choosing your Blue Cross of California indidual health plan

Choosing The Right Health Plan For You

Blue Cross of California offers a broad range of health plans, varying costs, levels of health coverage, and accessibility to health care. These are important considerations for helping you identify which plan is right for you.

Your Plan Type and Access to Health Care

The plan type you choose will determine how you select and access health care services. In general, the wider your choice of doctors and hospitals, the higher your costs will be in terms of premiums and/or levels of health care coverage.

Preferred Provider Organization (PPO) Plans

The PPO Plans offer you the most flexibility in your choice of doctors and hospitals (providers). PPO Plans provide coverage (at different levels) for services from both Participating and Non-Participating Providers. Please see he PPO Plan section of this brochure for definitions of these and other terms related to PPO Plan Coverage.

Price — What are the monthly premiums for each plan? What can you afford?

Features — What health care services does each program cover?

Cost-sharing — What would be your share of the cost for these services?

Access — Is it important to you to see any doctor you want or are you willing to trade that flexibility for some other benefit?

Common Terms & Definitions

Deductible = the amount you pay each year for covered services before your plan begins paying part of the cost.

Out-of-Pocket Maximum = The maximum amount for qualifying covered services you would have to spend in any one year, including your deductible, before your plan pays 100% of your covered costs for most services.

PPO AND HMO PLAN SELECTIONS

RightPlan PPO 40 Plans

The Blue Cross RightPlan PPO 40 Plans provide first-dollar coverage (no deductible) for doctor visits, preventive care, hospital stays and other covered medical services. The plans offer a choice of prescription drug coverage: generic only, generic and brand name or no drug coverage.

3500 Deductible PPO Plan

The Blue Cross 3500 Deductible PPO Plan provides 100% coverage for most services after the deductible is met, along with affordable monthly premiums.

PPO 3500 (HSA-Compatible) Plan

Like the Blue Cross 3500 Deductible PPO Plan, the Blue Cross PPO 3500 (HSA-Compatible) Plan provides 100% coverage for most services after the deductible is met, along with affordable monthly premiums. In addition, it is a qualified high-deductible health plan, which is required when establishing a Health Savings Account (HSA).

PPO Share Plans
The Blue Cross PPO Share Plans all cover the same comprehensive package of health care services. The difference is in the deductibles, coinsurance amounts and annual out-of-pocket maximums. Blue Cross offers a variety of PPO Share Plans so that you can more precisely choose the best pricing options for you.

Basic PPO and PPO Saver Plans
The Basic PPO and PPO Saver Plans offer in-hospital and surgical coverage with low affordable monthly premiums. These plans are designed to protect against great financial losses due to unexpected illness or injury. Both plans offer limited coverage for professional services; however, for a slightly higher premium, the PPO Saver Plan provides more covered professional services.

Individual HMO Plan

The Blue Cross Individual HMO Plan provides extensive coverage with low out-of-pocket costs for covered health care services you received only from HMO Network doctors and hospitals.

Select HMO Plan

The Blue Cross Select HMO Plan provides extensive coverage with lower premiums and low out-of-pocket costs for covered health care services you receive from doctors and hospitals in the Select HMO Network. The Select HMO Network is available in 22 California counties.

HMO Saver Plan

The Blue Cross HMO Saver Plan provides the same coverage as the Individual HMO Plan, but has a deductible amount for services you receive from hospitals and other health facilities to keep the premiums lower.

Selecting a Plan Type

Use the statements below to help determine that plan type best meets your coverage needs.

I want more control over my health care and access to any doctor or specialist I choose…………….PPO Plan

I need a lower monthly premium so I’m willing to pay more for my health care services as they occur through out the year……………….PPO Plan

I want to pay as little as possible when I see a doctor, so I’m willing to select a specific medical group and physician to coordinate all of my health care needs…………HMO Plan

I’m willing to pay higher premium up front so that my costs for health care services are lower as they occur throughout the year………..HMO Plan

Customize Coverage With FamilyElect^SM

If your family members have varying coverage needs, you can select a different plan (PPO or HMO) for each family member through the Blue Cross Family Elect program. This may help you design a program that works best for your family overall. For example:


Jim, age 46, and Jean, age 43, each select a RightPlan PPO 40 Plan because they like its simple, no-deductible design and don’t want or need to pay for maternity benefits. Jim selects comprehensive drug coverage, because he takes a brand-name drug. Jean selects generic drug coverage.	RightPlan PPO 40 w/ Comprehensive Rx	$197
	RightPlan PPO 40 w/ Generic Rx	$133
For their 15-year-old son, Jason, they choose the Select HMO Plan for its immediate benefits (no deductible), unlimited office visits and network of doctors and other providers in their area.	Select HMO	$115
They need single coverage for daughter, Jane, a 20-year-old college student. They choose the PPO Share 2500 Plan for its immediate preventive care and office visits benefits and reasonable premiums.	PPO Share 2500	$ 80
Total monthly premium for entire family		$525

How to Choose a Blue Cross of California Plan