Below form is for California only

left corner Anthem Blue Cross LUMENOS 5000 HSA
Consumer-Driven Health Plans

(877)566-5454 Toll Free
  Our innovative plans offer:  
         100% coverage for recommended preventive care  
         Health account to help pay medical expenses  
         Traditional health care coverage with a PPO plan  
         Personal Health Coach for over 40 conditions  
         Award-winning website with tools to help manage a consumer's
          health and health care dollars
 
              --Prescription drug cost information  
              --Hospital quality ratings  
              --Health assessment  
              --Surgical decision support tools  

    Lumenos HSA 5000 1 Member  In-Network Out-Of-Network
Annual Deductible   Individual: $5,000 Individual: $5,000
Annual Out-Of-Pocket Limit   Individual: $5,000 Individual: $10,000 
Lifetime Maximum   $5,000,000 $5,000,000
Office Visits   No Charge after Deductible 30%
Prescription Drugs   No Charge after Deductible 30%
Laboratory and Radiology   No Charge after Deductible 30%
Annual Physical Exam   No Charge 30% (Deductible Waived)
Annual OB-GYN Exam   No Charge 30% (Deductible Waived)
Well Baby Care   No Charge 30% (Deductible Waived)
Outpatient Surgery   No Charge after Deductible 30%
Emergency Room   No Charge after Deductible 30%
Ambulance   No Charge after Deductible 30%
Home Health Care   No Charge after Deductible 30%
Mental Health Services   No Charge after Deductible 30%
Chiropractic Care   No Charge after Deductible 30%
Acupuncture / Acupressure   No Charge after Deductible 30%
Inpatient Co-payment   No Charge after Deductible 30%
  Maternity Care No Charge after Deductible 30%
Inpatient Mental Health  No Charge after Deductible 30%
Chemical Dependency   No Charge after Deductible 30%

  Download Your Luminos HSA Brochure  

Apply for Anthem Blue Cross Health Online

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Or you can fill in this form to have your Anthem Blue Cross Health Insurance brochure with pricing & application mailed to you. Further information on our plans is shown below. Or just call us Toll-free at 1-877-Look4Life (1-877-566-5454).
Customer Information
Name
E-mail
Street address
City
County
State
Zip Code
Home Phone
Work Phone
FAX
People Covered
My Age  
Smoker? Yes No
Spouse's Age  
Spouse Smoker? Yes No
Child 1 age  
Child 2 age  
Child 3 age  
Child 4 age  

Have you any comments or special instructions?

 
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Important Disclaimer:  Answers and comments provided above are general information, and are not intended to substitute for informed professional medical, psychiatric, psychological, tax, legal, investment, accounting, governmental, or other professional advice. We do not endorse, and expressly disclaims liability for any product, manufacturer, distributor, service, health plan, or service provider mentioned or any opinion expressed in the website.  Replies, comments, or information gathered on BarricksInsurance.com  website may not be accurate but are intended to be helpful.

Barricks Insurance Services
13900 NW Passage #302, Marina Del Rey, CA 90292
Phone:  (310) 827-7286   |   Fax:   (310) 827-0256
Toll-Free 1-877-Look4Life  (1-877-566-5454)

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