ClearProtection Plus

How It Works

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Two Separate Deductibles

Each plan has two deductibles:

•Inpatient/outpatient surgical/ER services deductible

•Outpatient professional services deductible

IP/OP Surgical/ER Deductible

$1000 $3300

Outpatient Professional Deductible

$4500 $6800

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Two Separate Deductibles

40% coinsurance applies for inpatient, outpatient surgical, and emergency room services after the Inpatient/Outpatient Surgical/ER Deductible is met

•Member pays 100% of the negotiated rate before the deductible is met

IP/OP Surgical/ER Deductible

$1000 $3300

Outpatient Professional Deductible

$4500 $6800

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Two Separate Deductibles

0% coinsurance applies to outpatient professional services after the Outpatient Professional services Deductible is met

•Member pays 100% of the negotiated rate before the deductible is met

IP/OP Surgical/ER Deductible

$1000 $3300

Outpatient Professional Deductible

$4500 $6800

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Two Separate Deductibles

The Outpatient Professional Services Deductible amount is equal to the Total OOP Maximum amount

IP/OP Surgical/ER Deductible

$1000 $3300

Outpatient Professional Deductible

$4500 $6800

Total OOP Maximum (deductible plus Calendar OOP Maximum)

$4500 $6800

All in-network covered services covered at 100% (0% coinsurance) after the Total OOP Maximum is met.

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ClearProtection Plus Scenario 1

IP/OP Surgical/ER Deductible

OP Professional Deductible

Total OOP Maximum Amount Met

$1000 deductible satisfied; member pays 40% of balance (40% of $4000 = $1,600)

No amounts applied No – $2600 applied ($1000 + $1600)

$1000 Deductible ClearProtection Plus Plan: Member gets $5000 Inpatient Procedure

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ClearProtection Plus Scenario 1

IP/OP Surgical/ER Deductible

OP Professional Deductible

Total OOP Maximum Amount Met

$1000 deductible satisfied; member pays 40% of balance (40% of $4000 = $1,600)

No amounts applied No – $2600 applied ($1000 + $1600)

$1000 deductible satisfied; member pays 40% of $1000 ($400)

No amounts applied No – total amount applied is now $3000

$1000 Deductible ClearProtection Plus Plan: Member gets $5000 Inpatient Procedure; member then gets $1000 outpatient surgical procedure

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ClearProtection Plus Scenario 1

IP/OP Surgical/ER Deductible

OP Professional Deductible

Total OOP Maximum Amount Met

$1000 deductible satisfied; member pays 40% of balance (40% of $4000 = $1,600)

No amounts applied No – $2600 applied ($1000 + $1600)

$1000 deductible satisfied; member pays 40% of $1000 ($400)

No amounts applied No – total amount applied is now $3000

No amounts applied $1500 applied; $500 balance is paid at 100% after Total OOP Max is met

Yes – total amount applied is $4500

$1000 Deductible ClearProtection Plus Plan: Member gets $5000 Inpatient Procedure; member then gets $1000 outpatient surgical procedure; member needs $2000 in professional services

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ClearProtection Plus Scenario 2

IP/OP Surgical/ER Deductible

OP Professional Deductible

Total OOP Maximum Amount Met

No amounts applied $4500 applied; $500 balance is paid at 100% after Total OOP Max is met

Yes – total amount applied is $4500

$1000 Deductible ClearProtection Plus Plan: Member gets $5000 in professional services

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ClearProtection Plus Scenario 2

IP/OP Surgical/ER Deductible

OP Professional Deductible

Total OOP Maximum Amount Met

No amounts applied $4500 applied; $500 balance is paid at 100% after Total OOP Max is met

Yes – total amount applied is $4500

Inpatient charges paid at 100% after Total OOP Max is met

No amounts applied No amounts applied

$1000 Deductible ClearProtection Plus Plan: Member gets $5000 in professional services; member needs $5000 inpatient procedure

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ClearProtection Plus Scenario 3

IP/OP Surgical/ER Deductible

OP Professional Deductible

Total OOP Maximum Amount Met

$2000 applied No amounts applied No – $2000 applied

$3300 Deductible ClearProtection Plus Plan: Member gets $2000 outpatient surgical procedure

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ClearProtection Plus Scenario 3

IP/OP Surgical/ER Deductible

OP Professional Deductible

Total OOP Maximum Amount Met

$2000 applied No amounts applied No – $2000 applied

No amounts applied $4800 applied Yes -- $6800 total amount applied

$3300 Deductible ClearProtection Plus Plan: Member gets $2000 outpatient surgical procedure; member spends $4,800 in outpatient/diagnostic services

Neither IP/Surgical or OP Professional Services Deductible met, however all subsequent services will be covered at 100% because the Total OOP Max is met

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In a nutshell…

Anthem shares cost of inpatient/surgical/ER procedures after inpatient/Surgical/ER deductible

•$1000/$3300 – Individual

•$2000/$6800 – Family

Anthem shares cost of outpatient/professional services after outpatient/professional deductible

•$4500/$6800 – Individual

•$9000/$13600 – Family

Anthem will pay 100% of all in-network covered services, including outpatient professional services, after the total OOP Maximum is met

•$4500/$6800 – Individual

•$9000/$13600 – Family

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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 of Anthem Insurance Companies, Inc. The Blue Cross names and symbols are registered marks of the Blue Cross Association.