March 19, 2010

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Blue Cross of Idaho – Blue Care PPO – IDAHO

A comparison of the Blue Care PPO offered by Blue Cross of Idaho is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application Blue Care PPO Application Blue Care PPO Application
Brochure Blue Care PPO Brochure Blue Care PPO Brochure
Copay $30 N/A
Office Visit Physician Office Visit (You pay deductible and/or coinsurance for other services during a physician office visit): $30 Physician Office Visits (You pay deductible and/or coinsurance for other services during a physician office visit): 50%
Deductible Individual: $2,000, Family: $4,000 Individual: $2,000, Family: $4,000
Coinsurance 80% 50%
Coinsurance Limit Blue Care PPO Blue Care PPO
Out-of-Pocket Maximum $4,000 per person(Includes your deductible but does not include $5,000 pregnancy deductible) $4,000 per person(Includes your deductible but does not include $5,000 pregnancy deductible)
Lifetime Maximum $1,000,000 lifetime benefit limit per person $1,000,000 lifetime benefit limit per person
Prescription Drugs Prescription Drugs (Brand name and generic drugs): 50% coinsurance, no deductible required (Prescription drug benefit limited to a maximum of $1,200 per person, per benefit period. 90-day supply limit, mail order available) Prescription Drugs (Brand name and generic drugs): 50% coinsurance, no deductible required (Prescription drug benefit limited to a maximum of $1,200 per person, per benefit period. 90-day supply limit, mail order available)
Emergency Room
  • Emergency Room: 80% of the allowed amount for covered services after meeting you deductible
  • Ambulance Transportation Services: 80% of the allowed amount for covered services after meeting your deductible
    		•
  • Emergency Room: 50% of the allowed amount for covered services after meeting you deductible
  • Ambulance Transportation Services: 50% of the allowed amount for covered services after meeting your deductible
    		•
    Adult Preventative Care
  • Preventive Care Services: Nothing for services specifically listed up to $500 - for services in excess of $500 you pay your deductible and coinsurance
  • Immunizations: Nothing for specifically listed immunizations
  • Allergy Injections (Copayment applies when allergy injections is the only service provided during visit): $5 copayment per injection
    		•
  • Preventive Care Services: 50% of the allowed amount for covered services after meeting your deductible
  • Immunizations: 50% of the allowed amount for covered services after meeting your deductible
  • Allergy Injections (Copayment applies when allergy injections is the only service provided during visit): 50% of the allowed amount for covered services after meeting your deductible
    		•
    Child Preventative Care
  • Preventive Care Services: Nothing for services specifically listed up to $500 - for services in excess of $500 you pay your deductible and coinsurance
  • Immunizations: Nothing for specifically listed immunizations
  • Allergy Injections (Copayment applies when allergy injections is the only service provided during visit): $5 copayment per injection
    		•
  • Preventive Care Services: 50% of the allowed amount for covered services after meeting your deductible
  • Immunizations: 50% of the allowed amount for covered services after meeting your deductible
  • Allergy Injections (Copayment applies when allergy injections is the only service provided during visit): 50% of the allowed amount for covered services after meeting your deductible
    		•
    Lab / X-Ray Diagnostic Laboratory and X-ray Services: 80% of the allowed amount for covered services after meeting your deductible Diagnostic Laboratory and X-ray Services: 50% of the allowed amount for covered services after meeting your deductible
    Maternity Pregnancy Services (A separate $5,000 deductible applies, except in cases of involuntary complications): 80% of the allowed amount for covered services after meeting your deductible Pregnancy Services (A separate $5,000 deductible applies, except in cases of involuntary complications): 50% of the allowed amount for covered services after meeting your deductible
    Physical Therapy
  • Chiropractic Care Services (Limited to $800 per person, per benefit period): 80% of the allowed amount for covered services after meeting your deductible
  • Inpatient Physical Rehabilitation (From contracting provider only): 80% of the allowable amount for covered services after meeting your deductible
  • Outpatient Physical and Speech Therapy Services (Limited to $800 each per person, per benefit period): 80% of the allowable amount for covered services after meeting your deductible
  • Therapy Services (Therapies such as radiation, chemotherapy, renal dialysis, respiratory, inpatient occupational, enterostomal, growth hormone): 80% of the allowable amount for covered services after meeting your deductible
    		•
  • Chiropractic Care Services (Limited to $800 per person, per benefit period): 50% of the allowed amount for covered services after meeting your deductible
  • Inpatient Physical Rehabilitation (From contracting provider only): Not covered
  • Outpatient Physical and Speech Therapy Services (Limited to $800 each per person, per benefit period): 50% of the allowable amount for covered services after meeting your deductible
  • Therapy Services (Therapies such as radiation, chemotherapy, renal dialysis, respiratory, inpatient occupational, enterostomal, growth hormone): 50% of the allowable amount for covered services after meeting your deductible
    		•
    Skilled Nursing 80% of the allowable amount for covered services after meeting your deductible (Limited to 30-days per person, per benefit period) 50% of the allowable amount for covered services after meeting your deductible (Limited to 30-days per person, per benefit period)
    Home Health Care
  • Hospice Services (Lifetime benefit limit of $10,000 per person, no deductible required): You pay nothing for covered services
  • Home Intravenous Therapy: 80% of the allowable amount for covered services after meeting your deductible
  • Home Health Skilled Nursing (Limited to $5,000 per person, per benefit period): 80% of the allowable amount for covered services after meeting your deductible
    		•
  • Hospice Services (Lifetime benefit limit of $10,000 per person, no deductible required): Not covered
  • Home Intravenous Therapy: Not covered
  • Home Health Skilled Nursing (Limited to $5,000 per person, per benefit period): Not covered
    		•
    Mental Health Psychiatric Inpatient and Outpatient Services (Limited to 8 inpatient days and 20 outpatient visits per person per benefit period): 50% of the allowed amount for covered services after meeting your deductible Psychiatric Inpatient and Outpatient Services (Limited to 8 inpatient days and 20 outpatient visits per person per benefit period): Not covered
    Hospital Care
  • Physician, Surgical and Medical Professional Services: 80% of the allowed amount for covered services after meeting your deductible
  • Hospital Services: 80% of the allowed amount for covered services after meeting your deductible
    		•
  • Physician, Surgical and Medical Professional Services: 50% of the allowed amount for covered services after meeting your deductible
  • Hospital Services: 50% of the allowed amount for covered services after meeting your deductible
    		•
    Optional Benefits Supplemental Accident Benefit: $300 per person, per benefit period, for accident related expenses, no deductible or coinsurance payment required Supplemental Accident Benefit: $300 per person, per benefit period, for accident related expenses, no deductible or coinsurance payment required