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Seal Beach, CA  90740
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HMO Saver

HMO Saver -- the HMO Saver Plan gives you comprehensive benefits and features a $1,500 deductible that helps keep your monthly premium lower.  With this plan, you'll pay just $10 copay for doctor's office visits and preventive care.  HMO Saver also provides prescription drug coverage - choose from immediate benefits for generic drugs or brand name drug coverage after meeting a $250 deductible.  If you want rich HMO benefits at mid range monthly premiums, this plan is for you.

This unique HMO design offers the traditional office visit copays of $10, generic drugs copay of $10.  The $1,500 deductible only applies to Inpatient, Outpatient Hospital Services and Ambulatory Surgical Centers..

See benefit comparison chart.

It's easy to locate a HMO Saver provider online - just go to on the "Find a Doctor or Hospital (Provider Finder)" link.

Your comprehensive health coverage includes physical exams by your Primary Care Physician and preventive screenings such as Pap tests, mammograms, and testing for prostate cancer.  You also have the security of emergency and hospitalization services as well as maternity and prescription drug benefits.  And Blue Cross members can access helpful health and wellness information on our Web site at www.bluecrossca.com

For more information about the HMO Saver, please click here for a PDF file.

 


 

Benefits In-Select Network
Annual Deductible

$1,500 per member Inpatient/Outpatient and
Ambulatory Surgical Centers

Lifetime Maximum

unlimited

Annual Out-of Pocket Max.

$3000 per member;  (2 member maximum)

Doctor's Office Visits

$10 copay per visit

Professional Services
(X-ray, lab, anesthesia, surgery, etc.)

No charge for office visits related services
Hospital Inpatient

20 % of negotiated fee (after deductible)

Hospital Outpatient Services

20 % o negotiated fee (emergency and non-emergency services are subject to the deductible)

Emergency Services

20 % of negotiated fee (after deductible)

Preventive Care

$10 copay for specific health maintenance services

Ambulance

$50 copay unless admitted to hospital

Physical and Occupational Therapy; Chiropractic Services

Outpatient: $10 copay per visit
Inpatient: 20% of negotiated fee
Chiropractic services provided with medical group referral only

Acupuncture/Acupressure

Not covered

Maternity Office visits: $10 copay

Hospital Inpatient/Outpatient Services: After deductible, 20 % of negotiated fee

Prescription Drugs Blue Cross Formulary Drugs
Generic:
$10 copay
Brand Name: $30 copay after $250 annual brand name deductible (2 member maximum)

Self administered Injectables: 30 % of negotiated fee, except insulin

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