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Blue Cross Small Group $30 Co-Pay Plan
The basic differences between the $30 Co-Pay plan and the $35 co-pay plan from Blue Cross can be summed up as these: the $30 co-pay plan offers more options for prescription medications, and lower co-payment and co-insurance amounts. As with many of the plans offered by Blue Cross for small groups, the $30 co-pay plan has a lifetime maximum amount of coverage that is set at $5,000,000, which has been shown to be more than enough to cover the health care expenses of most employees.
Outpatient Coverage – Under this plan, there needs to be a pre-service review for specific procedures. Once it is determined that a procedure is covered, the next question is: is the doctor or facility a Blue Cross participant? If the answer is yes, the employee will have to pay 30% of the negotiated fee. If the doctor or service doesn’t participate with Blue Cross, this figure moves up to 100% of the charges over $380 per day. This care is also subjected to the plan deductible.
Office Visits – Office visits are not subject to the plan deductible – i.e., the visits are covered from the beginning, and 12 visits are allowed per year, for which the co-pay for a participating doctor is $30. After twelve visits, employees are required to pay a co-insurance payment of 45% of the negotiated fee. For services from a Blue Cross network physician such as lab work or x-rays, your employees will need to pay 30% of the negotiated fee after they reach their deductible.
Office visits with a non-participating physician cost them half of the negotiated fee, and they are entirely responsible for any non-covered charges. And from an out-of-network physician, the cost for x-rays, lab work, and other professional services moves up to 50% of the negotiated fee and, once again, 100% of any excess charges.
Annual Out-of-Pocket Maximum – Although the deductible under this plan is only $500, there is an out-of-pocket maximum amount of $4000 per member for participating providers. The out-of-pocket maximum for non- participating providers moves up to $10,000, so it’s obviously a better deal for the employee to visit participating doctors whenever possible.
Annual Deductible – Under the Blue Cross Small Group $30 Co-Pay Plan,
the annual deductible is only $500.
Prescription Drugs – Under this plan, the supply of medication that your employees may get is limited: for regular pharmacy orders, it’s limited to a 30-day supply. For mail order purchases, the limit is a 60-day supply. For participating pharmacies it will cost the employee $15 for a generic prescription, and $25 for a brand name prescription if its generic equivalent is not available. If a generic alternative is available but the employee wants to go with the brand name, he pays $15 plus the difference in price between the brand name and the generic prescription. There is a $150 annual deductible for all brand name prescriptions. At a non-participating pharmacy, Blue Cross requires a payment of 50% of the limited fee schedule for the medication, and all of any excess uncovered charges.
Hospital Inpatient Coverage – When an employee with this plan is admitted to a participating hospital, he or she will be required to pay for 30% of the care after the $500 deductible has been met. For professional services while in a participating hospital there is a co-insurance payment of 30% after the deductible.
The same care at a non-participating hospital will require 100% payment for services, after deducting $650 per day. For professional services received in these non-participating hospitals, the patient will be charged half of the negotiated, fee and 100% of any extra charges.
Learn more at: www.baahealth.com
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