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HSA Benefit Summaries

PW_B140661

Lumenos PPO Consumer Driven Health Plans with Rx Copays

Note: For HSA plan designs, the incentives for Fully Insured groups are available as gift cards only, so the benefit summary language is different. Please select the benefit summary under the correct funding arrangement. The benefit summaries with no incentives have the same language for both funding arrangements.  

Incentive Plans (Non-Embedded Deductible) 
Fully Insured Groups 
Self Funded Groups (ASO) 
PPO CDHP w/Rx Copays GHSA105 
PPO CDHP w/Rx Copays GHSA105 
PPO CDHP w/Rx Copays GHSA106 
PPO CDHP w/Rx Copays GHSA106 
 

Incentive Plans (Embedded Deductible) 
Fully Insured Groups 
Self Funded Groups (ASO) 
PPO CDHP w/Rx Copays GHSA109 
PPO CDHP w/Rx Copays GHSA109 
PPO CDHP w/Rx Copays GHSA110 
PPO CDHP w/Rx Copays GHSA110 
 
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Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.