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Select HMOAnthem Logo

The Select HMO plan from Blue Cross of California (Anthem Blue Cross) features the following:

Plan Type: HMO
Deductible: None
In-Patient Hospital Co-Payment/Coinsurance: $250
Prescription Drug Coverage (Out Patient): Yes
Maternity Coverage Included: Yes
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Select HMO Summary:

In Network Out of Network
Annual Deductible None Not Applicable
Annual Out-Of-Pocket Limit $3,000/member (Deductible not Included) Not Applicable
Lifetime Maximum Unlimited Not Applicable
Office Visits $25 after Deductible Not Applicable
Prescription Drugs Generic: $10 Brand: $30 ($250 Brand Deductible; 2 member max) Not Applicable
Laboratory and Radiology No Charge for office visit related services Not Applicable
Annual Physical Exam $25 after Deductible Not Applicable
Annual OB-GYN Exam $25 after Deductible Not Applicable
Well Baby Care $25 after Deductible Not Applicable
Outpatient Surgery 20% of negotiated fee; $250/surgery Not Applicable
Emergency Room 20% of negotiated fee plus $100 (Waived if admitted) 20% of negotiated fee plus $100
Ambulance $50 (Waived if admitted) $50 (Waived if admitted)
Home Health Care See Brochure Not Applicable
Mental Health Services - Outpatient See Brochure See Brochure
Chiropractic Care $25/visit (up to 60 days after an illness or injury) Not Applicable
Acupuncture / Acupressure Not Covered Not Applicable
Inpatient Hospital $250/day (4 day maximum/admission) Not Applicable
Maternity Care $250/day (4 day maximum/admission) Not Applicable
Mental Health - Inpatient See Brochure Not Applicable
Chemical Dependency See Brochure Not Applicable


IMPORTANT NOTICE: Coinsurance amounts represented with a "%" are payable after the plan deductibles are reached; Co-pay amounts represented with a "$" are not subject to plan deductibles (except where noted). Refer to contract for a detailed explanation of plan benefits, features, exclusions and limitations. Benefits subject to change without notice. Out of pocket maximum shown includes the plan deductible unless otherwise noted. Co-pays, Deductibles, and Coinsurance amounts listed above are your share of the costs for covered benefits.

Do Not Cancel your current coverage until a new policy is approved and you have received written confirmation of the policy's rates and benefits from the insurance company. Rate and Benefit Disclaimer Notification!

Information contained in this website is limited in scope, subject to change without notice, and does not contain all the terms, conditions, limitations, or exclusions of the referenced benefit plans. Only the insurance company Plan Documents and Policy's contain the exact terms and conditions of coverage.



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