Tonik

Have you heard about Tonik, the health insurance plans for thrill seekers, part-time daredevils and calculated risk takers? These three Individual PPO plans are simple and straight-up – giving you the benefits you need without making you pay for things you don’t want.
Tonik plans include immediate coverage for:

• Doctor visits – you pay just $20, $30 or $40 to see a doctor, depending on the plan you pick
• Generic prescription drugs – your copay is only $10
• Dentist appointments, x-rays, cleanings, and fillings
• Lowest out-of-pocket maximums (ex. $1500)
• Vision care services

SmartSense

Is SmartSense for you?
• Reliable, basic protection with some of our lowest monthly rates
• Choose the annual deductible/monthly rate combination that works for you
• Immediate benefits for first three visits to a doctor
• Choice of prescription drug benefits (Comprehensive Rx or Generic Only Rx)
• No need for maternity benefits
• Health plan pays up to $7,000,000 per member in lifetime benefits
What else do you get?
• Access to over 50,000 California PPO network doctors and specialists and nearly
400 hospitals – so chances are your doctor is one of ours
• Money in your pocket – because we’ve negotiated lower fees with our network
doctors and hospitals, your share of costs is less (a lot less)
• Free health and wellness programs – designed to keep you as healthy as can be
• Out-of-state coverage – so you’ll feel better wherever you are

Lumenos

Our Lumenos plans are for people who want to take more control of their health care and expenses. Does that sound like you?

At BC Life & Health Insurance Company, we think health plans should do more than pay for care when you’re sick. Good health is something to work on all the time. Whether you have a long-term condition, a temporary illness, or even if you’re currently in good health, there are things you could be doing to maintain or improve your health. Do you want a health plan that helps you do those things?

We thought so. And we developed a portfolio of health plans whose goal is to give you accounts, information, services and rewards to help maintain and improve your health. These consumer-driven plans — which we call our Lumenos plans — offer the kinds of things that help you reach your health potential and give you more control over your health care dollars, plus a whole lot more.

What makes the Lumenos plans different?
A health account that empowers you and offers flexibility Lumenos plans give you the ability to better manage and control your health care dollars. They are designed to help you reduce your out-of-pocket health expenses, while improving your health and well-being. Plus, you have three plan choices and a variety of deductible options, so you can tailor the plan to
your needs and budget — for even more flexibility.

• OPTION 1: Lumenos Health Savings Account (HSA) Plan
• OPTION 2: Lumenos Health Incentive Account (HIA) Plan
• OPTION 3: Lumenos Health Incentive Account Plus (HIA Plus) Plan

Remember, the higher the deductible, the lower your premium. You’ll also need to consider what you can comfortably afford to pay upfront for medical
care before traditional health coverage begins.
Preventive care covered — before your deductible
When you use our network providers, nationally recommended preventive care services are covered by us, with no additional cost to you. Below are
some of the covered preventive care services:

360° Health® — Personalized services and online tools for health-conscious consumers
360° Health is our approach to surrounding you with the resources, tools, guidance and support to help you make the right health care decisions for you
and your family. You’ll have access to a wealth of ways to improve and maintain your health — all at no additional charge, including:

• An online MyHealth Assessment designed to help you measure your overall health.
• Our health coaching programs for managing ongoing conditions, and our Healthy Lifestyles programs such as Tobacco-Free and Healthy Weight.
• A 24/7 NurseLine when you need a quick answer to a routine health question or information on a medical issue.
• An online health site with tools and information, including network provider listings, hospital quality ratings, prescription drug costs, wellness articles, and much more.

Built-in value through our discounts You choose your own doctor and you never need referrals — and when you use our network providers, you can save money because you’ll receive our negotiated discounts on services and prescriptions. If you visit an out-of-network provider, you’ll still have benefits, but your share of the cost for covered services will increase.

