Blue Cross Blue Shield of Georgia SmartSense Open Access POS In-Network Benefit Summary*
(click here for the out-of-network benefit summary)
*What is an Open Access POS Plan? Click here to find out.

Description of Benefits

SmartSense Open Access POS
Lifetime Maximum Per Member

$5,000,000
Calendar Year
Deductible Choices
(Separate deductibles apply for in-network and out-of-network		 Individual

$750
$5,000

$1,500
$7,500

$2,500
$10,000

$3,500
$20,000
Family

$1,500
$10,000

$3,000
$15,000

$5,000
$20,000

 $7,000
$40,000
Calendar Year
Out-of-Pocket
Maximum		 Individual

Your deductible plus $3,000
Family

Your deductible plus $6,000
Medical Services

 SmartSense Open Access POS
These amounts show your share of costs
Doctor's Office Visits

$30 copayment for the first 3 visits per member per year
not subject to deductible.

After 3 visits, once deductible is met, member pays 30%
Child Preventive Care
(Through age 5; immunizations, laboratory testing)

Member pays 30%, deductible is waived
Preventive Care (age 6 and over)
(mammograms, immunizations, PAP tests, PSA tests
and office screenings are not subject to the deductible)

Member pays 30%
(Annual deductible applies for some preventive services)
Professional Services
(x-ray, lab, anesthesia, surgeon, diagnostics, etc.)

Member pays 30% after
annual deductible
Hospital Inpatient
(overnight hospital stays)

Member pays 30% after
annual deductible
Hospital Outpatient
(if you don't stay overnight)

Member pays 30% after
annual deductible
Emergency Room Care (Accidental injury or Medical Emergency as defined by BCBSGa)

$500 Copay
(waived if admitted)
Emergency Room Care (Non-medical emergency or non-serious accidental injury as defined by BCBSGA)

Member pays 30% after
annual deductible
Maternity

Not covered
Dental

Optional coverage available
Life

Optional coverage available
Vision

Not available
Prescription Drug Coverage

SmartSense Open Access POS
These amounts show your share of costs
Generic Prescription Drug Coverage

$15 copay
(or 40%, whichever is greater) Not subject to deductible
Preferred Brand Prescription Drug Coverage
(included in the Standard SmartSense POS plan)
Includes select coverage of highly utilized brand-name drugs. Drugs were chosen based on evidence-based medicine. Plan does not include non-preferred brand name drugs. For more options see enhanced plan benefits below (additional charge for enhanced plan)

$15 copay
(or 40%, whichever is greater) Not subject to deductible
Comprehensive Drug Coverage Option
A separate $500 drug deductible applies to each member for Tier 2, 3 and 4 drugs
(you must elect the "Comprehensive Drug Option" at the time of application to have access to this benefit)
See SmartSense POS Enhanced Plan Rates that include the Comprehensive Drug Option

Enhanced plan utilizes the comprehensive POS drug Formulary
 Tier 1 - $15  Tier 2 - $30*  Tier 3 - $60*  Tier 4 - 40%*^
* if brand is chosen when generic available, mbr pays copay, coinsurance plus the difference between brand and generic- $500 ded. applies for tier 2, 3 & 4
^ $4,000 yrly out of pocket maximum per mbr. applies for Tier 4 drugs

Waiting period for pre-existing conditions is 12 months from contract effective date. If you apply within 63 days of terminating your membership with another "creditable" health care plan, then you can use your prior coverage credit toward the 12 month waiting period.
*Refer to your individual certificate of coverage for complete benefit details
including a full list of exclusions and limitations.
  Click here to request that an enrollment package be emailed or mailed to you

Agents are authorized agents for Blue Cross and Blue Shield of Georgia, Inc.
Blue Cross and Blue Shield of GeorgiaI nc. and Greater Georgia Life Insurance Company 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.


9 Dunwoody Pk., Suite 136
Atlanta, GA 30338

Call Chris, Holly or Bob at
(770) 396-9517
Outside of the Atlanta area,
call toll-free:
1-877-711-8376.
Email: holly@insurance-now.com