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Winning Is Easy When You Have The Advantage PPO |
Many PPO plans offer an excellent balance between the costs of premiums when compared to the extent of offered benefits. The Advantage PPO from Blue Cross of California makes the most of that balance with superior benefits offered.
An annual deductible of $250 per member is considered satisfied for the entire enrolled member family once two members each reach the maximum deductible. There is also a $3,600 per member annual out-of-pocket expense limit, which is also satisfied for the entire enrolled member family when two people reach that amount.
For out of network services, there in a maximum of $10,000 per member for covered expenses. Charges for in network services are negotiated by the plan to achieve the lowest possible health care prices for services such as doctor visits, hospital care and pharmaceuticals. Network members will accept plan payments of the negotiated fee as payment in full. Out of network providers will charge a higher fee.
Visits to the doctor’s office will cost the member a $25 copay for the first 12 visit a year. Additional visit will cost the member 45 percent of the negotiated fee up to a total of $9000. From $901 to $3,600 the charge will be 10 percent of the negotiated fee. Visits to doctors outside the network will cost 50 percent of the negotiated fee plus 100 percent of any excess charge.
For professional services ordered by the plan doctor, the charge will be 30 percent of the negotiated fee up to $900 and then it drops to 10 percent of the negotiated fee from $901 to $3,600. For professional services by an out of network provider, the charge will be 50 percent of the negotiated fee plus 100 percent of any excess charge. Inpatient and outpatient services at participating hospitals only will be charged at 30 percent of the negotiated fee up to $900. From $901 to $3,600 the fee will be 10 percent of the negotiated fee.
Prescriptions are charged to the member at a $15 copay for generic drugs and $25 copay for name brand drugs. For self-administered injectable drugs there is a 30 percent of the negotiated fee cost, except for insulin. For preventive care, there is a $25 copay, which is not subject to the deductible, plus a 30 percent of the negotiated fee for all other covered services up to $900. From $901 to $3,600 there is a 10 percent charge of the negotiated fee.
Each year members age seven to adult may choose between a HealthyCheck screening at $25 for basic or $75 for superior, or an annual physical exam for a $25 copay and 30 percent of the negotiated price up to $900, the 10 percent of the negotiated price from $901 to $3,600.
Learn more at: www.baahealth.com
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