Anthem Lumenos HSA Plus Virginia Health Insurance Plan

Lumenos HSA Plus

Health Savings Account (HSA) Compatible

Anthem Lumenos HSA Plus is a smart health plan, offering Health Savings Account (HSA) benefits. When you put your money into an HSA compatible plan, it’s your money, growing with tax-free interest. You own the money in your HSA, and it goes with you if you change health plans in the future. If you are generally healthy and want to save unused health insurance funds, Anthem Lumenos HSA Plus may be the right plan for you.

Covered Services	Summary of Benefits * (In-Network)
Doctor's Office Visits	Your Share of Costs (after deductible, unless waived or not subject to deductible) 0 or 20% copay after deductible for primary care physician, 0 or 20% copay after deductible for specialist
Preventive Care Services (Age 7 and older)	Covered 100%
Prescription Retail Drugs (and Mail Order when available)	(Deductible Waived): Standard Drug Coverage: Drugs on Formulary (Generic and Brand Name Drugs): 20% coinsurance Drugs not on Formulary: Not covered. Unlimited coverage See Anthem Drug Formulary List
Oral Contraceptives	Covered as Rx
Spinal Manipulation, Chiropractic	0% or 20% coinsurance after deductible
Professional & Diagnostic Services (X-rays, labs, anesthesia, surgeons, etc.)	0% or 20% coinsurance after deductible
Inpatient Services (overnight hospital / facility stays)	0% or 20% coinsurance after deductible
Outpatient Services (without overnight hospital / facility stays)	0% or 20% coinsurance after deductible
Emergency Room Services	0% or 20% coinsurance after deductible
Optional Coverage Options
Maternity Coverage	Not Available
Dental Insurance	Rider Available
Routine Vision Exams	Not Available
Other Covered Benefits:	Ambulance, Chiropractic Care, Durable Medical Equipment, Home and Hospice Care, Mental Health, Physical / Occupational Therapy, Substance Abuse, Speech Therapy, Urgent Care

Anthem Lumenos Deductible Options

Deductible Options (In-Network) The deductible is the annual amount you as the member or family must pay before coverage begins. You can usually lower your monthly premium by choosing a higher deductible.		Coinsurance
$1,500 Individual		20%
$3,500 Individual / $5,000 Individual		0%