Help with Out-of-Pocket Maximum

This is the most money you will be required to pay in a twelve-month period for applicable services. Your copayment responsibility for most services applies toward this copayment maximum.

Once the maximum is reached, for the rest of the remaining twelve months, Blue Shield will pay 100% of the allowable amount for all applicable services.

Copayment maximums vary by plan type and services. Refer to your Evidence of Coverage (EOC) or Certificate of Insurance (COI) for specific details.

An EOC or COI was sent to you when you first joined Blue Shield. If you need another copy:

  • Go to your Plan Summary page and download a copy or request that a copy be mailed to you (not available to all members).
  • Contact your Human Resource department for a copy if you have health care through your company.
  • Call the Member Services number on your Blue Shield ID card and request that a copy be mailed to you.