| Choosing
The Right Health Plan For You |
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Blue Cross of California
offers a broad range of health plans,
varying costs, levels of health
coverage, and accessibility to health
care. These are important considerations
for helping you identify which plan
is right for you. |
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Your
Plan Type and Access to Health Care |
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The plan type you
choose will determine how you select
and access health care services.
In general, the wider your choice
of doctors and hospitals, the higher
your costs will be in terms of premiums
and/or levels of health care coverage. |
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Preferred
Provider Organization (PPO) Plans |
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The PPO Plans offer
you the most flexibility in your
choice of doctors and hospitals
(providers). PPO Plans provide coverage
(at different levels) for services
from both Participating and Non-Participating
Providers. Please see he PPO Plan
section of this brochure for definitions
of these and other terms related
to PPO Plan Coverage. |
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- Price
— What are the monthly premiums
for each plan? What can you afford?
- Features
— What health care services does
each program cover?
- Cost-sharing
— What would be your share of
the cost for these services?
- Access
— Is it important to
you to see any doctor you want
or are you willing to trade that
flexibility for some other benefit?
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Common
Terms & Definitions |
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- Deductible
= the amount you pay each year
for covered services before your
plan begins paying part of the
cost.
- Out-of-Pocket
Maximum = The
maximum amount for qualifying
covered services you would have
to spend in any one year, including
your deductible, before your plan
pays 100% of your covered costs
for most services.
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Our
Plan Types |
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For complete rate
information, go to Easy
Guide to the Rates.
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Blue
Cross PPO AND HMO PLAN SELECTIONS |
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RightPlan PPO 40 Plans
The Blue Cross RightPlan PPO 40
Plans provide first-dollar coverage
(no deductible) for doctor visits,
preventive care, hospital stays
and other covered medical services.
The plans offer a choice of prescription
drug coverage: generic only, generic
and brand name or no drug coverage.
The Blue Cross 3500 Deductible
PPO Plan provides 100% coverage
for most services after the deductible
is met, along with affordable
monthly premiums.
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PPO 3500 (HSA-Compatible)
Plan
Like the Blue Cross 3500 Deductible
PPO Plan, the Blue Cross PPO 3500
(HSA-Compatible) Plan provides
100% coverage for most services
after the deductible is met, along
with affordable monthly premiums.
In addition, it is a qualified
high-deductible health plan, which
is required when establishing
a Health Savings Account (HSA).
PPO Share Plans
The Blue Cross PPO Share Plans
all cover the same comprehensive
package of health care services.
The difference is in the deductibles,
coinsurance amounts and annual
out-of-pocket maximums. Blue Cross
offers a variety of PPO Share
Plans so that you can more precisely
choose the best pricing options
for you.
Basic PPO and PPO Saver
Plans
The Basic PPO and PPO Saver Plans
offer in-hospital and surgical
coverage with low affordable monthly
premiums. These plans are designed
to protect against great financial
losses due to unexpected illness
or injury. Both plans offer limited
coverage for professional services;
however, for a slightly higher
premium, the PPO Saver Plan provides
more covered professional services.
The Blue Cross Individual HMO
Plan provides extensive coverage
with low out-of-pocket costs for
covered health care services you
received only from HMO Network
doctors and hospitals.
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The Blue Cross Select HMO Plan
provides extensive coverage with
lower premiums and low out-of-pocket
costs for covered health care
services you receive from doctors
and hospitals in the Select HMO
Network. The Select HMO Network
is available in 22 California
counties.
The Blue Cross HMO Saver Plan
provides the same coverage as
the Individual HMO Plan, but has
a deductible amount for services
you receive from hospitals and
other health facilities to keep
the premiums lower.
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Selecting
a Plan Type
Use the statements below
to help determine that plan type
best meets your coverage needs.
- I want more control over my
health care and access to any
doctor or specialist I choose…………….PPO
Plan
- I need a lower monthly premium
so I’m willing to pay more for
my health care services as they
occur through out the year……………….PPO
Plan
- I want to pay as little as possible
when I see a doctor, so I’m willing
to select a specific medical group
and physician to coordinate all
of my health care needs…………HMO
Plan
- I’m willing to pay higher premium
up front so that my costs for
health care services are lower
as they occur throughout the year………..HMO
Plan
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Customize
Coverage With FamilyElectSM |
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If your family members
have varying coverage needs, you
can select a different plan (PPO
or HMO) for each family member through
the Blue Cross FamilyElect Program.
This may help you to design a program
that works best for your family
overall. For example:
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| Jim,
age 46, and Jean, age 43,
each select a RightPlan PPO
40 Plan because they like
its simple, no-deductible
design and don’t want or need
to pay for maternity benefits.
Jim selects comprehensive
drug coverage, because he
takes a brand-name drug. Jean
selects generic drug coverage. |
RightPlan PPO 40 w/ Comprehensive
Rx
RightPlan PPO 40 w/ Generic
Rx |
$197
$133 |
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their 15-year-old son, Jason,
they choose the Select HMO
Plan for its immediate benefits
(no deductible), unlimited
office visits and network
of doctors and other providers
in their area. |
Select
HMO |
$115 |
| They
need single coverage for daughter,
Jane, a 20-year-old college
student. They choose the PPO
Share 2500 Plan for its immediate
preventive care and office
visits benefits and reasonable
premiums. |
PPO
Share 2500 |
$
80 |
| Total
monthly premium for entire
family |
$525 |
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