Request a quote
If you would like to request a quote, call 1-888-249-2118 .
FAQ
View our most frequently asked questions.
PPO 5000 HSA
Your current plan
| PPO 5000 HSA (you pay) | ||
|---|---|---|
| Benefits summary |  PPO 5000 HSA |
|
| Location | In-network (you pay) | Out-of-network (you pay) |
| Office visit | $0, after deductible | 50%, after deductible |
| Specialist visit | $0, after deductible | 50%, after deductible |
| Hospitalization | $0, after deductible; unlimited days | 50%, after deductible/ 70 days |
Personal Choice PPO cost-saving options
| PPO 8000 Deductible | ||
|---|---|---|
| Benefits summary | PPO 8000 Deductible |
|
| Location | In-network (you pay) | Out-of-network (you pay) |
| Office Visit | $25, no deductible | 50%, after deductible |
| Specialist Visit | 20%, after deductible | 50%, after deductible |
| Hospitalization | 20%, after $8,000 deductible; unlimited days | 50%, after deductible/ 70 days |
Once you have determined which plan is right for you, fill out the Plan Change Request Form. Sign and return the form to the address below or fax to 215-238-7067. For your new plan to be reflected in your next invoice, IBC must receive your completed plan change request form by June 4, 2012.
Independence Blue Cross
P.O. Box 41452
Philadelphia, PA 19101
Fax: 215-238-7067
If you have other questions concerning this rate adjustment, please call us at 1-888-249-2118 .