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Difference
Between Blue Cross Blue Shield of Arizona and
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Blue
Cross BLue Shield of Arizona
Provider Networks Both companies have
extensive doctor and hospital lists doctors and hospitals up and down
the state. Typically the lists overlap
with doctors/hospitals participating with
other carriers. Occasionally there will be a
doctor who participates with one company but
not the other so it's best to check on your
doctor.
Online
Doctor Listing
Financial Strength This really
is the main reason to go with the "Blues".
Smaller or less efficient carriers are
having difficulties with some filing for
Bankruptcy. If you are with a smaller
carrier that is offering significantly
reduced costs, they almost definitely raise
rates, lower benefits, and/or leave the
market entirely. If you have developed
health conditions, the other carriers will
not pick you up at that time.
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Difference
between
HMO and PPO
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Most
people already have a strong preference
between these two models but in case you a
need a quick summary, here it is.
With a
PPO, you have more flexibility
to choose your doctors; you are not locked
into a region or a primary care doctor.
You can self-refer yourself out to
specialists. The trade off is that you
will help share the costs when you get sick
or hurt in the form of a deductible or
co-insurance.
With an HMO, you choose a
Primary
Care Physician who has more control over
referral and/or decisions regarding your
care. You must remain within your
medical group and within a geographic
region. The trade off with this more
structured approach is that there will be
less out of pocket when sick or hurt.
For example, for inpatient hospital, you may
be looking at nothing out of pocket.
TIP HMO's have become more
expensive so compare the annual premium
difference with PPO options to make sure you
are not paying too much.
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How
are pre-existing conditions handled
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Getting
Approved When applying for
coverage, the carrier will make their
decision to approve/decline coverage and/or
increase rates based on pre-existing
conditions. You can find more
information on
qualifying for health insurance. They are mainly looking
for current or ongoing situations.
They will also heavily weigh anything that
is open-ended such as a doctor's request for
a check up in the future which has not
happened yet.
Medication now weigh
heavily because of the associated cost.
You can run your situation by us first to
see what the probable outcome might be.
The carriers cannot exclude a certain
condition from coverage in order to approve
a person's coverage.
Once Approved If you have not
had coverage in the prior 63 days before
your effective date, there is a 6 month
waiting period for pre-existing conditions.
This means they will not pay out for claims
relating to pre-existing conditions until
you have been on the plan for 6 months.
If you have not lapsed coverage more than 62
days up to your new effective date, the
carrier will take into account your prior
coverage against a 6 month waiting period.
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Is
my doctor on the list
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You
can check for your doctor or hospital below.
Make sure you specify HMO or PPO.
Sometimes, doctors are listed under medical
group or a billing doctor so if you do not
see your doctor on the list, call their
office and ask if they
EXAMPLE..."participate in the
Blue
Cross Blue Shield PPO network".
Online
Doctor Listing
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Can
you breakdown the PPO's plans
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This
is a simple breakdown and you should read
through the benefit summary for more detail
but it helps to simplify the plans.
PPO
plans breakdown into three main categories:
Office consultation, Prescriptions,
and...pretty much everything else (hospital,
labs/x-rays, emergency, surgery, etc..)
Most plans offer some type of immediate
coverage for the office consultation and
generic drugs. NOTE Blue
Cross' Basic 1000 PPO does not cover either
and Shield's Preferred Savings makes these
benefits subject to the deductible.
Keep in mind that there is usually a
separate deductible (from $250 up to $750
depending on plan) for Brand Name drugs.
The "everything else" is typically
subject to the main
deductible
($500-$5000 depending on plan). Once
you meet your deductible, you pay a
percentage until you reach your
max-out-of-pocket.
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What
does the deductible mean
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A
deductible is an amount that you will pay
first before the plan kicks in. Keep
in mind that you will still get the
discounted rate (usually 30-60% off) on
covered benefits, in-network even before you
meet your deductible. After the
deductible is met, you typically go into a %
of the discounted rate. Some benefits
such as maternity and brand name
descriptions will have their own, separate
deductible.
