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Superior Coverage Available With Premier PPO $10 Copay |
Designed to be one of several plans that offer the most coverage with the best benefit return for your premium dollar, the Premier PPO $10 copay plan offers a low annual deductible, immediate prescription and office visit benefits as well as comprehensive coverage for out-of-network services.
The $500 annual deductible for each enrolled plan member is satisfied for all members of the family in the plan once two enrolled members have attained the deductible. Additionally, the deductible, when paid, becomes part of the annual out-of-pocket expense. That amount is $2,500 per person, $5,000 for two people and has a maximum out-of-pocket expense to satisfy this cost for all enrolled family members in the plan.
This plan also offers care by health care providers not in the network and has a $5,000 per person out-of-pocket expense limit with a two person maximum out-of-pocket limit of $5,000.
Physician’s office visits are not subject to the annual deductible and have a $10 copay for network doctors for the first 12 visits per member. After that visits will be charged at 30 percent of negotiated fess established between the doctor and Blue Cross of California. For visits to caregivers not in the network, the charge will be 30 percent of the customary and reasonable charges plus 100 percent of the difference.
Professional services such as laboratory work, diagnostic labs and X-ray, and including maternity care, in network services will be charged at 10 percent of the negotiated fee. For non-network professional services, the fee will be 30 percent of the customary and reasonable charges plus 100% of the excess charges. Hospital charges, inpatient or outpatient at network facilities only, will be 10 percent of the negotiated fee.
Prescription drugs are not subject to the annual deductible, meaning the copay amounts take effect once the policy is active. For generic drugs, the copay is $10, and it is $20 for name brand drugs. Co-pas are for each 30-day supply or up to 60-days supply if available through mail order. Members may choose to accept a name brand drug, when a generic equivalent is available, if the physician notes on the prescription to fill as written or do not substitute. The name brand copay will be charged.
HealthyCheck screenings are available for $25 for basic or $75 for a premium physical exam. Each enrolled member can choose annually which he or she prefers. A physical exam in the doctor’s office will be charged at the $10 copay plus 20 percent of any negotiated fee for all other services. For an annual physical exam there is a $200 maximum annual benefit for those enrolled in the plan for more than six months and a $100 maximum limit for those enrolled six months or less.
Preventive care such as Well Baby immunizations, age seven to adult screening test, mammogram and breast exam for women and prostate exams for men will cost $10 office copay plus 10 percent of the negotiated fee for all other covered services.
Learn more at: www.baahealth.com
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