Anthem Blue Cross Power Select HMO Plan for Small Groups:

Now that we have gone through the available PPO type plans, it is time to start taking a look at the four HMO options that are available to Anthem Blue Cross small group customers. This plan features an unlimited benefit amount, as long as the services are provided in-network.

Annual Deductible - There is a $500 annual deductible under this plan. This deductible will apply to care received for in-network inpatient and outpatient care, unless there is a medical emergency, or if the care is received at an ambulatory surgical center or dialysis center.

Annual Out-of-Pocket Maximum - This plan features an aggregated method for determining the out-of-pocket maximum. This means that once one member of a covered family reaches the maximum amount, everyone in the family is considered to have met theirs as well. There is a $2250 maximum amount for singles and a $4500 per family maximum.

Office Visits - These visits are not subjected to the annual deductible and include office visits for maternity care. For a primary care visit, there is a $25 co-pay. If the visit is to a specialist or a referral visit, the co-pay is then $35.

Professional Services - Any professional services that are not classified as an office visit are completely covered by this plan. This includes lab work, maternity care and lab tests.

Hospital Inpatient Care - If an employee needs inpatient care under this plan there is a 10% co-insurance requirement, once the deductible has been met. While non-participating providers are not normally covered in an HMO plan, if there is an emergency, the plan will provide coverage.

Hospital Inpatient Professional Services - These services, such as anesthesia and other professional care are also completely covered by this plan.

Outpatient Care - There is a 20% co-insurance requirement, once the deductible has been reached for this type of care. Again, if there is an emergency the plan will provide coverage, even if a provider is considered a non-participating member.

Ambulatory Service Centers - There is a pre-service review required for coverage to be granted for services received at an Ambulatory center. If it is approved, there is a 20% co-insurance fee, after the deductible has been met. Emergency coverage is provided for non-participating centers.

Prescription Drugs - If a prescription is generic, there is a $15 co-pay for this medication. This moves up to $25 for brand name medication, if there is no available generic alternative. There is also a $150 brand name deductible for these prescriptions. If a generic is available, there is a $15 co-pay, plus a requirement of payment for the difference between the two prices of the medications. If a pharmacy is not participating with Anthem Blue Cross, these fees move up to 50% of the limited fee schedule, once the deductible has been met, and 100% of any additional charges. Mail order is not available for these non-participating pharmacies, but they can order a 30-day supply from their regular pharmacy. If they visit a participating pharmacy, a 30-day supply is allowed, and a 60-day supply is allowed for mail order purchases.

Health Insurance Blog