Blue Cross Small Group Saver PPO Plan:

The next plan offered to your employees’ in the Blue Cross small group health plan options is the Saver PPO plan. This plan has a little different specifications than the previous PPO plan we discussed. Here is what your employees’ can expect for coverage under this plan.

Annual Deductible - For regular health services, the annual deductible is $5000. The hospital deductible is only $500, which makes it easier for your employees to handle, should they have an emergency.

Lifetime Maximum - Your employees’ will have up to $5,000,000 of coverage under this plan.

Annual Out-of-Pocket Maximum - For hospital visits or initial professional services, the out-of-pocket maximum is $2000. After this has been reached, professional services will have an out-of-pocket maximum of $5000, including the deductible.

Office Visits - Your employees’ will be allowed two initial visits, combined between in-network and out-network providers. Visits to in-network physicians will have a $20 co-pay and the deductible is waived. After this point, they will be required to pay 100% of the negotiated fee. If they have children, the children will have access to four initial visits, with a co-pay of $20, and then after the initial four visits, subsequent visits will require 100% of the negotiated fee. Visits to out-of-network physicians will cost 50% of the negotiated fee, plus 100% of any excess fees, for the first two visits for an adult, or four for a child. After this has been reached, they will need to pay 100% of the negotiated fee and 100% of any additional charges.

Hospital Inpatient Coverage - This coverage requires a preservice review. There is a $500 deductible for in-network and out-of-network hospital stays. If you employees visit an in-network hospital, they will need to pay 20% of the negotiated fee once they have met their deductible. Out-of-network hospitals will result in having to pay all charges in excess of $650 per day, once the deductible has been met.

Outpatient Facility Coverage - After the $500 deductible has been met, the charges are 20% of the negotiated fee for an in-network provider. If an out-of-network provider is used, they will need to pay for all charges, minus $380 per day, once the deductible has been met.

Diagnostic Lab and X-Ray - The first $500 worth of these charges will not be subject to the deductible every year. Covered services require a payment of 20% of the negotiated fee up to the $500 covered amount. Once this is reached, a 100% payment is required for these services. If the provider is out-of-network, this changes to 50% of the negotiated fee and 100% of any excess fees, up to the $500 coverage amount. After that point, 100% payment is required.

Prescription Drugs - Prescriptions are not subject to the annual deductible of this plan, and are charged as follows. Generic drugs have a $10 co-pay. Brand name drugs will cost $25 if a generic alternative is not available and $10 plus the difference in cost if a generic alternative is available. For self-injectable medication, excluding insulin, the cost is 30% of the negotiated fee. Medication purchased from a non participating pharmacy will require payment of 50% of the negotiated fee and 100% of any excess fees.

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