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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements

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Benefit Summaries (effective 6/1/2012)

PW_E180045
 
Anthem Lumenos Open Access POS Consumer Driven Health Plans (HSA, HRA) 
HSA Benefit Summaries (effective 1/1/2018)
 
Anthem Lumenos Open Access POS Consumer Driven Health Plans (HSA, HRA) with Rx Copay Plans 
HSA Benefit Summaries with RX copays (effective 1/1/2018)
 
Blue Essential Plans  
Benefit Summaries (effective 1/1/2018)
 
Gatekeeper HMO Plans 
Rx Option AG Plans – Benefit Summaries (effective 1/1/2018)
Rx Option BG Plans – Benefit Summaries (effective 1/1/2018)
 
Gatekeeper POS Plans 
Rx Option AG Plans – Benefit Summaries (effective 1/1/2018)
Rx Option BG Plans – Benefit Summaries (effective 1/1/2018)
 
Healthy Support Open Access POS Plans 
Rx Option D Plans – Benefit Summaries (effective 1/1/2018)
Rx Option E Plans – Benefit Summaries (effective 1/1/2018)
 
Healthy Support PPO Plans 
Rx Option D Plans – Benefit Summaries (effective 1/1/2018)
 
Open Access HMO Plans 
Rx Option AG Plans - Benefit Summaries (effective 1/1/2018)
Rx Option BG Plans – Benefit Summaries (effective 1/1/2018)
 
Open Access POS Plans 
Rx Option AG Plans – Benefit Summaries (effective 1/1/2018)
Rx Option BG Plans – Benefit Summaries (effective 1/1/2018)
 
PPO Plans 
Rx Option AG Plans – Benefit Summaries (effective 1/1/2018)
Rx Option BG Plans – Benefit Summaries (effective 1/1/2018)
 
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