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Selecting the Right Plan…
We offer a broad scope of health coverage through PlanScape and our health maintenance organizations (HMOs). PlanScape plans all pay 100% of in-network covered costs up to $5,000,000 in a lifetime after you pay an annual maximum share of medical costs of $3,000 to 5,000 per person (up to two people per family).
Selecting the plan that is right for you is a matter of weighing your needs,
primarily in these four areas…
What are the monthly premiums for each plan? What can you afford?
What health care services does each program cover?
What would be your share of the cost for these services?
Is it important to you to see any doctor you want or are you willing to trade that flexibility for sorne other benefit?
Deductable: the amount you spend each year before the plan begins paying part of the cost
Out of pocket Maximum : The most you would have to spend in any one year before the plan pays 100% of your covered costs.
In general. the more of the risk you are w111ing to accept (below the annual out-of-pocket maximum of $3.000 to $5.000). the less you pay in monthly premiums. On the other hand, the higher the monthly premium you pay, the more favorable the features. That can mean a number of things. It can mean more services are covered. It can mean that the plan pays a larger portion of the cost for covered services. It can mean that features such as deductibles and out-of-pocket maximums are more favorable to you. Just as you do with any purchase, you need to decide what’s most important to you. To make it easier, we’ve divided the available plans into three relative price categories lower, medium and higher.
Lower Plan- Choose from four programs Medium Plan- Choose from three programs
Higher Priced Plan- Choose the plan available where you live.
PlanScape or an HMO?
PlanScape is an innovation in affordable health coverage the result of our commitment to keeping Californians covered. It consists of seven plans that offer a range of price/feature combinations. Most of these plans allow you to use any doctor or facility you choose, although the benefits are higher when you use one of the more than 40,000 network physicians or more than 400 network hospitals. Be sure to read the enclosed brochure PlanScape for Individuals for more information about the advantages of PlanScape, comparisons of the ondividual plans and other details of the program.
We also offer health maintenance organizations (HMOs). The HMOs provide more comprehensive coverage, both in terms of the services they cover and the share of the cost they assume. For many services, you pay only $10. However, HMOs limit the doctors and faciltties you can use, except in emergencies. Please read the enclosed brochure lndovidual and Family HMO Plans for more information.