Anthem Blue Cross of CA - California Family Health Plan 40 PPO

In 2003 Blue Cross of CA, introduced an innovative individual and family health insurance plan: the Right Plan 40 PPO. This California family health plan addresses a complaint many people have with traditional individual health insurance in California, namely that they pay a lot in monthly premium to the insurance company yet when they get sick the insurance company does not pay anything because of the high calendar year deductible.

The Right Plan 40 has NO deductible, so the Anthem Blue Cross of CA begins paying medical claims immediately. Also, the Right Plan 40 has a very low monthly premium. Combine the low monthly premium with a no deductible medical insurance plan and you have a very popular health plan. Blue Cross of California reports that the Right Plan 40 is one of its most popular family health plans.

There are a few limitations to the Right Plan 40 of which consumers should be aware:

1. Right Plan 40 does NOT cover maternity;
2. Right Plan 40 is an individual ONLY plan, meaning each person has his/her own calendar year maximum;
3. Right Plan 40 has a $7,500 calendar year out-of-pocket maximum (OOP max.), which is very high.

Accordingly, this California health insurance option is not a good plan for a person or family wishing to have a child. Nor is it a good choice for a family which would have separate OOP maximums. For example a family of four would have a $30,000 OOP max. If an entire family got sick this could lead to financial ruin.

The Right Plan 40 plan works like this:

• you go to the doctor for an office visit (medical insurance billing code that includes: patient medical history; diagnosis of symptoms; and, recommendation of treatment) and you pay $40;
• the doctor orders other tests, lab work, X-rays, or generally any other service billed under a different code and you pay 40% of the amount allowed under the Blue Cross of CA provider contract;
• you go into a Blue Cross "preferred participating" hospital and you pay $400 per day (maximum $1,600) plus 40 percent of the negotiated fee.

This plan is great because it begins paying immediately. On the other hand, if you incur very high medical expenses you will have to pay up to $7,500 in a calendar year. Remember also that if you get sick or injured in towards the end of the year (e.g., November, December) and have claims in two separate calendar years you will have two separate OOP maximums.

You can also customize your Right 40 California family health plan to have:

1. no prescription medicine (Rx);
2. generic only Rx; or,
3. generic and brand Rx.

Of course you pay more for the right to have generic and brand Rx as a benefit.

The Right Plan 40 is a very good plan; just understand what you are buying.

NOTE: This is my opinion and not a summary or explanation of benefits. Please refer to the Anthem Blue Cross of California Evidence of Coverage (EOC) for limitations, exclusions, and conditions of coverage. Rely only on printed description of benefits from Blue Cross of California when evaluating this medical insurance plan.

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