BLUE CROSS, BLUE SHIELD EXPAND ELIGIBILITY GUIDELINES FOR LOW-COST, SPECIAL CARE HEALTH INSURANCE PROGRAM
Blue Cross of Western Pennsylvania and Pennsylvania Blue Shield announced today the maximum annual income ceilings for Special Care have been raised. The program is available to individuals and families in the companies' 29-county service area. The income limits were increased on April 1.
An individual with an annual income of $14,319 is now eligible for Special Care coverage. Prior to April 1, the maximum annual income for an individual was $13,820.
For a four-person family, the annual income guideline is now $28,860. Previously, the annual maximum was $28,028 for a family of four.
Special Care is designed for persons under age 65 who are not eligible for a public or private health insurance program. In most cases, these are individuals whose income is too high to qualify for state Medical Assistance, but too low to afford traditional health insurance coverage.
Blue Cross and Blue Shield introduced Special Care in Western Pennsylvania in 1990. At the time, the program was one of the first private sector initiatives aimed at easing the uninsured problem. The Special Care program was later replicated as a statewide initiative by Pennsylvania Blue Shield and other Blue Cross plans serving the central and eastern portions of the Commonwealth.
In Western Pennsylvania, approximately 24,000 persons are currently enrolled in the Special Care program. Since its introduction, the program has been priced low to make it more affordable for the working uninsured. Blue Cross and Blue Shield subsidize the coverage and Special Care participating hospitals and physicians accept lower fees. The price is $59.65 per month for an individual and ranges to $147.80 per month for a family of four.
In 1995, Blue Cross provided $3.4 million in subsidy dollars for the Special Care program. The company charges less than cost for other health plans that are purchased by individuals and families directly from Blue Cross. Last year those subsidies amounted to $23.5 million. Blue Cross has earmarked an additional planned subsidy of $5.6 million for the Special Care program in 1996.
In addition, in 1995 Blue Cross donated $3.5 million and administrative costs to its affiliate, the Western Pennsylvania Caring Foundation. The Foundation provides funding for the Caring Program for Children, which provides free health care benefits to children of low-income families.
"While the discussion continues nationally on how to meet the needs of the uninsured, we believe the Special Care program is a good example of a local solution that provides quality, affordable health care," said William M. Lowry, president and chief executive officer of Blue Cross of Western Pennsylvania.
"As part of our community service mission, we'll continue to make health care coverage available to all segments of the community. We're currently reviewing additional programming activities that will enable us to make health care more available and affordable to low-income individuals and families."
Additional information on Blue Cross and Blue Shield's Special Care program, including an application form, may be obtained by calling 1-800-544-6679.
/EDITORS' ADVISORY: Following is a Special Care fact sheet.
New Income Guidelines -- Effective April 1, 1996
Family Size Family Size 1 $14,319 5 $33,707 2 $19,166 6 $38,554 3 $24,013 7 $43,401 4 $28,860 8 $48,248
Current Monthly Rates
-- Individual $59.65 -- One Parent and Child(ren) $88.15 -- Husband and Wife $119.30
-- Two Parents and Child(ren) $147.80
Key Services Covered
- 21 inpatient days per benefit period.
- Emergency accident and medical treatment; surgery; diagnostic
x-ray and lab services; chemotherapy and radiation therapy; annual mammogram for women beginning at age 40 (or when recommended by a physician); annual routine gynecological examination and PAP test; scheduled pediatric immunizations.
-- Physician, Med/Surgical
- Inpatient surgery; doctor visits while in the hospital;
outpatient surgery; emergency accident and medical treatment; anesthesia for covered surgical procedures; diagnostic services; annual mammogram for women beginning at age 40 (or when recommended by a physician); annual routine gynecological examination and PAP test; scheduled pediatric preventive services, including immunizations; four doctor visits per person per calendar year for diagnosis or treatment of illness or injury ($10 co-pay per visit)./
/CONTACT: John McDermott of Blue Cross of Western Pennsylvania, 412- 255-8247/
CO: Blue Cross of Western Pennsylvania; Pennsylvania Blue Shield ST: Pennsylvania IN: INS SU: PDT
CD-JS -- PGF009 -- 7497 04/12/96 14:10 EDT
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|Date:||Apr 12, 1996|
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