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Employee Group Plans: Comprehensive Major Medical
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Traditional Fee-for-Service Plan
Major Medical coverage is traditional indemnity ("fee-for-service") health
insurance. Major medical coverage offers the greatest choice of medical providers
of any Arkansas Blue Cross and Blue Shield plan. Major Medical coverage places no
restrictions on Arkansas Blue Cross members regarding their choice of physicians,
hospitals or other providers. Arkansas Blue Cross and Blue Shield pays a percentage
of allowable charges for health-care services after a deductible is met.
Preferred Payment Plan
Members may choose any provider they wish but can save money by choosing from health-care
providers who participate in the Preferred Payment Plan (PPP) and hospitals that
participate in the Hospital Reimbursement Program (HRP). These providers, listed
in our Blue Book, represent 95 percent of the doctors and 100 percent of the hospitals
in the state. (Go to
Provider Directory for a complete list of Blue Book providers.) Participating
health-care providers agree to accept allowances established by Arkansas Blue Cross
as payment in full and collect from the member only deductibles, coinsurance and
noncovered services.
Hospital Reimbursement Program
Closely related to the Preferred Payment Plan is the Hospital Reimbursement Program.
Under this program, hospitals agree to a reimbursement system based on maximum allowable
payments. For inpatient care, the allowable payments are based on diagnosis-related
groups (DRGs). Hospitals agree to accept as payment-in-full the lesser of their
billed charges or the maximum allowance set by Arkansas Blue Cross and to charge
the member for nothing other than deductibles, coinsurance and non-covered services.
Blue Book
The Blue Book lists participating health-care professionals and facilities.
Arkansas Blue Cross members are not required to use the participating providers
exclusively. In fact, members may use any physician they choose. However, only those
in the Blue Book have agreed to accept Arkansas Blue Cross allowances. (Go to
Provider Directory for a complete list of Blue Book providers.)
For More Information
Call: 501-378-3070 or 1-800-421-1112
E-mail: CompMjrMed@arkbluecross.com
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