Listed below is a summary of all the benefit changes for Anthem Blue Cross Life and Health
Insurance Company/Anthem Blue Cross (“Anthem”) individual and family health plans that will be
effective on 3/1/09. Please locate your plan under the plan name section for a description of the
changes to your policy. This is a summary only. Please refer to your plan endorsement, when it
arrives, for the full contract language.
Plan Name
3/1/09 Benefit Changes
SmartSense


Lumenos


Tonik


PPO 3500 (HSA-Compatible)


3500 Deductible PPO


RightPlan 40


PPO Share
500/1000/1500/2500

PPO Share 5000


PPO Saver


Change family deductible so it can be satisfied by two
or more members. (One member no longer has to meet
the Individual deductible before the family deductible
can be met.)
Change family out-of-pocket maximum to include an
individual out-of-pocket maximum on family contracts.
Add HealthyCheck benefits.
Increase number of visits from 12 to 24 for Physical
Therapy, Occupational Therapy and Chiropractic
Services.
Increase generic drug copay from $10 to $15.
Increase number of visits from 12 to 24 for Physical
Therapy, Occupational Therapy and Chiropractic
Services.
Increase generic drug copay from $10 to $15 and brandname drug copay from $30 to $35.
Increase number of visits from 12 to 24 for Physical
Therapy, Occupational Therapy and Chiropractic
Services.
Increase generic drug copay from $10 to $15 and brandname drug copay from $30 to $35.
Increase number of visits from 12 to 24 for Physical
Therapy, Occupational Therapy and Chiropractic
Services.
Increase generic drug copay from $10 to $15 and brandname drug copay from $30 to $35. (N/A for RightPlan
PPO 40 -No Rx.).
Increase number of visits from 12 to 24 for Physical
Therapy, Occupational Therapy and Chiropractic
Services.
Increase number of visits from 12 to 24 for Physical
Therapy, Occupational Therapy and Chiropractic
Services.
Increase generic drug copay from $10 to $15.
Increase number of visits from 12 to 24 for Physical
Therapy, Occupational Therapy and Chiropractic
Services.
Increase generic drug copay from $10 to $15 and brandname drug copay from $30 to $35.
Increase number of visits from 12 to 24 for Physical
Therapy, Occupational Therapy and Chiropractic
Services.
Medical plans are offered by Anthem Blue Cross and/or Anthem Blue Cross Life and Health Insurance Company. 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 Anthem Blue Cross names and symbols are registered marks of the Blue Cross Association.