Blue
Cross and Blue Shield
Types of Coverage and Benefits
Blue Cross offers broad coverages and pays claims on a service basis.
The
plan covers hospital daily room and board, outpatient services for
minor surgery
or accidental injury, medical emergencies, diagnostic testing, physical
therapy, kidney dialysis, chemotherapy, and in some cases preadmission
testing.
Family plans may also include coverage for dependent handicapped
children.
Maternity benefits are also made available the “same as for
any other disability.”
Blue Cross also has a supplemental coverage for catastrophic loss,
which is
similar to commercial major medical plans. This supplement has a
deductible
and an 80%/20% coinsurance feature.
Blue Shield offers prepaid medical coverage for physician services
received
by plan subscribers. Again, through the contractual arrangement with
the
providers, Blue Shield will normally pay the participating physician
a predetermined
amount for the specific service provided. Usually, this amount will
be based on the usual, customary, and reasonable (UCR) fees charged
by
other physicians in the same geographical area for the same or similar
medical
procedures.
It is also possible to obtain dental coverage through Blue Cross/Blue
Shield,
which contracts with dental providers and pays fees on a service
basis.
