| |
|
 |
 The
Power of Blue:
member-focused service, a wide choice of plans and
doctors, financial strength and affordable rates. |
|
 |
What it take to get life Insurance
It takes more than money and good
health. It takes a combination of caring, common sense,
character and commitment. If your death will create an
economic loss for your family, business, estate,
community, college, church, or for your favorite
charity, you need life insurance.
• Why are successful people more likely to buy life
insurance than other people? Perhaps because they
understand their value to others and the economic impact
that their death will have. There Is a low cost to
having Life Insurance, but there can be a big terrible
cost to not having it.
|
|
|
|
BC Life & Health Basic PPO 2500 (R418)
Lifetime Maximum
Participating Provider
$5,000,000/member
Non-participating Provider
$5,000,000/member
Annual Out-of-Pocket Maximum
(includes deductible) Participating Provider
$5,000/single (2-member maximum)
Participating and
non-participating combined1
Non-participating Provider
$5,000/single (2-member maximum)
Participating and
non-participating combined1
Annual Deductible
Participating Provider
$2,500/member (2-member maximum) All covered benefits
Non-participating Provider
$2,500/member
(2-member maximum) All covered benefits
Office Visits
Participating Provider
No office visit benefit until out-of-pocket maximum met,
then 100% of negotiated fee
Non-
participating Provider
No office visit benefit until out-of-pocket maximum met,
then 100% of negotiated fee
Professional Services
(other office visits, X-ray, lab, anesthesia, surgeon,
etc.)
Participating Provider
20% of negotiated fee, hospital only. No office visit
benefits until out-of-pocket maximum
met, then covered
at 100% of negotiated fee
Non-participating Provider Covered expenses paid at 50%
of the
limited-fee schedule
plus 100% of excess
Hospital Inpatient/Outpatient
Participating Provider
20% of negotiated fee
Non-participating Provider
All charges except: $650/day inpatient,
$380/day
outpatient
Hospice
Participating
Provider
$10,000 lifetime maximum, participating and
non-participating providers combined
Non-participating
Provider
$10,000 lifetime maximum, participating and
non-participating providers combined
Emergency Services
Participating Provider
20% of negotiated fee3
Non-participating Provider
20% of customary & reasonable for the
first 48 hours
plus 100% of excess; after 48 hours, you pay all charges
except $650/day for
covered services3
Maternity
(after deductible)
Participating Provider
Not covered
Non-participating Provider
Not covered
Preventive Care
Participating Provider
HealthyCheck Centers: $25 or $75 copay for basic
screenings; routine mammogram, PSA
and cancer screening,
ordered by physician: 20% of negotiated fee (deductible
waived)
Non-participating
Provider
Outside California, 50% of customary & reasonable to
maximum of $250/year; routine mammogram,
PSA and cancer
screening, ordered by physician: 50% of customary & reasonable plus 100% of excess
Ambulance
Participating Provider
20% of negotiated fee ($750/trip maximum
paid by BC Life & Health Insurance Company)
Non-participating Provider
50% of customary & reasonable plus 100% of excess
Physical and Occupational Therapy; Chiropractic Services
Participating Provider Not covered unless during inpatient admission
Non-participating Provider
Not covered
unless during inpatient admission
Acupuncture/Acupressure
Participating Provider
Not covered
Non-participating Provider
Not covered
Drug Benefits
(retail or mail order: 30-day supply)
Participating Provider
Not covered
Non-participating Provider
Not covered
Please Note: When locating a provider, PPO plans are
also referred to as Prudent Buyer
1 Non-participating
charges in excess of the negotiated
fee will not be paid and do not apply to the
out-of-pocket maximum. 2
Additional $500 admission charge at Participating
Hospitals (no additional for Preferred Participating
Hospitals) is
for surgery or infusion therapy. This
charge is not required for Ambulatory Surgical Centers
or medical
emergencies.
3 Additional $30 copay for PPO Plans applies for each
emergency room visit (waived if admitted as
inpatient).
|
|
|
|
|
|
