HDHP (High-Deductible Health Plan) coverage means the member has a higher deductible than traditional plans, often paired with a Health Savings Account (HSA). Most services require the member to pay out-of-pocket until the deductible is met. Preventive care is typically covered before the deductible. Submit claims normally to the payer listed above.
POS (Point of Service) plans combine features of HMO and PPO coverage. Members choose a primary care physician and can get referrals to see in-network specialists at lower cost, or self-refer to out-of-network providers at higher cost. Claims should include referral information when the member uses the in-network benefit level.
Under this EPO prefix, the member has no out-of-network coverage for routine care. However, unlike HMO plans, no referral is needed to see a specialist within the network. When billing, confirm the provider's network participation status with the plan before submitting the claim.
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.