)
In-Network: (deductible waived):
  • Teir 1 (Generic and Brand Name) Drugs: $15 copayment or 40% coinsurance, whichever is greater
  • Teir 2 (Specialty) Drugs 40% coinsurance up to $500 maximum per perscription.
  • $5,000 annual maximum coverage for Tier 1 drugs
  • Expense limit per prescription: $10,000 / year Max
     
Out of Network (deductible waived):
  • Same benefits, but member is responsible for filing claim and for paying the difference between the pharmacy charge and Anthem's allowable charge, in addition to any copayments or coinsurance.
  • Tier 2 drugs not covered; for non-specialty Tier 1 drugs members pay $15 copayment or 40% coinsurance, whichever is greater.
Optional Drug Coverage
(if available)		 N/A
Oral Contraceptives
 Covered as Rx
Other Covered Benefits: Ambulance, Chiropractic Care, Durable Medical Equipment, Home and Hospice Care, Mental Health, Physical / Occupational Therapy, Substance Abuse, Speech Therapy, Urgent Care, Routine Vision Exam


   
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Anthem HealthSmart w/Rx Optional Benefits 


You may personalize your plan by purchasing additional benefits to expand your coverage. These options include:

  • Preventive Dental
  • Well Child Care 
  • Supplemental Accident 
  • Life Insurance

For details, call us at (757) 426-9797 or 1-(888) 380-2505 or contact us via email.  We would be glad to help you.

Note: This is not an Anthem Insurance Policy, but a brief summary of benefits offered by Anthem. Click here to visit Anthem's Website.