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Basic PPO 2500 Provides Reduced Premiums |
For a basic health care plan without a lot of extras added in, the Basic PPO 2500 provides lower premiums while providing needed coverage for hospitalization and emergency services.
Blue Cross of California negotiates certain fees with doctors, professional services providers and other to achieve the lowest possible price for those services, helping to manage the ever growing cost of medical care. By having all services conducted by an in-network member costs can be maintained and premiums kept at an affordable level.
The annual deductible for the Basic PPO 2500 is $1,000 per member. However if two enrolled members reach the annual deductible of $2,500 the remainder of the deductible for the other plan members will be waived. For example, a family of four is enrolled in the plan and two members both satisfy the deductible of $2,500, the other members’ annual deductible is considered as being satisfied. That can realize a savings of up to $2,000 if all members had to meet the deductible requirement.
Whether the provider is a participating network health care provide or is outside the network and out-of-pocket expenses will be considered part of the annual maximum provided the services are otherwise covered in the plan. The maximum out-of-pocket expense for an individual is $3,500 but if two enrolled members each reach an out-of-pockets expense of $5,000 the maximum for all other enrolled members in the plan is waived.
While there are no initial benefits for doctor’s visits, once the out-of-pocket maximum is satisfied, all future visits will be covered 100 percent of the negotiated fee. For X-rays, lab work, anesthesia or other professional services the enrolled member will pay 20 percent of the negotiated fee for inpatient or surgical procedures only. The cost of office visits is not covered until the annual maximum out-of-pocket expense has been reached, at which time visits will be covered 100 percent of the negotiated fee.
For hospital inpatient or outpatient services there is a cost of 20 percent of the negotiated fee for the service. Emergency room treatment is available at a cost of 20 percent of the negotiated fee as well as a $100 deductible, which is refunded if the patient is admitted from the emergency room. There is an additional $500 admission charge at participating hospitals for inpatient stays, outpatient services or infusion treatment. It is not required for ambulatory surgical care or medical emergencies. Under the Basic PPO 2500 plan there is no coverage for maternity care or prescription drugs. Preventive care is, however part of the plan’s coverage.
At HealthyCheck centers, there will be a $25 copay for basic physical exams and a $75 copay for premium physical screening. For routine exams ordered by the network doctor like mammograms, PSA or Pap tests, the charge is 20 percent of the negotiated fee.
While some additional services, as well as prescription coverage, may be available with other plans, the Basic PPO 2500 is designed for lower premiums and does not include a lot of extras until certain restrictions are met, such as maximum out-of-pocket expenses.
Learn more at: www.baahealth.com
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