The Anthem Blue Cross Ohio Core Direct Access Health insurance plans were affordable options designed to reduce premiums while offering comprehensive coverage. Featuring Anthem’s lowest rates, these policies offered a wide variety of deductibles and higher cost-sharing to provide a low premium.
Unlimited lifetime benefits were included with a large range of coinsurance options. Premiums were significantly lower than many other individual options in Ohio. Only short-term plans were less expensive. However, these contracts are no longer available. The plans, descriptions, and rates described below, are referencing policies that can not be purchased. There are also no grandfathered plans in this category.
This policy requires you to pay a higher share of the cost of provided services compared to other Anthem plans. It is ideal for individuals and families that seek protection against catastrophic medical expenses. Receiving negotiated repricing helps reduce your out of pocket expense, especially if a higher deducible is selected.
There are seven Core DirectAccess choices that can be purchased during Open Enrollment or whenever you qualify for an approved “special event” that can occur at any time throughout the year. Preventive expenses are covered at 100% on all seven plans. A brief description of each policy, along with the most commonly used benefits is listed below:
cabt – $4,300 deductible with two allowed non-preventive office visits with a $35 copay. 20% coinsurance. Deductible and 20% coinsurance applies to all prescriptions.
cabu – $5,000 deductible with a $45 copay and 30% coinsurance keeps premiums low. Deductible and coinsurance apply to prescriptions.
cdbu – Identical to cabu with the exception that children’s dental coverage is included.
caaz – $5,500 deductible with $45 copay and 20% coinsurance. However, copays on Tier 1 and 2 drugs instead of paying out-of-pocket until deductible is met.
cafd – Same as caaz except slightly higher deductible and copay ($5,750 and $50).
caah – $6,000 deductible but only 10% coinsurance. Unlimited office visits with a $35 copay instead of a limit of two. Same RX benefits as caaz and cafd policies.
caas – HSA-eligible with $6,000 deductible and no coinsurance.
cbce – $2,000 deductible with $35 copay on THREE (not two) office visits. $15 and $40 copay on Tier 1 and Tier 2 prescriptions.
cbey – HSA-eligible with $2,500 deductible and 10% coinsurance.
cbpa – $2,500 deductible with unlimited office visits subject to a $30 copay. 10% coinsurance with $15 and $40 copays on Tier 1 and Tier 2 drugs.
cbwl – $3,000 deductible with $40 copay for first three office visits only. 10% coinsurance.
cbai – $3,500 deductible with unlimited office visits subject to $45 copay. 0% coinsurance.
ccac – Low $1,250 deductible with unlimited office visits subject to a $30 copay. 0% coinsurance.
cdcq – Same as ccac with child dental added.
The Provider Network
The plan uses the Pathway Tiered and Pathway X Tiered (Exchange) Hospital network, which are two of the largest provider networks in the state. A “welcome kit” is always sent after enrollment to provide additional details. The new ID cards are now blue, white, and black instead of all black and white. Ancillary providers are also included.
If you travel outside of your area, network providers across the country are available. You do not need a referral to see a specialist (unless it is an HMO plan) and there are no claims or paperwork when a provider is used. After you are treated, although a copay may be required, the claim is immediately processed, and the policyholder can review the specific details regarding the cost of service, who paid for that service, and your remaining responsibility (if any). Most hospitals will negotiate a flexible payment arrangement for large balances.
Here in Ohio, the Network is very prominent, and you can always find a participating physician. We can provide a listing of doctors and hospitals or we can email a link that allows you to research using different search criteria. It is also found here.
Most family practices and Urgent Care facilities accept this plan. However, there are numerous provider networks so it’s important to ensure you are utilizing the correct one. Also, each year, the list changes as additional facilities are added and the area of coverage expands.
Adding Dental And Vision
Although maternity is already included, a separate policy rider for dental or vision may be added. Since they are separate from the main policy, you can add or delete them at any time, without jeopardizing other parts of your contract. Naturally, the cost of the riders will depend on the level of coverage and numbers of persons to be insured. Typically, ancillary products are not impacted by major healthcare legislation.
Dental benefits for each adult cost approximately $15-$28 per month, depending on which plan you select. Although preventive X-rays and visits (twice per year) are mostly covered, there are large variances in benefits provided for major items, such as a root canal, tooth extraction, or bridge work.
How To Enroll
We offer the policy through this website at the absolute lowest rate (just as we do all policies on our website). Since it is a “niche” product, we will only recommend coverage in certain situations. While it is a contract backed by a reputable company, the coverages are designed for specific circumstances. And unless you are looking for cheap major medical catastrophic benefits with a higher deductible, this plan may not be the best fit.
Out of pocket expenses can be potentially higher than many other options. And since we also believe that it will continue to be available “inside the Exchange” in future years, it’s always good business practice to allow us to review all available options from multiple carriers.
You can compare the Anthem Ohio rates with other plans from different carriers by using the “Quote” section at the top of this page. Although they aren’t always the least expensive choice, typically, their prices are in the top three of all of the highest-rated carriers.
This plan will be offered as part of Anthem’s Exchange policy portfolio in 2014. If you currently own a policy and it was issued before September of 2010, you may be able to keep it, under the “grandfather” clause. Otherwise, you will have to switch to a more compliant contract before the end of 2013, or the renewal date, whichever comes later.
Prices for the Core Direct Access plans should not significantly change for 2015 effective dates. Although there will be increases from most carriers, this set of plans will feature choices that keep premiums at or near recent levels.