Right Plan 40

• Simple, immediate benefits (including doctors’ office visits) with no medical deductible
• Choice of prescription drug benefits (Comprehensive Rx, Generic Only Rx or No Rx)
• No maternity benefits
Choose the plan that’s right for you.
• RightPlan PPO 40 with No Rx – If you don’t need prescription drug coverage,
this is a good way to keep your monthly rates as low as possible
• RightPlan PPO 40 with Generic Rx – Pay just a $10 copay for generic drugs
from our Generic Rx Formulary
• RightPlan PPO 40 with Comprehensive Rx – Pay a $10 copay for
generic drugs and a $30 copay for brand-name prescription drugs from the Blue Cross
Formulary (after meeting the $500 brand-name prescription drug deductible)

Basic PPO 1000/2500

Is the Basic PPO for you?
• Basic (mainly catastrophic) coverage for hospitalization and emergency services
• Choice of $1,000 or $2,500 medical deductible
• Doctors’ office visits are covered once you meet your out-of-pocket maximum
• No prescription drug benefits
• No maternity benefits

PPO Saver

• Basic (mainly catastrophic) coverage for hospitalization and emergency services
• Two separate medical deductibles: $500 for hospital/emergency services and $5,000 for other covered services

• Immediate benefits for 4 doctors’ office visits for children and 2 for adults
• Brand-name and generic prescription drug coverage
• No maternity benefits

PPO Share Plans

• Our most comprehensive PPO coverage – simply choose the medical deductible/monthly premium combination that works for you
• Immediate benefits for doctors’ office visits
• Brand-name and generic prescription drug coverage
• Maternity benefits

3500 Deductible PPO

• Simple, comprehensive coverage – just meet your medical deductible and then pay $0 for most covered services in-network
• One of our lowest out-of-pocket maximums
• Brand-name and generic prescription drug coverage
• No maternity benefits
With the 3500 Deductible PPO, just meet
your annual deductible and you'll then pay
$0 for most in-network covered services.

Core 5000

• Our lowest monthly premiums
• Immediate benefits for preventive care
• You pay only a percentage of the Blue Cross negotiated fee for inpatient and outpatient hospital services as well as emergency services, once you meet your deductible
• Doctors’ office visits are covered once you meet your out-of-pocket maximum
• Immediate generic drug benefits
• No maternity benefits

PPO 3500 (HSA-Compatible)

Our PPO 3500 (HSA-Compatible) Plan gives you
low monthly premiums and the opportunity to
set up a tax-advantaged health savings account.
A high-deductible health plan is not a health savings account (HSA). An HSA is a separate arrangement between an individual and a qualified financial institution. To take advantage of tax benefits, an HSA needs to be established. This brochure provides general information only and is not intended to be a substitute for the advice of a qualified tax professional. If you are considering an HSA, talk with your tax advisor.

• Gives you the opportunity to combine a tax-advantaged health savings account (HSA) with your health plan
• Simple, comprehensive coverage – just meet your medical deductible and then pay
$0 for most covered services in-network
• Brand-name and generic prescription drug coverage
• Combined medical/pharmacy deductible – so your payments for prescription drugs
apply toward your deductible and out-of-pocket maximum
• No maternity benefits

HMO Plans

If you enroll in one of our HMO plans, you’ll choose a primary care physician who will coordinate your
health care services and authorize referrals to any specialists you may need.
Which HMO Plan is for you?

Select HMO
• Exclusive network of doctors and hospitals in 22 California counties
• Comprehensive HMO coverage with lower monthly premiums
• Immediate, no-deductible benefits
• Brand-name and generic prescription drug coverage
• Maternity benefits
What else do you get?
• Access to nearly 15,000 California network doctors and specialists and nearly 400 hospitals in 22 California counties – bringing comprehensive HMO coverage closer to more people
• Money in your pocket – because we’ve negotiated lower fees with our network doctors and hospitals, your share of costs is less (a lot less)
• Free health and wellness programs – designed to keep you as healthy as can be
• Out-of-state coverage for emergency and urgent care

Dental Blue

The Benefits of Dental Blue
All Dental Blue networks offer:

• 18,000+ dental professionals to choose from
• No deductibles for cleanings, exams and X-rays
• No claim forms or paperwork to deal with
• Discounts on popular services like whitening,implants and braces
• Dental Specialists within both networks
• Continued savings even after you reach your annual maximum. You keep saving because you pay OUR negotiated (and less expensive) fee, not full price, for dental services.

Dental HMO

Blue Cross Dental plans offer:

• More choices – three HMO plans and a large network of dentists to choose from
• Comprehensive benefits – a broad range of preventive, basic and major services
• Specialty services – orthodontic and cosmetic
• Affordable monthly rates – choice of payment options with low $5 office visit fees for exams.