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Comparing Basic PPO 1000 And Basic PPO 2500 |
When developing balance between reasonable premiums and excellent benefits, PPO plans offer flexibility to meet varying needs of families for health care benefits. Two such plans offered by Blue Cross of California, offer this balance, the Basic PPO 1000 and the Basic PPO 2500. They offer lower premiums for hospitalization and emergency services.
While these two plans share many similar features the differences are designed to meet the varying needs of families in different circumstances. Most fees for medical service have been negotiated with the health care providers belonging to the network to offer the lowest cost health care available. The negotiated fees are those the provider will accept as payment in for full specific treatments and exams while providers, outside of the network, can charge their normal prices.
An annual deductible of $1,000 is in effect for the Basic PPO 1000 and when two members of the same enrolled family reach the limit the deductible is satisfied for the rest of the enrolled family members. The annual deductible for Basis PPO 2500 plan members is $2,500 per member and will also be considered satisfied for all members once two member have reached the deductible level.
Annual out-of-pocket expenses for those enrolled in the Basic PPO 1000 if $3,500 per person. When two members each reach the maximum, it is satisfied for the remaining members of the enrolled family. Members of the Basic PPO 2500 will have a maximum annual out-of-pocket expense of $5,000 and will be considered satisfied for the remaining members of the enrolled family once two members have reached the maximum. Out-of-pocket expenses in both plans includes the deductible and participating and non-participating provider covered services apply.
There are no immediate benefits for doctor’s office visits for either plan until the out-of-pocket maximum has been met, at which time visits will be paid 100 percent of negotiated fee. There will be a 20 percent of negotiated fees charged for inpatient and outpatient care in the Basic PPO 1000 and Basic PPO 2500, as well as a 20 percent fee for emergency room services. There is also an additional $100 copay for emergency room service that will be waived if the patient is admitted into the hospital.
Neither of these two plans offers benefit coverage for maternity care or prescription drug costs. Preventive care is covered in both the Basic PPO 1000 and the Basic PPO 2500 through HealthyCheck Centers through $25 copay for basic screening or a $75 copay for premium screening. The deductible is waived for this service.
Routine mammogram, Pap and PSA testing, which are ordered by a network physician, will be 20 percent of the negotiated fee. These plans have been designed for persons who may not need maternity care or prescription drug benefits, but wish to be prepared for any potential major health emergencies.
Learn more at: www.baahealth.com
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