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| Is a Blue Shield Individual and family Plan right for me? |
Individual and Family Plans may be right for you if you are:
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Self-employed or not covered under a group plan
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Not satisfied with your current health plan
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Needing coverage for a child or dependent
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What
is the difference between a PPO and an HMO? |
Health
Maintenance Organization (HMO) and Preferred Provider Organization
(PPO) plans offer different ways to access medical care,
charge different types of copayments for covered services
and feature different monthly rates
With Health Maintenance Organization (HMO) plans, you:
- Receive many covered services right away at no charge or for a fixed copayment;
- Choose a Personal Physician from Blue Shield's HMO network who provides, refers and coordinates your medical care; and
- Receive all medical services from providers in your Personal Physician's medical group or IPA.
Blue Shield calls their HMO plan Access+ HMO |
Preferred Provider Organization (PPO) plans allow you to:
- Choose your own providers each time you seek medical care.
- Reduce out of pocket costs when you use Blue Shield's preferred provider network.
- Receive some preventive care benefits even before you meet any plan deductible, and
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- Pay a percentage of charges for most covered services after
you meet any applicable plan deductible.
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Blue Shield's PPO plans include:
- Four Spectrum PPO Plan Options
- Two Preferred Savigns Plan Options
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| What is the differences among Blue Shield's PPO Plans? |
Each of their Deductible Plans offers unique benefits and advantages.
However, as a general rule, the higher the deductible for
a plan, the lower its monthly dues. Lower dedcutibles tend
to have higher monthly dues, more gererous prescriptions
drug benefits, and lower office visti copayments.
One of the Preferred Savings Plans may be a good choice if you
are self employed or simply want to cover unexpected healthcare
expenses, such as an accident or illness. |
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| Can I get coverage for just my children? |
| Yes. Blue Shield offers YouthCare plans at special
rates. There is a YouthCare plan available for each of their Individual and Family Plans. Putting your child on his/her own plan may save you money. |
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| Can individual family members have different plans? |
| Yes. It may better suit some families healthcare needs or budget to place family members on different types of plans. It's
best to consult your agent to discuss which plan is right for each one of your family members. |
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| Tell
me about Blue Shield's provider networks. |
| Blue Shield's Preferred Provider Network |
The Blue Shield preferred network provides covered service to
PPO plan members. One of California's largest, this network includes:
- 52,000 preferred physicians
- 360 preferred hospital
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- 40,000 other participating health professionals including: chiropractors,
physical therapists, and many others.
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| Blue Shield's HMO Network |
| Blue Shield's extensive HMO
Network is available in many counties throughout the state. This network consists of physicians, specialists, medical groups, IPA's, hospitals and non-physician healthcare practitioners. |
| It's easy to find out which plans include your doctor |
| The "Find a Provider" online directory allows
you to search for providers by name, language, location,
specialty and medical group or IPA. |
| Network Choice |
The Blue Shield preferred hospital network includes two types
of providers: Choice and Affiliated.
These new categories were introduced as a way of managing
the rising cost of healthcare. Some doctors and hospitals
are more expensive than others, making it necessary for
us to ask members to pay more when using their non-emergency
services. An additional member copayment per day, visit
or surgery weill be charged for non-emergency hospital services
obtained from an Affiliated hospital. If
you go to a Choice hospital, there are no extra copayments.
In additon, Blue Shield of California is making quality and
patetient experience measures an essential part of how they
categorize hospitals along with relative costs. As long
as a hospital's costs are not significantly above the regional
norm, participating in these quality and patient experience
programs may allow a hospital to be classified as Choice. |
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