| Calendar year deductible | $7,000 per individual / $14,000 per family |
| Calendar year pharmacy deductible | N/A |
| Calendar year out-of-pocket maximum | $7,000 per individual / $14,000 per family |
| Preventive Care | $0 |
| Well Baby Care | $0 |
| Prenatal Office Visits | $0 |
| Pediatric Dental Benefits: Preventive | $0 |
| Pediatric Vision Benefits: Exams | $0 |
| 24/7 Nurse Hotline | No additional cost |
| Shield Concierge | Not available |
| Health and Wellness Discounts (gym, weight loss programs, and more) | No additional cost |
| Retail Prescription Drugs | Before deductible: |
| Tiers 1-4 = Full cost | |
| After deductible: | |
| Tiers 1-4: $0 |
| Office Visit - Primary Care (internal medicine, family practice, OB/GYN, pediatrics) | Before deductible: |
| Full cost | |
| After deductible: | |
| $0 | |
| Office Visit - Specialist Care | Before deductible: |
| Full cost | |
| After deductible: | |
| $0 | |
| Teladoc | 0% after ded |
| Retail clinics | Cost depends on the service performed. Cost is the same as if the service was performed elsewhere. |
| Acupuncture (from an American Specialty Health Plans network acupuncturist) | Before deductible: |
| Full cost | |
| After deductible: | |
| $0 | |
| Chiropractic (from an American Specialty Health Plans network chiropractor) | Not covered |
| Laboratory Tests | Before deductible: |
| Full cost | |
| After deductible: | |
| $0 | |
| X-rays | Before deductible: |
| Full cost | |
| After deductible: | |
| $0 | |
| Imaging (CT / PET scan, MRI) from an outpatient radiology center | Before deductible: |
| Full cost | |
| After deductible: | |
| $0 |
| Urgent care | Before deductible: |
| Full cost | |
| After deductible: | |
| $0 | |
| Emergency Room Services | Before deductible: |
| Full cost | |
| After deductible: | |
| $0 | |
| Ambulance | Before deductible: |
| Full cost | |
| After deductible: | |
| $0 |
| Maternity - Prenatal Office Visits | $0 |
| Maternity - Other professional services | Before deductible: |
| Full cost | |
| After deductible: | |
| $0 | |
| Maternity - hospital stay | After deductible: |
| $0 | |
| Before deductible: | |
| Full cost |
| Outpatient Surgery Services | Before deductible: |
| Full cost | |
| After deductible: | |
| $0 | |
| Hospital Stays | Before deductible: |
| Full cost | |
| After deductible: | |
| $0 |
| Pediatric Dental Benefits: Preventive | $0 |
| Pediatric Dental Benefits: Restorative Procedures | 20% |
| Pediatric Dental Benefits: Medically Necessary Orthodontics | 50% |
| Pediatric Vision Benefits: Exams | $0 |
| Pediatric Vision Benefits: Eye Glasses | 1 pair per year |
Extra financial help is available to help lower the cost of coverage. Check to see how much you could qualify for, and apply for a health plan today during open enrollment.
Our health plans include affordable pricing with Trio HMO and the flexibility to choose your provider with a PPO. If you see a plan you like, call us at (888) 273-4540.
Explore 2023 Blue Shield of California health insurance plans
*HMO not available in all areas *Los planes HMO no están disponibles en todas las áreas.
Partner with a doctor in your local area to coordinate your care at lower costs.
It’s important to know which doctors and hospitals are included in your plan’s provider network before you choose a plan. Use our Find a Doctor tool to determine if your preferred doctors and hospitals are included in our PPO and/or Trio HMO networks.
Watch this video to learn more!
Don’t forget dental, vision, and life insurance coverage.
Good health includes your dental and vision health, too. We’ve got you covered with a variety of dental and vision plans, as well as individual life insurance and Accidental Death and Dismemberment Coverage*.
Protect your smile with one of our PPO or HMO dental plans.
Vision plans starting at only $6.90 per month.
Protect your loved ones’ financial security.
A health insurance policy determines the types of medical services or benefits you are covered for, which doctors you can see, and what hospitals you can visit. Your plan also determines what you pay for care and services.
After purchasing a health plan, you can then visit a doctor or hospital in the Blue Shield of California network. A network is a group of doctors, hospitals, and healthcare providers that work with a health plan like Blue Shield. That means you only have to pay a certain amount for healthcare services instead of the full cost. By using in-network doctors and hospitals, you can keep your costs lower.
Health insurance is for preventive and event-based care – meaning you don’t have to wait until you’re sick to see a doctor. Preventive services like annual exams and flu shots are available to you at no additional cost.
A fixed percentage of the cost of your services that you’re responsible for. This is usually after you’ve met your deductible.
A fixed amount you pay for benefits such as doctor’s visits or any wellness services. This is usually after you’ve met your deductible if your plan has one.
The amount you pay each calendar year for most benefits before Blue Shield begins to pay. Some benefits, such as preventive care, are covered before you meet your deductible.
A health plan where you choose a primary care physician (PCP) who treats you regularly. This includes preventive visits and referrals to specialists. You’ll need to see only other doctors or specialists in your PCP’s medical group. There is no coverage for services received from doctors who are outside your PCP’s network.
A group of providers – including hospitals, doctors, specialists and other healthcare providers – that have agreed with Blue Shield to provide benefits for a specified amount.
The most you are required to pay in combined deductible, copayment, and coinsurance amounts for all of the covered services each year.
A health plan in which members can choose to see any provider in the PPO provider network without a referral. Members also have the freedom to use non-network providers for most services if they are willing to pay a higher share of the cost.
* This is for informational purposes only. * Underwritten by Blue Shield Life & Health Company
