Independence Blue Cross Personal Choice PPO Bronze Basic is an affordable health insurance policy offered in Southeastern Pennsylvania. Premiums are typically lower than comparable plans from other major carriers and the policy meets all Affordable Care Act (ACA) and Marketplace regulations and requirements. Office visits, prescriptions, ER, maternity, and hospital (inpatient and outpatient) benefits are included. Coverage is offered in the following Delaware Valley counties: Philadelphia, Bucks, Delaware, Chester, and Montgomery.
We offer IBX plans at the lowest available rates. You can easily choose and compare plan details by adding your zip code at the top of the page. There is no obligation to purchase any policy when you view prices. If you purchase the policy during an Open Enrollment period, there are no medical questions to answer and any pre-existing conditions will be treated the same as any new illness or injury. If you miss the deadline, you may qualify for an alternative enrollment throughout the year.
Large Provider Network
This plan uses the “Keystone” Network so you pay much less for treatment when you utilize approved providers. Out-of-network coverage is limited, unless it is an emergency. The Personal Choice PPO Bronze Reserve and and Keystone HMO policies are alternatives to this plan, although premiums are higher. In 2018 and beyond, it is anticipated that additional carriers will offer private coverage.
A referral is not needed when you use this policy. With more than 45,000 doctors and 160 hospitals available, you don’t have to drive far to get treatment. This also includes specialists, which may be utilized at any time. Pharmacies and Urgent Care facilities are also included, along with Urgent Care centers, Retail health clinics, vision and dental providers, outpatient labs, and patient-centered medical homes. Online assistance is also provided at all times.
The policy covers all qualified preventive services at 100% without any waiting period or deductible. The most common preventive benefits are routine annual physicals, mammograms, pediatric immunizations, pap tests and routine gynecological exams. However, many additional tests and screenings are also included with no out-of-pocket expense. President Trump’s new healthcare initiatives will continue to provide 100% coverage for preventative benefits.
Additional Highlights Of Personal Choice PPO Bronze Classic Plan:
The deductible is $7,150 although there is no coinsurance. Thus, if you reach the deductible, there will not be an additional 10%, 20% or 30% of out-of-pocket expenses you are responsible for. Regardless of how many major medical claims throughout the calendar year, only one deductible needs to be met.
Office Visit Copay
For the first three non-preventive visits to your primary care physician (pcp), only a $40 copay will apply. However, on the fourth and subsequent visits, although a network-negotiated discount will help reduce the cost, the deductible will apply. For example, a non-preventive visit would include treatment of the flu, common cold, stomach or other virus, minor aches and pains, and ailments that require a specialist. Once the deductible has been met, all office visits (pcp and specialist) will be covered at 100%. Substance abuse disorder and mental and behavioral health outpatient visits can also qualify for the $40 copay.
Typically, diagnostic tests (including x-rays and blood work), imaging (including an MRI, PET scans and CAT scans) are covered after the deductible has been met. However, the previously-mentioned network-negotiated discount can reduce these expenses by up to 75%. MRI savings are often between $500 and $1,500. Urgent Care and ER visits, although subject to the deductible, also receive large network repricing discounts.
Generic, preferred brand, non-preferred and specialty drugs are covered at 100% after the deductible. Preferred, non-brand and specialty drugs are treated the same way. However, many specialty drugs require precertification. Some of the most common examples are: Avastin, Remodulin, Remicade, Zemaira, Xolair, Synagis, and Botox. The complete listing can be found on the IBX Speciality Precertification RX List. NOTE: Other services that require precertification include skilled nursing and long term acute care facility admissions, rhinoplasty, sex reassignment surgery, and hair transplants.
Immediate Medical Attention Or Hospital Stay
Regardless whether your treatment involves a short stay of a few hours or an extended visit of days, weeks or months, your expenses are covered. Physician and surgeon fees, ambulatory center expenses, emergency room services, Urgent Care, facility charges, and related room costs are typically some of the most common expenses.
Additional long-term covered expenses include hospice service, durable medical equipment, skilled and home health care, and rehabilitation services.
Mental Health And Related Needs
Most benefits are paid at 100% once the deductible has been reached. This includes mental/behavioral inpatient and outpatient services, and substance abuse disorders (also both inpatient and outpatient). Precertification is usually required on most of these coverages.
It is especially important to ensure your specialist and/or facility is considered “in-network.” Otherwise, your out-of-pocket cost will be significantly higher since non-participating preferred providers may request that you pay the difference in IBC’s allowed amount vs. the cost of the non-network provider.
Maternity expenses are covered as a mandated “Essential Health Benefit” under the Affordable Care Act. Any new plans approved by the Trump Administration should continue to cover these expenses. Prenatal and postnatal care are included along with delivery and inpatient services. Deductibles and daily charges (if applicable) will apply.
Newborn children can be insured at any time of the year since they qualify as an SEP (Special Enrollment Period). Thus, even if the official Open Enrollment period has ended (typically in February), a delivered baby can apply for any Metal-tier plan. Preventive and well-baby check-ups will be covered with no out-of-pocket expense. One annual eye exam and a pair of glasses are also included, although a deductible applies. Dental is not included.
Common Services That Are Not Covered:
Bariatric and cosmetic surgery
Routine foot or eye care
Private duty nursing
Compliance To Affordable Care Act Legislation
This policy complies with ACA legislation (Obamacare) and by enrolling in the plan, you will not be subject to the 2.5% household income tax for non-compliance. The policy can be canceled at any time by the customer. However, the insurer can only terminate the plan if you commit fraud, the policy is not available in Pennsylvania, or you move outside the five-county service area. Also, if your claim is denied, you have the right to appeal the decision.
Also, “Minimum Essential Coverage is included. These are the 10 required and mandated categories of benefits that must be contained in all Marketplace (subsidized or unsubsidized) plans. Among the most commonly used benefits are substance abuse and mental illness, prescriptions, ER visits, maternity, and preventive expenses.
NOTE: This policy replaces the old Personal Choice 5000, which is no longer offered.