Comparing the Anthem Blue Cross Classic HMO Plan and the Saver HMO Plan:
The last two HMO plans offered by Anthem Blue Cross for small group customers are the Classic HMO plan and the Saver HMO plan. We’ll take a look at how these two plans differ from one another. In some cases, the difference is quite significant. The annual lifetime maximums for both of these plans are unlimited, allowing a greater level of coverage for you employees.
Deductibles - The Classic HMO Plan features no annual deductible. The Saver HMO Plan has a $1500 per deductible per member under this plan, which is applicable to inpatient and outpatient care, unless there is an emergency.
Annual Out-of-Pocket Maximums - The Classic HMO plan as a $1750 out-of-pocket maximum for singles, or a $3500 maximum for a family. The Saver HMO plan has a $2250 maximum for a single person, or a $4500 maximum for a family.
Office Visits - Both plans feature a $20 co-pay for any office visits that are necessary. These co-pay is also applicable for maternity care. For professional services that are necessary during the office visit, such as an x-ray, there is no charge under either plan.
Hospital Inpatient Care - The Classic plan requires a $250 co-pay for each admission to a hospital. Once you have met your annual deductible, the Saver plan will pay for 100% of the care you receive as an inpatient at a hospital. As with office visits, there is no charge for any professional services received at the hospital.
Outpatient Care - There is a 20% co-insurance requirement for outpatient care under the Classic plan. However, the Saver HMO plan offers 100% coverage for outpatient care once the annual deductible is met.
Prescription Drugs - Both plans have the same prescription schedule. For generic prescriptions, there is a $10 co-pay required. If there is no generic substitute, a brand name prescriptions’ co-pay is $25, once the annual deductible has been met. If a generic substitute is avialable, the co-pay drops to $10, plus any difference in price.
Ambulance Service - If an employees’ primary care physician orders an ambulance, or if there is an emergency both plans offer complete coverage.
Mental Health Care - There is a $20 co-pay from both plans for services that are provided to the mentally ill.
Physical Therapy - The Classic HMO plan and the Saver HMO plan feature similar methods of calculation of benefits in this area. Both have agreed to provide coverage for health needs.
Skilled Nursing Facility - As nursing costs soar, and home health care becomes too cost-prohibitive, these two plans offer skilled nursing care at no additional. Up to 100 days per year are covered by these plans, but they are limited to covering therapy that takes place within 60 days of an accident.
Ambulance - As long as an ambulance is ordered by a primary care physician or it is an emergency, there is no charge for transport under either of these plans.
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