FAQ
Personal Choice® PPO (guaranteed enrollment)
Below are frequently asked questions about Personal Choice PPO. Click on a topic below to view a list of related questions.
Personal Choice Plans
What are my plan options?
What are the key differences between the two new plans?
What is a Preferred Provider Organization (PPO)?
What is the meaning of in-network/out-of-network benefits?
Can you tell me if my doctor or hospital is in the Personal Choice network?
How are emergencies covered?
Prescriptions
How are prescription drugs covered?
What happens if I do not use a participating pharmacy?
How does the prescription drug benefit maximum work?
Deductibles
What is a deductible?
What is the purpose of the deductible?
Health Savings Accounts (HSA)
What is an HSA?
What will I receive from Bancorp Bank if sign up for an HSA with them?
Am I required to open an HSA if I select the Personal Choice Value HSA plan?
Personal Choice Plans
What are my plan options?
We offer two plans: Personal Choice Basic and Personal Choice Value HSA. Both plans will provide coverage in and out of network, and you never need a referral to see a specialist. To see more information on these plans, review the benefits summary for each plan.
What are the key differences between the two new plans?
In addition to each plan having a unique cost-sharing schedule, there are some important differences between Personal Choice Value HSA and Personal Choice Basic. Personal Choice Value HSA is an HSA-qualified, high-deductible health plan. This means that Personal Choice Value HSA meets federal guidelines that allow you to use your plan in combination with a Health Savings Account (HSA). Learn more about deductibles and HSAs. While Personal Choice Value HSA is an HSA-qualified plan, some benefits are not covered under this program, including maternity care, mental health care, and substance abuse treatment. These services are covered benefits under the Personal Choice Basic plan. See the benefits summary of the plans and how services are covered.
What is a Preferred Provider Organization (PPO)?
PPOs are a combination of fee-for-service and HMO programs. They offer the preventive benefits of an HMO and the freedom of traditional insurance to choose the doctor or hospital you want.
PPOs give you a financial incentive to use in-network (preferred) providers. When you do, a greater portion of the cost of services is covered. But you can opt for out-of-network doctors or facilities and still receive some coverage. When you receive care out-of-network, you will be responsible for a deductible and coinsurance. In addition, out-of-network, non-participating providers may bill you for the differences between the plan allowance and the provider’s actual charge.
Unlike an HMO, a PPO does not require you to coordinate your care through a Primary Care Physician or obtain a referral to see a specialist.
What is the meaning of in-network/out-of-network benefits?
When you use a provider that participates in the Personal Choice network or the BlueCard® PPO program, they are considered in-network. Providers that do not participate in the Personal Choice network or BlueCard PPO are considered out-of-network, and your benefits are reduced.
Can you tell me if my doctor or hospital is in the Personal Choice network?
To find a participating provider, use the online provider search. You can also call Personal Choice Customer Service at 1-800-ASK-BLUE (1-800-275-2583).
How are emergencies covered?
An emergency is a medical condition manifesting itself in acute symptoms of sufficient severity that the absence of immediate medical attention could result in serious medical consequences or place your health in serious jeopardy. If you are experiencing symptoms that might reasonably indicate such a condition, then you may need emergency care and should go immediately to the emergency department of the closest hospital. Health concerns of a pregnant woman also may extend to her unborn child. If you believe your situation is life threatening, you should call 911.
Try to notify your personal physician within 48 hours of being treated, or as soon as possible if follow-up care is needed.
Emergency services are paid according to your in-network level of coverage. If you are admitted to an out-of-network hospital, you must notify us within two (2) business days, or as soon as reasonably possible. If you are not admitted to the hospital, you are not required to call us.
Prescriptions
How are prescription drugs covered?
In order to provide members with the most value, our pharmacy benefits manager, FutureScripts®, administers our prescription drug benefits. FutureScripts pharmacies have agreed to charge a discounted price for drugs when you show your Personal Choice identification card. More than 60,000 retail pharmacies nationwide participate in the FutureScripts network.
The FutureScripts network includes many neighborhood pharmacies, as well as large chain stores. When you go to any participating pharmacy, simply show your Personal Choice identification card. The pharmacist will charge you the Personal Choice prescription program negotiated discount price. The pharmacist will file a claim with us on your behalf, eliminating paperwork for you.
What happens if I do not use a participating pharmacy?
- Pay the pharmacist for your prescription and obtain an original pharmacy receipt that includes the drug’s National Drug Control (NDC) number and the price that you paid. A cash register slip or credit card receipt is not acceptable.
- Complete a FutureScripts Prescription Reimbursement Claim Form, attach your receipt, and mail it to the address on the form. To obtain claim forms, call FutureScripts Customer Service at 1-888-678-7012.
How does the prescription drug benefit maximum work?
Personal Choice Basic includes coverage for prescription medications with a maximum prescription drug benefit of $2,500 per individual per calendar year, combined in- and out-of-network. The maximum prescription drug benefit is calculated on either the negotiated discount price at a participating pharmacy or the retail charge at a nonparticipating pharmacy. Once the maximum benefit has been met, members are responsible for 100% of either the discount price at a participating pharmacy for covered prescription drugs or the retail charge at a nonparticipating pharmacy.
The Personal Choice Value HSA plan covers prescriptions 100% once you meet your deductible.
Deductibles
What is a deductible?
A deductible is the amount, per calendar year, that a member may pay for certain covered medical services before Personal Choice provides benefits as described in the plan. For services that require a deductible, you will be responsible for paying the provider for services until the deductible has been met. Certain items, such as premium payments, copayments, and expenses not covered by your plan, do not count toward your deductible.
What is the purpose of the deductible?
Deductibles are used to lower your monthly insurance premium payment because you only pay for the services subject to the deductible if you use them. You may save more money by having insurance with a deductible and lower monthly insurance premiums than if you had insurance that pays most of your expenses but has a higher monthly payment. And remember, with an HSA-qualified plan like Personal Choice Value HSA, you can use your tax-advantaged HSA account to pay for out-of-pocket medical services.
Health Savings Accounts (HSA)
What is an HSA?
HSAs are tax-advantaged, personal bank accounts that you can set up and fund to reimburse covered medical expenses or save to supplement retirement savings. IBC has a preferred relationship with an independent company, The Bancorp Bank, where you may open an HSA; you may also use another bank of your choice. Information about Bancorp HSAs can be found at: www.mybancorpHSA.com. If you are interested in setting up a Bancorp HSA, check the box on your application: “Yes, I’d like an HSA account with The Bancorp Bank. Please send Bancorp my information.”
Reminder: Only members enrolled in our Personal Choice Value HSA medical plan are eligible to open an HSA account.
What will I receive from Bancorp Bank if sign up for an HSA with them?
The Bancorp Bank will send you a welcome package. To formally open your account, you’ll need to complete and sign the signature card included in the package and return the form to Bancorp in the business reply envelope. After your signature card is received, Bancorp will issue you checks and a debit card with which you will have access to your account funds, as needed.
Am I required to open an HSA if I select the Personal Choice Value HSA plan?
You do not need to open an HSA to use with Personal Choice Value HSA. However, opening and using an HSA could be financially beneficial to you. The money you deposit into your HSA will reduce your taxable income for the year, money saved in an HSA earns interest, and qualified medical expenses paid from your HSA are tax free. You can learn more about HSAs at www.mybancorpHSA.com. You should also consult your tax professional for tax advice.
