What types of utilization review, pre authorization, or certification procedures are included?
Costs How much is the premium from Blue Cross of California or another provider? $_____________________________________________ Are there any discounts available for good health or healthy behaviors (e.g., non-smoker)? ________________________________________________________________ How much is the annual deductible from Blue Cross of California or other providers? $_________________________________ per person $_________________________________ per family What coinsurance or co-payments apply? _________________________________% after I meet my deductible $_________________________________copay or % coinsurance per office visit $_________________________________copay or % coinsurance for “wellness” care (includes well-baby care, annual eye exam, physical, etc.) $_________________________________% copay or coinsurance for inpatient hospital care Other Forms of California Health Insurance In addition to broad coverage for medical, surgical, and hospital expenses, there are many other kind
