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HMO 100% Provides Most Effective Coverage |
Most HMO health care plans offer the most consistent and predictable costs, compared to other types of coverage plans and you can know what the costs will be up front with few charges dependent on provider costs.
Blue Cross of California has worked with network providers to receive the absolutely lowest health care cost available. Many fees for professional health services are negotiated with providers and, even if their regular charges are higher, they have agreed not to charge the plan members more for the negotiated price.
This is a very cost-effective means of reducing the costs for everyone and all network health care providers participate in the fee negotiations. This is especially helpful when enrolled members are responsible for a certain percentage of negotiated fees as when the fees are lower, so are the fees enrollees must contribute. The coverage can remain consistent by those enrolled in one of our HMO plans visiting health care providers and those offering professional service whom belongs to the network.
In the HMO 100 percent plan there is no annual deductible for health services, except for name brand prescription drugs, to meet before coverage begins. Annual out-of-pocket will not exceed $1,750 per member, or $3,500 per family. This means that once one or more enrolled plan members reach out-of-pocket expenses, the limit is satisfied for all other members of the enrolled plan.
Visits to the doctor’s office will require a $10 copay if the doctor is a member of the network. Visits made to doctors outside the network are not covered. For professional services ordered by your network doctor such as diagnostic lab services or maternity, there is no charge except the $10 office visit copays if services are conducted by labs in the network. No coverage is available to professional services performed by out of network providers.
There are numerous hospitals offering outpatient as well as inpatient services and visits to them, if ordered by your network doctor, have no charge. Emergency room visit are treated the same. There is no coverage provided for providers outside the network.
Prescription drugs costs are being contained through the use of network pharmacies, and generic prescriptions have only a $10 copay. There is a $150 annual deductible per member for name brand drugs and once met there will be a $20 copay per prescription for name-brand drugs.
For self-administered injectable drugs, with the exception of insulin, there will be a charge of 30 percent of the negotiated fee for the drugs, which is subject to the availability of a generic equivalent. If the injectable prescription is a brand name drug, the $150 deductible will apply.
Additionally, if the enrolled member chooses a name brand drug when a generic drug is available, even if the physician specifies a brand name be dispensed by writing do not substitute or fill as written on the prescription, the member will be responsible for the generic copay in addition to the difference between the price of the generic drug and the name brand drug. This amount will not apply to the annual name brand deductible. The HMO 100 percent plan also places no ceiling on the lifetime covered charges that are paid by Blue Cross of California for covered in-network charges.
Learn more at: www.baahealth.com
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