Basic PPO 1000/2500 Plan

No one can put a price tag on good health. We just make it more affordable to protect yours.

Even if you are healthy right now, you never know what the future holds. And if you wait until you become ill or injured, you may not qualify for coverage. Getting an Individual health care plan now will give you peace of mind knowing you are protected – no matter what.

Our Basic PPO plan for Individuals and Families provides basic and catastrophic coverage for hospitalization and emergency services, and includes:

A choice of two deductibles: $1,000 or $2,500
Hospital coverage in the event of a catastrophic illness or injury
Doctors’ office visits are covered once you meet your annual out-of-pocket limit

With a PPO (preferred provider) health plan, you’ll pay a lower share of your medical expenses when you use doctors or hospitals that participate in our PPO provider network. And with more than 50,000 PPO doctors and nearly 400 hospitals throughout the state of California, the chances are that your doctor is one of ours.

For a total benefit solution, we also offer a wide range of dental and term life coverage options.

Want to know more? See the following benefits-at-a-glance for a detailed look at the benefits our Basic PPO Plans offer.

If you have any questions, you can:

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Basic PPO 1000/2500 Plan benefits at-a-glance These amounts show your share of costs after deductibles, if any.
Plan Benefit	In-Network Receive negotiated savings	Out-of-network Pay higher costs
Lifetime Maximum (combined for in and out-of-network)	Health plan pays up to $5,000,000 per member
Annual Deductible Choices	$1,000/ $2,500 per member inpatient or surgical procedures only (combined for in-network and out-of-network; Each family member has an individual deductible. Once 2 members each reach the deductible, the deductible is satisfied for the entire family.)
Annual Out-of-Pocket Limit1 (in addition to deductible)	$2,500 / $2,500 per member (combined for in-network and out-of-network; Each family member has an individual out-of-pocket limit. Once 2 members each reach the deductible, the deductible is satisfied for the entire family)
Doctors’ Office Visits	No office visit benefit until out-of-pocket max is met, then you pay $0 of negotiated fee	No office visit benefit until out-of-pocket max is met, then you pay 50% of negotiated fee, plus all excess charges
Professional Services (x-ray, lab, anesthesia, surgeon, etc.)	20% of negotiated fee for inpatient or surgical procedures only. No office visit benefits until out-of-pocket limit is met, then you pay $0 of negotiated fee.	50% of the Negotiated Fee Rate for Covered Services for the remainder of the Year.
Hospital Inpatient (overnight hospital stays)	20% of negotiated fee2	All charges in excess of $650 per day for Covered Services.
Hospital Outpatient (if you don’t stay overnight)	20% of negotiated fee2	All charges in excess of $380 per day for Covered Services.
Emergency Room Services ($100 copay applies for each visit; waived if admitted as inpatient.)	20% of negotiated fee	All charges in excess of $380 per day for Covered Services.
Maternity	Not covered	Not covered
Preventive Care (tests ordered by physician are covered, including appropriate screening for breast, cervical, ovarian and prostate cancer)	HealthyCheckSM Centers: $25/$75 copay for basic/premium screening (deductible waived) Routine mammogram, Pap and PSA tests: 20% of negotiated fee (deductible waived)	Routine mammogram, Pap and PSA tests: 50% of negotiated fee plus all charges (deductible waived)
Chiropractic Services	Not covered unless during inpatient admission

Prescription Drug Coverage Options	In-Network Receive negotiated savings	Out-of-network Pay higher costs
Comprehensive Prescription Drug Coverage (see brochure for more information)	Not covered
Generic Prescription Drug Coverage (see brochure for more information)	Not covered
1 Excludes non-participating charges in excess of the Anthem Blue Cross negotiated fee and non-participating charges in excess of customary and reasonable fees for emergency care. Copays/coinsurance to participating and non-participating providers apply to out-of-pocket maximum except where specifically noted in the policy. 2Additional $500 admission charge at participating hospitals (no additional charge for preferred participating) is for inpatient stays or outpatient surgery or infusion therapy. The charge is not required for ambulatory surgical centers or medical emergencies.

For complete benefit details, view the brochure.

Basic PPO 1000/2500 Plan

Anthem Blue Cross California

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