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2 11/2005
Description of Products
BlueChoice PPO
is the name of BCBSGa’s PPO product. This managed care plan
provides the option of using a network of contracted providers or using any health
care provider outside the network. BlueChoice PPO provides in-network benefits and
out-of-network benefits; the member has the option to choose either a preferred
network provider and have benefits paid at the higher in-network benefit rate, or a
non-preferred provider and have benefits paid at the lower out-of-network benefit
rate.
BlueChoice Healthcare Plan
is the name of BCBSGa’s HMO product. This plan is built
on the primary care physician (PCP) model, emphasizing the PCP as the coordinator of
a patient’s health care. Physicians in the following specialties are eligible PCPs:
• Family Practice
• General Practice
• Internal Medicine
• Pediatrics
BlueChoice Healthcare Plan is designed to keep members healthy. When illness
occurs, the plan provides for quality care in the most appropriate setting at an
affordable cost to employers and members. Members have the freedom to select
their PCP from a panel of participating BCBSGa physicians. The PCP provides and
arranges all necessary medical services, including preventive care and treatment for
illnesses and injuries. The PCP also coordinates referral specialist services and
hospitalizations among participating BCBSGa providers.
BlueChoice Option
is the name of BCBSGa’s Point of Service (POS) product. A POS plan
is a hybrid of an HMO and traditional indemnity coverage. What distinguishes a POS
plan from an HMO plan is the availability of out-of-network benefits.
BlueChoice Option members are considered in-network when they access all
healthcare services through their designated PCP and use the services of BCBSGa
participating providers. If a member uses out-of-network services that are not
coordinated by the PCP, his or her benefits are paid at a lower rate, which results in
higher out-of-pocket expenses.