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HMO Saver Offers Increased Benefit Returns |
Probably one of the most benefit satisfying plans developed by Blue Cross of California is the HMO Saver plan which offer great benefit returns for the cost of the premiums. This HMO plan allow members to have some predictability with their health care costs as well as control.
All plans have negotiated fees with health care providers such as doctors, hospitals and pharmacies to obtain the best possible pricing for plan members. Network members accept these negotiated fee payments from the plan administrator as payment in full. Out of network health care providers typically charge fees higher than those negotiated by the plan do.
Members will have a $1,500 deductible per member for inpatient or outpatient hospital services and ambulatory care centers. The annual out-of-pocket expense caps out at $3,000 per member, but once two members reach the maximum, the out-of-pocket maximum for all family members is satisfied.
While there is a $10 copay for visits to the network doctor’s office there is no additional charges for professional services such as X-ray, diagnostic lab work or others. With hospital related charges, whether inpatient or outpatient, members will be responsible for 20 percent of the negotiated fee, subject to the deductible.
Emergency room services are billed to the member at 20 percent of the negotiated fee plus a $100 emergency room copay. This copay, however, is subject to being waived if the patients are admitted by the attending physician.
An office visit copay of $10 for maternity care is the responsibility of the member. For inpatient and outpatient services they will be charged 20 percent of the negotiated fee. For preventive health care services, the charge is a $10 copay for health maintenance services.
Prescription costs can be minimized by using Blue Cross formulary drugs that require only a $10 copay per prescription. There is a $35 copay for name brand drugs once a $250 name brand drug deductible has been met. Two plan members reaching the $250 deductible satisfy the deductible for the entire family.
A member who chooses a name brand drug when an equivalent is available in generic form will be responsible for the generic copay as well as the difference in the cost of the generic drug and the cost of the name brand drug, even if the doctor wrote dispense as written or do not substitute on the prescription. For self-administered injected drugs, the member will pay 30 percent of the negotiated price, except for insulin.
Learn more at: www.baahealth.com
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