Below are frequently asked questions about Personal Choice PPO. Click on a topic below to view a list of related questions.
Information about guaranteed enrollment Personal Choice plans
About deductibles
About prescription drug coverage, including self-injectable medications
About health savings accounts (HSAs)
How to enroll
What happens after you select your new plan?
What is a PPO plan?
Preferred Provider Organizations or PPOs are health plans that have doctors and hospitals that have contracted with a health insurer, in this case Independence Blue Cross (IBC), to provide care to our members at a discounted rate. As a PPO member, you may see any doctor in the PPO network without special approval and do not need to choose a primary care physician. You may also use doctors or hospitals outside the network but your benefits will be reduced and you will have higher out-of-pocket costs. IBC’s Personal Choice network is robust with more than 58,000 doctors and more than 100 hospitals.
What advantages does Personal Choice have over other types of coverage?
When you are a Personal Choice member, you have the freedom to see any doctor or use any hospital you choose. You will get the most from your benefits when you use doctors or hospitals in our expansive network. In our area, Personal Choice has more than 58,000 participating doctors and more than 100 hospitals, including Philadelphia’s premier university hospitals. Plus, your in-network coverage goes with you when you travel. Simply present your ID card to any participating Blue Cross or Blue Shield
BlueCard PPO provider anywhere in the U.S. and your costs will be the same as if you were being treated by a local Personal Choice doctor or hospital.
What are my Personal Choice plan options?
IBC offers six guaranteed enrollment plans for you to select from and they are grouped into three categories: basic, health savings account, and hospital care. All plans will provide coverage in and out of network, and you have the freedom to see specialists directly. To see detailed information on these plans, please review the benefits summary.
What are the key differences between Basic, Value HSA, and HospitalCare?
In addition to each plan having its own member cost-sharing for medical services, there are several important differences between the Personal Choice Basic, Value HSA, and HospitalCare plans.
Personal Choice Basic I and II plans offer comprehensive coverage, including prescription drug coverage, physician office visits, X-ray/lab testing, and hospitalization.
The Personal Choice Value HSA is an HSA-qualified, high-deductible health plan. This program does not provide benefits for maternity care or for the treatment of mental health/substance abuse. The Value HSA plan meets federal guidelines that allow you to use your plan in combination with a health savings account (HSA). Learn more about opening an HSA to help you save for unreimbursed medical expenses.
The Personal Choice HospitalCare I, II, and III programs provide coverage for inpatient/outpatient hospital services, along with X-ray/lab testing. The HospitalCare plans include coverage for up to three office visits per year from a primary care or specialist (combined). The Personal Choice Hospital Care programs do not provide coverage for prescription drugs.
This chart summarizes the plan differences discussed above.
| Maternity care | Mental illness | Substance abuse | HSA qualified | Primary and specialty office visits | Prescription coverage | |
|---|---|---|---|---|---|---|
| Basic I and II |  |
|
|
|
|
|
| Value HSA | |
|
|
|||
| Hospital Care I, II, and III | |
(inpatient only) |
(inpatient only) |
(up to 3 visits per year; combined) |
What is a deductible?
A deductible is the amount, per calendar year, that a member must pay for certain covered medical services before Personal Choice pays for benefits covered by the plan. For services that require that you pay a deductible, you will be responsible for paying the provider until the deductible has been met. Certain expenses, such as premium payments, copayments, items not covered by your plan, do not count toward your deductible. Also, certain designated preventive services are 100 percent covered with no deductible when you use in-network providers.
What is an out-of-pocket maximum?
An out-of-pocket maximum is a dollar amount that limits the amount of money that you have to pay for covered medical services during a calendar year. The out-of-pocket maximum includes coinsurance and deductibles in the Personal Choice plans but does not include amounts that are balanced billed by providers that are outside the network.
What is the purpose of the deductible?
Deductibles are used to control the escalating cost of premiums by having you pay for certain services up to a specified dollar amount before insurance benefits begin to pay. Not all services are subject to the deductible. In fact, under recent health care reform legislation, certain designated preventive services are provided at no cost to you and with no deductible when you use in-network providers.
Keep in mind, you pay for the services subject to the deductible only if you use them. You could save more money by choosing a plan with a deductible and a lower monthly premium instead of a plan that pays most of your expenses but has a higher monthly premium. And remember, with an HSA-qualified medical plan like Personal Choice Value HSA, you can deposit the money you have saved in a tax-advantaged HSA to help you pay for unreimbursed health care services.
How do I find my monthly premium rate?
Rates are based on the age of the oldest family member covered under the policy. Please refer to the monthly rates information and find the age category of the oldest member covered under the policy, select the plan you would like, and then locate the rate that corresponds with your current coverage type (Individual, Individual and child, etc.).
Do all plans include prescription drug coverage?
Personal Choice Basic I, II, and Value HSA include coverage for prescription drugs. Basic I and II have no deductible requirement for prescriptions, offer generic medications for just $10, and offer brand medications that are discounted by 50 percent with a maximum copayment of $250 per prescription when using a participating pharmacy. With Value HSA once the individual or family deductible has been met, covered prescription medications are available at no cost to the member from participating pharmacies.
Are self-injectable medications covered?
