CareFirst Blue Cross / Blue Shield’s most comprehensive HIPAA plan in Virginia is Blue Preferred HIPAA PPO. This plan is ONLY available to individuals that are eligible under HIPAA portability guidelines and is most similar to traditional group health insurance with low deductibles and predictable fixed costs for services like office visits and prescription drugs. There is no charge for preventative care and you can save money on prescriptions by getting a 90-day supply through mail order. Individuals in good health can apply for coverage under the fully underwritten version of this plan called BluePreferred PPO. Benefits for BluePreferred HIPAA PPO are as follows:
Deductible – $100, $300, $500, $750, or $2,500. Deductibles are per person, maximum of two per family.
Co-insurance – 20% after deductible. 10% for the $100 deductible plan. 10% co-insurance optional for $300 deductible.
Annual out of pocket limit for individuals – $5000 for the $2500 deductible option, $3500 for the $750 deductible option, $2500 for the $500, $300, and $100 deductible options.
Annual out of pocket limit for families – Double the out of pocket maximum for individuals, but no more than the individual maximum for any one person.
Lifetime Maximum – Unlimited
Office visits – $25 co-pay for both primary care and specialists
Preventative care – No charge
Prescriptions – $100 prescription drug deductible per person, then $10 co-pay for generics, $25 for brand name, $45 for non-formulary brand name (30-day supply). If using mail order, up to a 90-day supply is $20 for generics, $50 for brand name, and $90 for non-formulary brand name.
Emergency Room – $50 co-pay plus 20% co-insurance after deductible
Outpatient Lab/X-ray – 20% co-insurance after deductible. 10% for $100 deductible option and if selected for $300 deductible.
Outpatient Surgery – 20% co-insurance after deductible. 10% for $100 deductible option and if selected for $300 deductible.
Hospitalization – 20% co-insurance after deductible. 10% for $100 deductible option and if selected for $300 deductible.
Maternity Benefits – Requires optional rider. Rider costs $126 per month and has a 10-month waiting period.
Chiropractic – 20% co-insurance after deductible. 10% for $100 deductible option and if selected for $300 deductible.
Mental Health – 20% co-insurance after deductible for visits 1-5, 50% after deductible for visits 6-20. 10% for $100 deductible option and if selected for $300 deductible.
Substance Abuse – 20% co-insurance after deductible for visits 1-5, 50% after deductible for visits 6-20. 10% for $100 deductible option and if selected for $300 deductible.
To get an instant quote for CareFirst BluePreferred HIPAA PPO and apply online, just click the banner at the top or bottom of the page to get started. You can give us a call at 1-800-571-2980 if you have any questions from 9 AM to 9 PM or send us an e-mail at Info@terminsurancebrokers.com 24 hours a day.