This prefix includes traditional indemnity coverage. Indemnity plans are the oldest form of health insurance and offer maximum provider choice with no network restrictions. Members pay a percentage of charges after meeting their deductible. Reimbursement is based on reasonable and customary rates for the service area.
This is a Health Maintenance Organization (HMO) prefix. HMO plans have stricter routing requirements than PPO plans. Members select a PCP who manages their care and issues referrals. Claims for specialist services should include the referral number. Out-of-network claims will typically be denied unless emergency criteria are met.
Under this POS prefix, the member can access care both in-network and out-of-network, with cost-sharing that varies based on how the care is accessed. In-network care coordinated through the member's PCP has the lowest out-of-pocket cost. Include referral documentation when billing at the in-network benefit level.
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.