![]() ![]() If you want to be able to coordinate your own health care, a PPO plan might be right for you. But if you stay in your network, you’ll pay less. You can see doctors inside or outside your network. PPO plans have more flexibility than HMO plans. If you want low monthly premiums and copays and you don’t travel much, an HMO plan might be right for you. When you have an HMO plan, you choose a primary care physician who works as your partner. They coordinate all your care and can refer you to trusted doctors and specialists in your network. It's important to note that, with an HMO plan, most health care isn't covered outside your network. PPO stands for preferred provider organization.HMO stands for health maintenance organization.These acronyms all signify different health plan types: After that point, you pay the full amount each day. And if you're in the hospital or a skilled nursing facility, Original Medicare only pays for a certain number of days. There's no cap on what you pay out of pocket. Original Medicare doesn’t have an out-of-pocket maximum. This is called the out-of-pocket maximum. When you reach a certain amount, we pay for most covered services. When you have a Blue Cross plan, we track all the costs you pay – deductible, copays and coinsurance. We pay the Original Medicare deductibles for you. Original Medicare has its own deductibles, but if you have a Medicare Advantage plan, you don't have to worry about them. Most Medicare Advantage plans have separate medical and pharmacy deductibles. After you reach your deductible, you’ll still have to pay any copays or coinsurance. For most services, you'll pay the full cost until you reach the deductible. ![]() DeductibleĪ deductible is the amount of money you pay for care before your plan starts paying. You pay 20 percent coinsurance for most services with Original Medicare. Our Medicare Advantage plans use copays for most services. Your health insurance plan pays the rest of the cost. Copays and coinsuranceĪ copay is a fixed amount of money you pay for a certain service. Written authorization given by the student health center (SHC) to seek care outside of the SHC for medically necessary services.These terms all describe money you pay toward health care when you have a health insurance plan.When a non-Anthem Blue Cross physician is used, the patient is responsible for payment of all charges in excess of the Anthem Blue Cross C&R payment. A Customary and Reasonable charge, as determined annually by Anthem Blue Cross, is a charge which falls within the common range of fees billed by a majority of physicians for a procedure in a given geographic region, or which is justified based on the complexity or the severity of treatment for a specific case.You’ll typically pay more and may need to file a claim for payment. Health care professionals, hospitals, clinics, and labs that do not belong to the Anthem Blue Cross Prudent Buyer network.UC SHIP contracts with Anthem Blue Cross to provide access to its extensive network of hospitals and providers, including UC Family facilities and provider groups. You’ll usually pay less when you use a network healthcare provider. A group of healthcare providers and facilities-including doctors, hospitals, and labs-that contract with your healthcare plan to provide services at negotiated discount rates.After you meet the maximum, UC SHIP covers 100% of all eligible costs for the rest of the plan year. The maximum amount of money you’ll have to pay for health care in a year.If you receive services from an out-of-network provider, the provider will bill you the difference, if any, between their charges and the maximum allowed amount. It is the claims administrator’s payment toward the services billed by your provider, combined with any deductible or coinsurance you may owe. The total reimbursement payable under your plan for covered services you receive from in-network and out-of-network providers.An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm or death.The amount you have to pay toward medical costs before UC SHIP starts paying part of the bill.For example, you might pay 20% of the cost for a particular service, and the insurance company or plan will pick up the tab for the remaining 80%. The slice of a medical service you’re responsible for.For example, you might pay a $15 copay to see a primary care doctor or specialist. ![]()
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