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New Smart Sense plan

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BLUE CROSS OF CALIFORNIA
NEW SMART SENSE INDIVIDUAL FAMILY PLAN
SmartSense is a smart choice for California Individuals and Families if this is what they want:

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

What’s Different About SmartSense

  • Embedded (family) deductibles make it easier for families to satisfy deductible requirement:
    • Once any family member meets their single deductible, their deductible is satisfied
    • After one family member’s single deductible is satisfied, the family deductible can be met by one or more family members
  • Fourth quarter carry-over deductible feature
  • Separate in-network and out-of-network out-of-pocket maximums
  • No $500 per admittance charge for inpatient services or outpatient services related to surgery or infusion therapy at a participating hospital
  • Healthy Check and coverage for acupuncture and acupressure services are not included
  • Your clients’ annual out-of-pocket costs for brand name prescriptions are capped for their protection
  • SmartSense contract codes are based on:
    • Deductible
    • Rx selection
    • 1 member vs. 2+ members
    • Each plan has a different contract code

SmartSense Rating Differences
To give us the flexibility to offer the lowest rates possible, the following rating criteria are being used:

  • Gender rating (male vs. female)
  • Single age bands
  • For one-member contracts, there is one set of rates; for two or more members on a contract, there is a discounted rate  
  • SmartSense members will not "age attain" until the rate action following their birthday (for example, if your client has a birthday, and there is rate action three months later, your client’s rate will not increase until the rate action)
  • SmartSense will have 14 rating areas (effective with the next rate action, all products will use these 14 rating areas)

 

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14 years of experience with California health insurance since 1994