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G. William Moore
Cal. Ins. Lic. # 0707682
Seal Beach, Calif.
562-431-5575 |
Health Savings Account
A Health Savings Account (HSA) is a personal
savings account that gives you more control over how you save for and manage
your health care costs. It allows you to earn interest as you save for
qualified medical expenses on a tax-advantaged basis. Qualified medical
expenses include your deductible, coinsurance, prescription, drug copays, and
many other health expenses not covered by insurance. You must first be
enrolled in a qualified high-deductible health plan, such as the PPO 3500 (HSA
Compatible) Plan, to set up an HSA. The two work together to provide you
with the medical coverage you need, and an account to help you pay for what the
plan does not cover.
PPO 3500 (HSA-Compatible Plan)
can be purchased separately
-
100 % coverage for most in-network services
(after the deductible is met)
-
Low premiums
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Low, negotiated provider fees that reduce your
out-of-pocket costs
-
Freedom to go to any doctor you choose
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Out-of-state and out-of-country emergency coverage
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Variety of additional services to enhance your
life, including health improvement programs and discounts on health wellness
products and services
HSA Advantages
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Optional Contributions up to the annual IRS limit are
tax-deductible
-
Withdrawals are federally tax-free if used for
qualified medical expenses
-
Savings can be used to pay for qualified medical
expenses not covered by the PPO 3500 (HSA Compatible ) Plan
-
Savings can cover some or all of out of pocket
expenses
-
Money not spent rolls over to the following year
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Potential exists to build significant, nest-egg
balances after years of tax-advantaged contributions and interest earnings
HSA
fees (Provided by JP Morgan Bank, N.A. (Chase)
HSA Investment Choices
|
PPO 3500 (HSA Compatible) Plan
Benefits Amounts listed below
represent member's share of the costs after deductible unless
otherwise noted. |
|
Benefit |
Participating Provider |
Non-Participating Provider |
|
Annual Deductible (Medical/Pharmacy
combined In- and out-of-network combined) |
Single member: $3500
Families: $7000 aggregate |
|
Lifetime Covered Charges Paid by BL&H |
$5,000,000 per member |
Annual Out-of Pocket Max.
(Medical/Pharmacy combined In- and
out-of-network combined) |
Single member: $5,000
Families: $10,000 aggregate |
|
Office Visits |
After deductible, 0% of the negotiated fee |
After deductible, 50% of negotiated fee
plus 100% of charges in excess of the negotiated fee |
|
Professional Services
(X-ray, lab, anesthesia, surgery, etc.) |
After deductible, 0% of the negotiated fee |
After deductible, 50% of negotiated fee
plus 100% of charges in excess of the negotiated fee |
|
Hospital Inpatient |
After deductible, 0% of the negotiated fee |
After deductible, all
charges except $650 per day |
|
Hospital Outpatient Services |
After deductible, 0% of the negotiated fee |
After deductible, all
charges except $380 per day |
|
Emergency Services
($100 copay for each visit - waived if
admitted) |
After deductible, 0% of the negotiated fee |
After deductible, all
charges in excess of 100% of customary and reasonable for the first
48 hours. After 48 hours; All charges except $650 per day |
|
Preventive Care |
After deductible, $100
copay plus0% of the negotiated fee |
After deductible, 50% of negotiated fee
plus 100% of charges in excess of the negotiated fee |
|
Ambulance |
After deductible, 0% of the negotiated fee |
After deductible, 50% of negotiated fee
plus 100% of charges in excess of the negotiated fee |
|
Physical and Occupational Therapy; Chiropractic Services |
After deductible, 0% of the negotiated fee |
After deductible, all
charges except $25 per visit |
|
Acupuncture/Acupressure |
After deductible, all charges except $25 per visit |
|
Maternity |
Not covered |
|
Prescription Drugs
30 day supply retail; up to 60 day supply available
through mail order
Subject to annual deductible |
Blue Cross Formulary
Drugs: $10 copay generic copay; $30 copay brand name copay after
annual deductible; 50% coinsurance for non-formulary drugs; 30% of
negotiated fee for self- administered drugs, except insulin |
50 % of the Drug Limited
Fee Schedule within California |
Click here to apply
For more complete information, please download brochure.
PPO 3500 (HSA Compatible Plan)
PPO 3500 (HSA-Compatible Plan) Rates
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