Under this PPO prefix, members are covered for both in-network and out-of-network care. The plan pays a higher percentage of allowed charges when members use participating providers. No gatekeeper or primary care referral is required. Verify the member's specific benefits for cost-sharing details.
This prefix is associated with a High-Deductible Health Plan. HDHP members pay more out-of-pocket before insurance coverage begins. These plans are commonly paired with HSA or HRA accounts. When billing, be aware that the member may have significant cost-sharing responsibility until their annual deductible is satisfied.
HMO (Health Maintenance Organization) plans require members to choose a primary care physician (PCP) and obtain referrals before seeing specialists. Out-of-network services are generally not covered except in emergencies. Claims must be submitted to the payer listed above and should include referral authorization when applicable.
Health insurance provider offering Medicare, Medicaid, commercial, dental and vision plans to over 8 million California members. Independent licensee of the Blue Cross Association founded in 1937.