Scott & White Baylor Texas PPO Plan Outlines

KennyWest

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Scott & White Baylor Texas PPO plan outlines

Received PDF (attached) from Scott & White Baylor today. We will have rates on the ACAExpress.com site as soon as CMS gives go ahead to show them.

Nice at least to see they have branched out from being only HMO.

From the email they sent:
===============================================
Great news! The Insurance Company of Scott & White is proud to announce that in our Texas service area we will have ACA qualified PPO plans available.
Rates will be announced soon, but today we wanted to give you a preview of our exciting new 2016 PPO portfolio. Appointed agents will be able to sell the attached plans both ON & OFF exchange for 2016.

2 Bronze
3 Silver
5 Gold

We utilize the Baylor Scott & White Hospitals along with both the Children’s & Cook Children’s Hospitals in DFW. For additional network (details) please visit our website at www.SWHP.org.

Coming soon:
· “Open Access” HMO plans
· Direct enrollment website (subsidy sales without using the FFM)
· Optional GUARANTEED ISSUE: Life, Dental, Accident & Critical Illness
===============================================
 

Attachments

  • 2016 ScottAndWhiteMyPlan PPO Product Grid 10-1.pdf
    453.6 KB · Views: 20
interestingthat the verbiage appears to indicate that out of network will work with the same in network deductible and OPKT:



Coverage outside of the Insurance Company of Scott & White Network
MyPlan PPO options include coverage when utilizing providers out of the participating provider network. However, you will be responsible for any amounts that are above the allowed charges. These amounts can be billed to you by the provider, and do not apply to your Annual Out of Pocket Maximum under the plan.
 
interestingthat the verbiage appears to indicate that out of network will work with the same in network deductible and OPKT:

Coverage outside of the Insurance Company of Scott & White Network
MyPlan PPO options include coverage when utilizing providers out of the participating provider network. However, you will be responsible for any amounts that are above the allowed charges. These amounts can be billed to you by the provider, and do not apply to your Annual Out of Pocket Maximum under the plan.

AKA...if you are OON, plan on paying for it.

But this is standard language for all PPO s :)
 
interestingthat the verbiage appears to indicate that out of network will work with the same in network deductible and OPKT:



Coverage outside of the Insurance Company of Scott & White Network
MyPlan PPO options include coverage when utilizing providers out of the participating provider network. However, you will be responsible for any amounts that are above the allowed charges. These amounts can be billed to you by the provider, and do not apply to your Annual Out of Pocket Maximum under the plan.

It says there are no limits to what you could be charged for balance billing when you are out of network. What are you reading buddy? Nothing to see here...........move on.
 
No limit cap to Out of Pocket, when Out of Network.. Right?

Allen a friend of mine who was on the bcbs webinar said that's what bcbs is moving to. I don't know that is fact because I wasn't on the webinar.
 
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To the BCBS, at least in HCSC states, they are launching an HMO which does provide out of network benefits, albeit at lower benefit levels.
 
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