Yes, coverage is available through the pharmacy benefit with the Basic and Value HSA plans. By covering self-injectable drugs under the pharmacy benefit, they are treated like any other self-administered drug, like capsules or tablets your doctor may prescribe. To obtain self-injectable medications, you may fill your prescription at a participating retail drugstore or through the FutureScripts® Direct Ship Specialty Pharmacy program. FutureScripts, an independent company, is the pharmacy benefits manager for your plan. You can learn more information about the Direct Ship program by calling 1-888-678-7012 or visiting www.futurescripts.com.
It is important that you estimate your expected yearly expense for self-injectable medications to help you decide which plan would work best for you. If you are not sure what the actual cost of your self-injectable medication is, you may want to check with your pharmacy to find out. Self injectable medications can be expensive.
What is an HSA?
HSAs are tax-advantaged, personal bank accounts that you can set up and fund to reimburse allowable medical expenses or to supplement retirement savings. To support members who are enrolled in our Personal Choice Value HSA product, IBC has a preferred relationship with an independent company, The Bancorp Bank (Bancorp), 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, complete the 
application and check “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.
Am I required to open an HSA if I select the Personal Choice Value HSA plan?
No, 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. Consult with a tax professional to determine if an HSA is right for you.
May I open an HSA with Bancorp anytime?
Yes, according to federal guidelines, you may open and contribute to an HSA if you are:
Personal Choice Value HSA is an HSA-qualified HDHP. If you are unsure as to your eligibility to contribute to an HSA, check with a qualified tax adviser for assistance.
How do I open an HSA with Bancorp?
If you are enrolled in Personal Choice Value HSA and wish to open an HSA with Bancorp, please download and complete the Bancorp HSA Enrollment Request form. Please return your completed form to us at Direct Pay, Independence Blue Cross, P.O. Box 41452, Philadelphia, PA 19101, or by fax to 215-238-7067.
What will I receive from Bancorp Bank if I sign up for an HSA?
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. Bancorp will issue you checks and a debit card that will give you access to your HSA funds, as needed.
Are claims for services I received before the HSA is set-up eligible for reimbursements from the HSA?
No. Only expenses for services you had after the HSA is set-up are eligible for reimbursement from your account.
If you open an HSA after your enrollment in Personal Choice Value HSA only services received on or after the date your HSA is in place are eligible for tax-free reimbursement from your account. For example, if you enroll in Vaule HSA on May 1, 2011 and open an HSA on July 1, 2011, qualified services that you received on or after July 1, 2011, will be eligible for tax-free reimbursement from your HSA account. Services you received between May 1, 2011, and June 30, 2011, would not be eligible for tax-free reimbursement.
If I open an HSA, are there any limits to the amount I contribute to it?
Yes, there are limits on the amount that you may contribute to an HSA. These limits are set by the federal government and are generally updated each year to account for inflation.
The contribution limits include all contributions made on behalf of the individual (including contributions made by an employee, an employer, a self-employed person, or a family member).
If you have more than one HSA, the annual contribution limit applies to the total of all HSAs. You can decide how to contribute to your HSA (one time or multiple times throughout the year) as long as you don't exceed the maximum allowable annual contribution.
If I open an HSA, may I still claim itemized deductions for medical expenses on my tax return?
You may be able to claim the medical expense deduction even if you contribute to an HSA. Please check with a qualified tax adviser for additional information and assistance.
How do I enroll in one of the Individual Personal Choice plans?
To enroll in one of the Personal Choice plans, please complete, sign, and return the application, to: Direct Pay, Independence Blue Cross, P.O. Box 41452, Philadelphia, PA 19101, or by fax to 215-238-7067.
What is the procedure to change plans?
The six Personal Choice plans vary in the level of benefit coverage that each provides. Changing plans depends on whether you are moving to a plan that has a higher level of benefits or a lower level of benefits than the plan you have today. Here’s a look at the benefit level of the Personal Choice plans.
Personal Choice Basic I provides the highest level of benefits, then Basic II, followed by Value HSA, and then HospitalCare I, HospitalCare II and finally HospitalCare III. You may move from a plan with more benefits to a plan that has a lower level of benefits at any time.
However if you want to switch to a plan with a higher level of benefits than the plan you have today, you may only do so:
If I change to a plan with a lower level of benefits than the one I have today, how does that affect billing?
You may switch to a plan with a lower level of benefits at anytime during the year. Any difference in premium will show as a credit on your account. You may request a refund by calling Customer Service at the number on your ID card.
For customers who pay by Automatic Clearing House (ACH), the credit will reduce the amount of your next bill, which will reflect your new plan and your new monthly premium rate.
For customers who pay by ZipCheck®, the credit will remain on your account, and the next bill will show your new monthly premium rate. We review ZipCheck accounts monthly, and if there is a credit on your account IBC will send you a refund check.
When will I receive my new ID card?
After we receive your first premium payment for your new plan, you will receive your new ID card. You may always visit www.ibxpress.com to print a temporary ID card to use until you receive your new card.
When will I receive my new insurance contract?
After we receive your first premium payment for your new plan, your “Welcome Kit” will be mailed to you; it contains your ID card and a link to your new contract. If you have any other questions about the new Personal Choice plans, please contact IBC Customer Service at the number on the back of your ID card.