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Immediate Benefits Come With Saver And Classic HMO Plans |
The cost of health care service continues to spiral upwards and Blue Cross of California is working hard to devise plans that can offer excellent benefits that offer a good return on the premium cost. Two such plans are the Saver HMO and Classic HMO, with each designed to meet specific needs.
All plans offered by Blue Cross of California include fees that are negotiated with doctors, hospitals and other health card providers, as well as pharmacies, to insure enrolled planned members receive the lowest costs available. Network providers will accept the negotiated fees as payment in full for the services, once the copay is applied.
The Classic HMO plan requires no annual deductible while the annual deductible for the Saver HMO is $1,500 per person. This deductible, however applies to inpatient and outpatient services, ambulatory surgical centers and dialysis centers, except for medical emergencies.
Annual out-of-pocket limits vary slightly with Classic HMO being $1,750 per member or a $3,500 family total and the Saver HMO is $2,250 per person or a family total of $4,500. The Saver HMO has a $20 copay for office visits, which is not subject to the deductible. The Classic HMO requires a $20 copay as well. Out of network office visits are not covered under either plan.
If the network doctor orders professional services such as X-ray, diagnostic services and maternity there is no charge except for the office copay for maternity visits for both the Classic HMO and Saver HMO plans. Out of network professional services have no coverage under either plan as well.
Inpatient and outpatient hospital services, available only at network participating hospitals have an inpatient copay of $250 per admission under the Classic HMO Plan along with a 20 percent copay for outpatient services. Under the Saver HMO there is no charge once the annual deductible has been paid.
Both the Saver HMO and the Classic HMO plans offer generic drugs at a $20 copay. Additionally, copay for name brand drugs is $25 after an annual brand name prescription drug deductible of $150 per person enrolled in the plan has been paid. These deductibles apply for every 30-day supply, or a 60-day supply if order through the mail. For self-administered injectable drugs, there will be a charge of 30 percent of the negotiated price, except insulin and the drug may be subject to the name brand copay deductible.
Members choosing to receive a name brand drug when a generic alternative is available, they will be subject to the generic copay and will also be charged the difference between the cost of the generic drug and the cost of the name brand drug. This cost will not apply to the annual name brand drug deductible. This applies to both plans, even if the doctor writes dispense as written or do not substitute on the prescription. There is no limit placed on the lifetime charges for all covered services in either plan.
Learn more at: www.baahealth.com
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