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California health insurance  -  California group health plans  -  Lumenos and Preventative Benefits

The Lumenos plans offer rich preventative benefits

Keep in mind that for non-grandfathered health plans, the Health Reform mandate for 100% coverage of eligible preventative benefits may supercede the Lumenos benefits below.  You can quote the ACA group plans here.

 The Lumenos suite of plans offer an attractive combination of benefits for some people...low cost, high deductible coverage (can be HSA compatible or HIA option) and rich preventative benefits.

This is a great mix of core benefits for people who are health conscious and prefer to have more catastrophic-type coverage but still want some help with annual preventative benefits in order to stay healthy. Ultimately, these plans should increase slower than the other more traditional plans due to the type of person who is attracted to the above benefits.

Let's look a little deeper into the plan structure.
Rich Preventative benefits not subject to the deductible.
The Lumenos plans on both the Individual Family health insurance side and Small Group health market offer a pretty unique benefit. The preventative benefits are not subject to the main deductible on a high deductible plan. In addition, they are covered at 100% which is very rich. Please see the brochure for more detail and exclusions:

Individual/Family Lumenos
What constitutes preventative care for adults? On the individual side, the Lumenos plans list:
Office visits for preventative services
Screening Tests
vision (eye chart), hearing, coronary artery disease, colorectal cancer, prostate cancer, diabetes, and osteoporosis. Also includes mammogram, as well as pelvic exam, Pap test and contraception management.
Immunizations
Hepatitis A
Hepatitis B
Diphtheria, Tetanus, Pertussis (DtaP)
Varicella (chicken pox)
Influenza - flu shot
Pneumococcal Conjugate (pneumonia)
Human Papilloma Virus (HPV) - cervical cancer
Herpes Zoster (shingles)
The group brochures basically says "Includes nationally recommended preventative services".

According to the brochure, Blue Cross' Lumenos plans cover preventative services recommended by the U.S. Preventative Services Task Force, the American Cancer Society, the Advisory Committee on Immunization Practices and the American Academy of Pediatrics. The preventative care benefits include screening tests, immunizations and counseling services designed to detect and prevent medical conditions in advance and help keep you healthier in the long run.

All preventative services received from an in-network provider are covered at the coinsurance listed in the benefits comparison chart and are not subject to your deductible. If you see an out-of-network provider, then your deductible and out-of-network coinsurance responsibility will apply. If you receive any of these services for diagnostic purposes - for example, colonoscopy when symptoms are present - the appropriate plan deductible and coinsurance will apply and available health account dollars may be used to cover these costs. This essentially means a preventative colonoscopy will fall under the preventative benefits while one used to evaluate symptoms will be subject to the main body of the plan (deductible and co-insurance).
Preventative services for children through the Lumenos Plans
Well Baby and Well Child Preventative Care
Office Visits for preventative services

Screening Tests
Vision (eye chart), hearing, and lead exposure. Also includes pelvic exam, Pap test and contraceptive for females who are age 18 or have been sexually active
Immunizations:
Hepatitis A
Hepatitis B
Diphtheria, Tetanus, Pertussis (DtaP)
Varicella (chicken pox)
Influenza - flu shot
Pneumococcal Conjugate (pneumonia)
Human Papilloma Virus (HPV) - cervical cancer
H. Influenza type b
Polio
Measles, Mumps, Rubella (MMR)
Meningococcal Polysaccharide
Rotavirus
The HIA differs from the HSA in a few key ways. The HSA allows a person to fund pre-tax dollars in a Health Savings Account or tax-favored checking account. You can find more information on the HSA at our site. The HIA either pre-funds an account you can use to pay medical expenses and/or allows you to "earn" dollars with certain healthy behaviors such as smoking cessations course completion.

 

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