Anthem Blue Cross HMO 100% Plan:
The next HMO plan offered by Anthem Blue Cross is the HMO 100% Plan. This plan features comprehensive coverage and is perfect for an employee who needs a high level of covered medical services. There is no plan maximum benefit for the HMO 100% plan.
Annual Deductible - This plan has no deductible for medical services. There is a $150 brand name prescription deductible that must bet met before coverage for brand name medications takes effect.
Office Visits - There is a $10 co-pay for all office visits, even if they include maternity care. There is no maximum amount of office visits allotted each year. For professional services received, such as x-rays or lab work, there are no additional charges.
Hospital Inpatient Care - If there is an emergency, this service will be covered in the event that an employees has to visit a non-participating provider. Otherwise, there is absolutely no charge for inpatient care that is received from a participating hospital. Any professional services that are required during this time are also completely covered. There is a pre-service review required for this care.
Outpatient Care - If your employees’ need a certain procedure, such as a diagnostic procedure, they may need to wait for a pre-service review before coverage will take effect. Once this criteria has been met, all services are completely covered.
Prescription Drugs - There is a $10 co-pay for generic prescriptions purchased from a network pharmacy. If your employees prefer brand name medications, they will need to pay a $150 brand name deductible and then $20 if no generic alternative is available or $10 plus any difference between the medications in price, if there is a generic alternative.
If a pharmacy does not participate with Anthem Blue Cross, this fee moves up to 50% of the limited fee schedule plus 100% of any excess fees. This is the case, no matter what type of prescription is required. Once the brand deductible has been met, coverage will kick in for these medications.
Skilled Nursing Facility - There is no charge under this plan for care received at a skilled nursing facility. With rising health care costs and concerns over their last days, your employees may appreciate this option.
Emergency Care - This coverage includes professional services. There is no charge for emergency care received at either a participating or non-participating provider. There is a $100 hospital deductible, but this amount is waived if an employee is admitted to the hospital.
Mental Health Care - Many plans do not offer mental health care options. The HMO 100% plan will provide mental health coverage, for up to 20 visits each year. There is a $20 co-pay for these visits.
Physical Therapy - If your employees were injured, would you be able to keep everything running smoothly? This plan provides complete coverage for physical or occupational therapy, as long as it is ordered by the employees’ physician.
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