Blue Cross of California offers two Premier versions of their Preferred Provider Organization (PPO) options to members. Their Premier PPO plans are the most comprehensive plans available through the organization, offering comprehensive medical coverage for a higher monthly premium.

The Premier PPO plans are great for those who are treating an on going medical condition or see the doctor or visit the hospital more frequently throughout the year. The Premier PPO option with the $20 co pay is the less expensive of the two plans. This option offers an annual deductible of $250 per member, with a two-member limit; the annual deductible applies toward the out of pocket maximum amount, which is $3000 per member for in network medical expenses, and $5000 per member for out of network expenses, both with a two-member maximum. After the out of pocket maximum is satisfied, the plan kicks in and will pay the member’s remaining expenses for the remainder of the covered year.

As with other Blue Cross of California PPO plans, plan members are allowed a maximum of twelve covered office visits per calendar year for the $20 co pay charge. After those twelve visits, if more doctors’ office visits are necessary, the $20 co pay Premier PPO will pay 60 percent of the costs of ‘reasonable and customary’ care for in network expenses. As far as coverage for visits to a doctor who does not participate in Blue Cross’s network, the plan will cover none of the charges incurred, ‘reasonable and customary’ or not.

For professional services, including maternity expenses, lab work and x-ray diagnostics, the $20 co pay Premier PPO plan will pay 80 percent of the cost for in-network professionals, whereas the plan only pays 60 percent of the cost of out of network professional services. Also, inpatient and outpatient services at participating Blue Cross of California hospitals are covered at 80 percent, leaving the member to pay the remaining 20 percent, which counts toward satisfying the annual out of pocket maximum.

Unlike other Blue Cross of California PPO plans, the $20 co pay Premier PPO does not require a member deductible for brand name drugs. Prescription drugs through this PPO require a $15 co pay for generic drugs and a $25 co pay for name brand prescriptions.

As with the other PPOs that Blue Cross of California offers preventative care, including Well Baby check ups and certain cancer screenings, include prostate exams and mammograms. While the more basic PPO options that are offered have no coverage for yearly physical exams, members have the opportunity to choose between annual HealthyCheck exams (for adults and children above age 7) and an annual physical exam. The HealthyCheck screening co pay is either $25 or $75, based on the type of service the plan member has elected. The co pay for the annual physical exam if chose is $20 for the office visit, and the plan will pay 80 percent of other related expenses incurred from the visit.

Learn more at: www.baahealth.com<