Comparing the Anthem Blue Cross Small Group Power Health Fund Plans:

There are two power health plans offered by Anthem Blue Cross to their small group customers. The Power Health 750 Plan and the Power Health 500 Plan are currently available. These plans are very similar, and differ only in the required amounts for co-payments and co-insurance. Here’s a side-by-side comparison of the two plans, which both feature a $5,000,000 maximum lifetime benefit.

Annual Deductible - The Power Health 750 plan has a $500 deductible for any single member, and a $1000 deductible for a family contract. The Power Health 500 plan has a $1000 deductible for a single member and a $2000 deductible for a family.

First Dollar Coverage - The 750 plan features first-dollar coverage of $750 for a single member of a policy or $1500 for a family. This moves down to $500 for a single member and $1000 for a family under the 500 plan. In-network and out-of-network costs are combined. This amount is available to your employees immediately, for their medical needs, excepting prescription drugs. However, this amount does not count towards the annual deductible.

Annual Out-of-Pocket Maximum - For participating and non-participating providers, the annual out-of-pocket maximum is the same for both plans. The maximum amount your employees’ will spend for care received at a participating provider is $5000 for a single person and $10,000 for a family. This moves up to $10,000 and $20,000 respectively for non-participating providers.

Office Visits - The 750 plan requires a $35 co-pay for office visits with a participating provider. Otherwise, these charges go up to 50% of the negotiated fee and 100% of any other charges. The 500 plan has a $40 office visit co-pay with a participating provider, and the same fee schedule for non-participating providers.

Professional Services - The 750 plan features a 25% co-insurance fee for professional services received from a participating provider. Non-participating provider costs go up to 50% of the negotiated fee for both plans. The 500 plan has a 40% co-insurance fee for the same services.

Hospital Inpatient Care - The 750 plan has a 25% co-insurance requirement, and the 500 plan requires a co-insurance payment of 40% with a participating hospital. In the event that your employees’ receive inpatient care at a non-participating facility, both plans require 100% payment for services received, minus $650 per day. If professional services are required while an employee is in the hospital, the 750 plan requires 20% of the negotiated fee, and the 500 plan has a 40% requirement. If these professional services are received during the course of treatment at a non-participating hospital, the charges go up to 50% of the negotiated fee and 100% of any extra charges.

Outpatient Care - Under the 750 plan, there is a 25% co-insurance requirement for this type of care with a participating doctor or facility. The 500 plan requires a 40% payment. Both plans require 100% payment for services received in a non-participating facility or clinic, minus $380 per day.

Prescription Drugs - The 750 plan offers prescription coverage at the following rates: generic drugs have a $10 co-pay. If a brand name prescription is purchased, and there is no generic equivalent available, there is a $30 co-pay once the annual $250 brand name deductible has been met. If there is a generic alternative available, after the deductible has been met, there is a $10 co-pay, plus the difference in cost between the prescriptions. The co-pays change under the 500 plan to $10 for a generic prescription, $35 for a brand name prescription with no generic being available and $10 plus the difference for brand name prescriptions that are purchased when there is a generic alternative. This plan also features a $250 annual brand name prescription deductible. Both plans require a payment of 50% for prescriptions that are purchased from a non-participating pharmacy and 100% of any extra fees. These prescriptions are also subject to a $350 brand name deductible.

Health Insurance Blog