Anthem Blue Cross HMO Saver Plan:
If you need an HMO plan with a few more options, you may want to look at the Anthem Blue Cross Saver HMO type plan. This plan does require a deductible, but the deductible is lower than many PPO plans. Your individual monthly premiums may vary, according to your circumstances, but here is a general idea of the benefits that you can expect under this plan.
Lifetime Maximum - This plan does not have a set limit for coverage. You will have an unlimited amount of access to health care services without any limits over time.
Annual Out-of-Pocket Maximum - This amount includes your deductible and is $3000 per person, each year.
Annual Deductible - This plan has a $1500 annual deductible for inpatient hospital services, and outpatient ambulatory surgical centers.
Office Visits - Each time you require an office visit from your primary care physician, you will only need to pay $10. There are no co-insurance fees for office visits under this plan.
Professional Services - If you need x-rays, lab tests, anesthesia, the services of a surgeon or an office visit that does not fall into the typical office visit category, you will need to pay $10 for each visit. If you require these services while an inpatient, there is no charge. There is also no limit to the amount of services you may have.
Hospital Inpatient and Outpatient - Once you have met your $1500 deductible, there are no charges for inpatient care. If you need care on an outpatient basis, once you have met your $1500 deductible, you will need to pay for 20% of the negotiated fee for these services.
Emergency Services - If you need emergency services and have received group authorization within 48 hours of the emergency, there is no charge for inpatient or professional services under this plan. If you need outpatient emergency services, there is a $100 emergency room co-pay, and you will also need to pay for 20% of the negotiated fee for these services.
Maternity - For a professional office visit for maternity care, you will be charged $10 per visit. Once you reach your $1500 deductible, there is no charge for hospitalization. If you need outpatient maternity care, you will need to pay 20% of the services after you have reached your deductible amount.
Preventative Care - There are specific preventative care options offered under this plan that will only require a $10 co-payment for services. Your representative will be able to assist you in finding out which services you will be able to use.
Ambulance - If you need an ambulance and are not admitted to the hospital, there is a $50 co-pay. If you are admitted to the hospital, there is no charge for this service.
Physical and Occupational Therapy - For the sixty days following your sickness or your injury, you will pay $10 per visit. If you are an inpatient and receive this care, there is no charge under this plan.
Prescription Drug Benefits - Generic prescriptions from a participating provider will only cost $10. There is a $250 deductible for brand name prescriptions and a $30 co-pay. If the prescription you need is not considered part of the Anthem Blue Cross Formulary, generic prescriptions will cost 50% of their charge, and you will have to pay 100% for brand prescriptions until you reach your brand deductible. Prescriptions from non-participating pharmacies are also subject to your deductible, and then charged according to 50% of the Limited Fee Schedule in California.
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