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Blue Cross HMOs--The Classic HMO |
Blue Cross offers a Classic HMO, one of the richest of the four HMO plans that Blue Cross of California offers. HMO stands for Health Maintenance Organization, and they are the most popular plans for people who don’t always make the most of their insurance, or people who have family members they would like to include on their insurance.
Similar to the Saver HMO option that Blue Cross offers, the Classic HMO option has an out of pocket maximum of $1750 for an individual member and $3500 aggregate out of pocket expenses for a family, regardless of how many members of the family are included on the HMO.
Another similarity between the Classic HMO and the Saver HMO is that the plan carries with it a $150 deductible for name brand prescription drugs. After the $150 deductible has been satisfied, name brand drugs only require a $25 co pay; generic drugs require a mere $10 co pay. It is highly recommended and suggested by the HMO that members utilize the generic drug option whenever possible; even if the physician has specified that the name brand drug is to be used, plan members could end up having to pay the difference in cost between the name brand version of the prescription drug and the generic brand, in addition to the $10 co pay.
One of the differences that set the Classic HMO apart from other Blue Cross of California plans is that there is no deductible to satisfy, so the plan immediately starts kicking in when medical expenses are incurred by a plan member. While visits to an out-of-network physician are not covered by the Classic HMO, there is a modest co pay of $20 for visits to participating health care providers. Also, visits to the doctor related to pregnancy are covered, requiring only the $20 co pay for the office visit.
With the Classic HMO, there is no deductible to meet for visits to the hospital (inpatient services our outpatient services) but there is a modest co pay of $250 for inpatient services. For out patient services, the plan member is only required to pay 20 percent of the total bill they incur. The HMO covers the remaining 80 percent of the bill for these outpatient services.
As far as professional services like lab work and x-rays are concerned, these expenses are covered by the HMO. Maternity services are however, considered to be professional services as far as the plan is concerned and, as previously discussed, the only charges that the member is responsible for regarding professional services are co pays for doctor’s visits related to maternity.
Blue Cross of California offers these HMO options in 22 counties in the state of California. The list of in network providers that are considered “preferred” by Blue Cross HMO administrators are in these 22 counties.
Learn more at: www.baahealth.com
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