Blue Shield of California - HMO and PPO and explanations for a quick look at three of their Health Plans.
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Blue Shield of California is a health insurance, founded in 1938 by the California Medical Association.
Based out of San Francisco California, the company services over 3.
2 million subscribers and nearly 350 hospitals and 59,000 nationwide contract.
With Blue Shield of California you have a couple different styles of coverage to choose from.
More than likely, you have the PPO and HMO terms thrown around to hear.
What do these terms mean?
PPO
A Preferred Provider Organization (PPO) gives you the availability to choose from a much larger network or doctors, specialists and hospitals.
A visit to a provider contract with Blue Shield of California PPO you will receive a rate negotiated price for services covered.
It is always important to make sure the doctor, specialist or hospital you choose is contracted with the company before you receive care.
If you happen to select an out-of-network provider, then you can use a higher cost for the service.
HMO
A Health Maintenance Organization (HMO) is a smaller organization of healthcare providers that have contracted with an insurance company to offer services at fixed rates.
You will be asked a doctor (family doctor), to be responsible for deciding all aspects of your doctor will be.
Blue Shield has 2 different HMO plan options available in California on the individual and family plans network.
You can set the HMO physicians contract with Blue Shield to wait to offer a smaller number of suppliers with PPO plans.
Generally you must get a referral from your primary care physician in order to receive care from a specialist.
Let's take a look at some of the most popular plans that are currently offered in 2009.
PPO Savings Plan 4000
This plan is great for a health young male who doesn't require many office visits per year.
This plan does not include motherhood, but it is recommended for women who do not want maternity coverage or who are pregnant in the past year.
With most health plans you must satisfy a deductible and then pay a co-insurance percentage.
With the PPO 4000 is 100% covered after the meeting with the calendar year deductible! You also have the availability of a physical examination once a year for a $ 35 co-pay.
If you are someone looking for affordable catastrophic coverage, this plan is highly recommended.
Balance PPO Plans 2500, 1700 and 1000 have the balance plans to visit a good balance between deductibles, office co-payments, medications, and a decent monthly price.
Each deductible option (2500, 1700 and 1000) comes with first dollar office visit co-pay of $30.
There is also $ 10 co-payment for generics and $ 35 co-payment for brand name drugs ($ 500 brand deductible and $ 2,500 maximum benefit to label year).
If you happen to be the type of person that visits a doctor more frequently than once per year, and needs prescription drug coverage, take a look at the balance plans!
Access HMO
The Access HMO with Blue Shield of California is one of the better benefit plans on the market, however the monthly premium tends to be to unaffordable for most.
Following a meeting with a deductible of $ 2000 will be a $ 250 charge for the impatient and outpatient hospital visits, until they make a total of $ 3000 in out-of-pocket expenses (including deductible).
Office visit co-pays are $20 before deductible; you will pay a $10 generic drug co-pay and a $35 brand name co-pay after a $200 brand name drug deductible.
Remember, this plan have a small network of HMO providers than the PPO options.
Make sure to verify that all providers you use are a contracted physician or hospital with Blue Shield before receiving care.
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