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Blue Cross Of California HMOs--Saver HMO |
Blue Cross of California offers four different types of Health Maintenance Organization plans, the Power Select HMO, the Saver HMO, the Classic HMO and the HMO 100%. HMOs are great for families and people on a budget who are willing to adhere to the list of preferred physicians that the network provides, as HMOs provide no coverage for visits to medical professionals or laboratories that are not “preferred” or in-network.
If the HMOs that Blue Cross of California were arranged in order of premium cost, the Saver HMO would be one of the least expensive plans, second only to the Power Select HMO. The more expensive the HMO plan is however, the richer the benefits are so whether or not this is the right HMO for you really depends on the type of health coverage you seek and how often you actually seek medical care.
The Saver HMO requires a $1500 annual deductible, which is of course applied towards the out of pocket maximum. The out of pocket maximum for the Blue Cross of California Saver HMO plan is $2250 for an individual plan member or $4500 aggregate, for families who are covered under the plan.
As with all Blue Cross HMOs, out of network office visits are NOT covered, but visits to the Primary Care Physician are covered. They require a $20 co pay. Primary Care Physicians are doctors that are chosen when the HMO is first implemented. Members must visit the primary care physician for all medical issues--if the issue requires a specialist, the physician will write up a referral to a specialist, who a co pay is also due to upon arrival. Office visits are not subject to the annual deductible, although hospital services both inpatient and outpatient (excluding Emergency Room visits).
Professional services are secondary services that are performed by a professional other than a specialist or a primary care physician. This includes visits to the lab to get blood tests done or x-rays taken. Professional services also include visits to the doctor or hospital related to a pregnancy. These services are completely covered by the HMO; the only exception is for doctor’s office visits related to maternity, in which the $20 doctor’s office visit co pay must be paid. Visits to labs or professionals that are not participating in the Network are not covered; any charges incurred during such a visit are the responsibility of the member.
Both inpatient and outpatient visits are covered under the Saver HMO after the deductible is satisfied. Under the Saver HMO generic drugs are a bit cheaper, a $10 co pay. However, name brand drugs require a $25 co pay after the $150 name brand prescription drug deductible has been satisfied. The plan will pay 70 percent of the cost of Blue Cross of California does not offer any coverage for preventative services except those that are covered under hospital visits or regular office visits.
Learn more at: www.baahealth.com
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