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What
does max-out-of-pocket mean
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This
basically lets you know how the plan will
treat large bills...so called
catastrophic or major
medical coverage. Your
max-out-of-pocket let's you how much you
will pay up to for covered benefits,
in-network in a calendar year.
Usually, the max is per person up to two
people maximum. The Blue Shield
Preferred Savings plans have a family
deductible for 2 or more people on one plan.
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Can
the rates change
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The
rates can change by class (the entire state
of Arizona or county) or when you move up
to a new age band (typically at 5 year
increments such as age 35-39). The
stronger the carrier, the less severe and
less often the rate increases. Once
approved, they cannot change rates based on
your medical health or claims.
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Can
a child have a plan alone
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Yes.
With either carrier, you have a single child
or multiple siblings on one plan if they are
under the age of 18.
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What is needed
to start the
process |
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We basically
need the
completed
health insurance
application
(download
here
or have a
hard copy
sent to you),
and the first
payment to the
carriers for at
least one
month's worth of
premium
(with the
exception of
LifeWise, which
has no premium
requirement;
BlueCross has a
$20 application
fee, as does
Health Net
for paper
applications) .
If there are
medical records
needed, the
carrier
will send
them to you and
request that you
secure the
information from
the doctor. The
application process
can be expedited
by faxing
(866/394.8320)
us a copy of the
app and check,
and then sending
the original in
the mail
to l:
Walter Jarvis
Insurance
Services
6264 Saylin
Lane
Los Angeles,
Ca 90032 -2149
Blue
Cross Blue
Shield of
Arizona,
Health Net of
Arizona and
LifeWise of
Arizona have
an
online
application
and credit card
option as well.
More information
on
applying for
health insurance.
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How long
does it take ? |
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There are two
different
scenarios. If
the applicant is
in good health
and there isn't
much the carrier
wants to check
into, we usually
hear back in one
to three weeks.
If the volume of
applications is
running high in
underwriting,
the time frame
can be longer.
If the carrier
wants further
information on
something listed
in the
application,
they will
request records and
this
can delay the
processing
time. It
usually adds
another 2-4
weeks depending
on how quickly
the doctor
responds back to
the
request.
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Do I
submit payment
with the
application ? |
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The first
month's premium
must be
submitted with
the application
(with the
exception of
LifeWise) .
This can be done
with a check
made out to the
carrier or via
credit card (for
Blue Cross Blue
Shield of
Arizona, Golden
Rule, CIGNA
of Arizona or
Health Net of
Arizona).
If the
application is
not approved,
this initial
payment will be
fully refunded.
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Is there
a fee to apply ? |
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BlueCross
charges a
$20 non-refundable
application fee. |
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Is a
physical
required ? |
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A physical is
not
required...only
the completed
application and
first months
premium. Some
carriers
require a
physical for
applicants over
the age of 55
who have not had
one in the last
two years.
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How can
I expedite the
processing ? |
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Blue Cross ,
Health Net,
Golden Rule and
LifeWise have an
online
application
which tends to
process very
quickly.
Otherwise, you
can fax your
completed
application and
copy of check
(or the
completed
credit
card section) to
866/394.8320 to
start the
process
immediately.
You would then
mail the
original if
paying by
check. The
credit card
option just
requires the
faxed copy.
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Am I
locked in for a
period of time ? |
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No. The policy
can be cancelled
or renewed (by
payment) month
to
month.
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How is
payment handled ? |
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There are a few
options for
payment with
the
carriers .
Billing -
Blue Cross Blue Shield
bills monthly
electronic bank
draft; or
monthly or
quarterly paper
bill
Health Net of
Arizona bills
monthly either
by bank draft,
credit card
charge or paper
bill
Golden Rule
bills either a
monthly bank
draft or a
quarterly paper
bill.
LifeWise jhas
either a monthly
bank draft or a
quarterly direct
bill. |
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