Blue Shield of California - Explanations For PPO and HMO and a Brief Look at 3 of Their Health Plans

Blue Shield of California is a health insurance company that was established in 1938 by the California Medical Association. Based out of San Francisco California, the company services over 3.2 million members and is contracted with nearly 59,000 and 350 hospitals across the state.

With Blue Shield of California you have a couple different styles of coverage to choose from. More than likely you have heard the terms PPO and HMO thrown around. What do these terms mean?

PPO

A Preferred Provider Organization (PPO) gives you the availability to choose from a much larger network or doctors, specialists and hospitals. By visiting a contracted PPO provider with Blue Shield of California you will receive a negotiated fee rate for covered services. It is always important to make sure the doctor, specialist or hospital you choose is contracted with the company before you receive care. If you happen to pick an out-of-network provider then you may be subject to higher cost for service.

HMO

A Health Maintenance Organization (HMO) is a smaller organization of healthcare providers that have contracted with an insurance company to offer services at fixed rates. You will be required to choose one doctor (primary care physician) who will be responsible for providing all aspects of your healthcare. Blue Shield has 2 different HMO plan options available in California on the individual and family plans network. You can expect HMO doctors that are contracted with Blue Shield to offer fewer providers than with the PPO plans. Generally you must get a referral from your primary care physician in order to receive care from a specialist.

Let's take a look at some of the more popular plans that are currently being offered in 2009.

PPO Savings Plan 4000

This plan is great for a health young male who doesn't require many office visits per year. This plan doesn't include maternity, however we do recommend it to females who don't want maternity coverage or are past child bearing years. With most health plans you must satisfy a deductible and then pay a co-insurance percentage. With the PPO 4000 you are covered at 100% after meeting the calendar year deductible! You also have the availability of a physical exam, once a year for a co-payment of $35. If you are someone looking for affordable catastrophic coverage, this plan is highly recommended.

PPO Balance Plans 2500, 1700 and 1000

With the balance plans you have a good balance of deductible, office visit co-pays, prescription drugs, and a decent monthly premium. Each deductible option (2500, 1700 and 1000) comes with first dollar office visit co-pay of $30. There is also $10 co-pay for generic drugs and $35 co-pay for brand drugs ($500 brand name deductible and $2500 brand maximum benefit per year). If you happen to be the type of person that visits a doctor more frequently than once per year, and needs prescription drug coverage, take a look at the balance plans!

Access HMO

The Access HMO with Blue Shield of California is one of the better benefit plans on the market, however the monthly premium tends to be to unaffordable for most. After you satisfy a $2000 deductible you will have a $250 co-pay for impatient and outpatient hospital stays until you satisfy a total of $3000 in out-of-pocket expense (deductible included). Office visit co-pays are $20 before deductible; you will pay a $10 generic drug co-pay and a $35 brand name co-pay after a $200 brand name drug deductible. Remember, this HMO plan will have a smaller network of providers compared to the PPO options. Make sure to verify that all providers you use are a contracted physician or hospital with Blue Shield before receiving care.