Anthem Blue Cross BlueShield of Indiana
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Anthem Blue Cross and Blue Shield IN - Lumenos HIA Plus Plan 2

Includes Health Incentive Account (HIA) to pay for medical care and prescriptions.

  • You receive annual Health Incentive Account (HIA) Allocations1 from Anthem. This is the "Plus" component of HIA Plus.
  • You can also earn Anthem funding into your HIA through Healthy Rewards Incentives3.
  • Funds in the HIA are used to pay for covered health expenses, and are also applied against your deductible. This reduces the out-of-pocket cost you must incur before traditional coverage begins.
  • Unused HIA dollars rollover from year to year, so your account can keep growing to help meet future health care costs.
  • Your HIA balance will rollover as long as you are actively enrolled in the Anthem Lumenos plan. If you leave the plan, the funds in your HIA are forfeited.
HIA Plus Allocation Annual Funding
Anthem Contribution to Health Account $500 per individual or $1,000 per family2
Healthy Activity Healthy Rewards Incentives
Health Assessment $50 per family per year2
Personal Health Coach Program $100 per person for enrolling and $100 for graduating2
Smoking Cessation Program $50 per person2
Weight Management Program $50 per person2
Plan Feature In-Network You Pay Out-of-Network You Pay
Lifetime Maximum Benefit Unlimited amount per covered person (combined network and non-network)
Per individual, per calendar year.
$2,500 individual / $5,000 family4

$5,000 individual / $10,000 family4

Out-of-Pocket Expense Limit
Including deductible.
$5,000 individual / $10,000 family5

$15,000 individual / $30,000 family5

Physician Office Visits 20%3 40%3
Preventive Care 0% not subject to deductible 40%3
Well Child Care 0% not subject to deductible 40%3
Diagnostic Services 20%3 40%3
Inpatient Hospital 20%3 40%3
Outpatient Services 20%3 40%3
Emergency Room 20%3 20%3
Urgent Care 20%3 20%3
Including air
20%3 20%3
Maternity Services Not covered
Optional Maternity
Subject to 12-month waitng period
20%3 40%3
Outpatient Therapy Services
Maximum visits per benefit period for network and non-network combined:
  • Physical Therapy and Manipulation Therapy - 20 visits maximum
20%3 40%3
  • Speech Therapy - 20 visits maximum
20%3 40%3
  • Occupational Therapy - 20 visits maximum
20%3 40%3
  • Spinal Manipulation - 20 visits maximum
20%3 40%3
Mental Health and Substance Abuse
20%3 40%3
Home Health Care
Maximum visits per benefit period - 60 visits
20%3 40%3
Hospice 20%3 40%3
Durable Medical Equipment
$4,000 maximum per benefit period
20%3 40%3
Human Organ and Tissue Transplant Services
$1,000,000 Lifetime maximum combined network and non-network transplant provider services (Kidney and cornea transplant services covered same as any other illness under medical) Includes transportation, lodging, and meals.
20%3 40%3
Optional Anthem Blue Preferred Term Life Available as an option for additional cost
Anthem Dental Blue Option Available as an option for additional cost

Outpatient Prescription Drug Benefit In-Network You Pay Out-of-Network You Pay
30 day supply
20%3 40%3
Mail Service
Up to a 90-day supply of maintenance drugs is available through mail service.
20%3 40%3

1Anthem makes the annual allocation ($500 for an individual or $1000 for a family) to your Health Incentive Account (HIA). 25% of the annual allocation is made available at the start of each calendar year quarter (January 1, April 1, July 1, October 1), but the first allocation is always made on the start date of your plan. So if you start your plan on February 1 instead of January 1, you will receive allocations to your account on February 1, April 1, July 1 and October 1.

2HEALTHY REWARDS INCENTIVES: Anthem will contribute dollars into your Health Incentive Account for taking any of the following steps to help improve and maintain your health:
  • Completing or updating a Health Assessment, Anthem's online tool designed to heap measure your overall health. The health information you provide is secure and strictly confidential. Earn $50 per family, per year.
  • Enrolling in and graduating from the Personal Health Coach Program, a one-on-one support program intended to help you proactively manage your health. Available if you qualify. Earn $100 per person for enrolling and $100 for graduating.
  • Completing Anthem's Smoking Cessation Program, designed to help you lead a tobacco-free lifestyle. Participation is open to you and your coverage family members age 18 or older, and includes counseling support and tools, including nicotine replacement therapy coverage. Earn $50 per covered person.
  • Completing Anthem's Weight Management Program, a personalized phone course with a team of counselors (a regostered dietitian and health educator) designed to help you adopt lifestyle changes necessary to lose weight and maintain weight lass. Participation is open to you and your covered family members age 18 and older who have a Body Mass Index (BMI) of 25 or higher. Earn $50 per covered person.
3Services subject to calendar-year deductible. Network and Non-network deductibles are separate and do not accumulate towards each other.
4The family deductible must be satisfied by either on or all members collectively before any covered services will be paid by the plan.
5Once the family out-of-pocket maximum is satisfied by either one or all members collectively, no additional coinsurance will be required for the family for the remainder of the benefit period.

Blue Access PPO Network
These plans are available with the Blue Access PPO network. To find a doctor or local hospital, visit www.anthem.com and select the "Find a Doctor" button for a complete list of providers within the network.

Brief Outline of Coverage
This Lumenos HIA Plus Plan Benefits Overview is intended to be a brief outline of coverage and is not intended to be a legal contract. The entire provisions of benefits and exclusions are contained in the contract or certificate of coverage. In the event of a conflict between the contract or certificate of coverage and this Lumenos HIA Plus Plan Benefits Overview, the terms of the contract or certificate of coverage will prevail.

READ YOUR POLICY CAREFULLY; This outline of coverage provides a brief description of the important features of the Policy. This is not the insurance contract, and only the actual Policy provisions will control. The Policy itself sets forth in detail the rights and obligations of both you and your insurance company. It is, therefore, important that you READ YOUR POLICY CAREFULLY!