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 |
Healthy Savings | 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 |
If you’ve experienced a qualifying life event, you can apply for coverage in this Special Enrollment Period. Federal financial help can significantly lower the cost of your coverage. You may even qualify to pay $0 per month for a plan.
Based on the information you provided, you may be eligible for federal premium assistance.
1 The results from this tool are an estimate based on the information you have provided. Only Covered California can determine your eligibility and actual subsidy amount. Additionally, this tool does not determine Medi-Cal eligibility. A single household may have a mix of eligibility with some family members eligible for Medi-Cal coverage and others eligible for subsidies. For more information please visit coveredca.com/medi-cal.
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) 273-0010.
Explore 2022 Blue Shield of California health insurance plans
Based on the information provided, you may be eligible for federal premium assistance that allows you to enroll in the Silver 94 Trio HMO plan for $0 per month. The Silver 94 Trio HMO plan is a high-value plan offering you the lowest out-of-pocket costs when using covered benefits.
1 The results from this tool are an estimate based on the information you have provided. Only Covered California can determine your eligibility and actual subsidy amount. Additionally, this tool does not determine Medi-Cal eligibility. A single household may have a mix of eligibility with some family members eligible for Medi-Cal coverage and others eligible for subsidies. For more information please visit coveredca.com/medi-cal.
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) 273-0010.
Explore 2022 Blue Shield of California health insurance plans
Based on the information you provided, it appears you may be eligible for Medi-Cal. Blue Shield of California Promise Health Plan currently serves Medi-Cal members in Los Angeles and San Diego counties. We are contracted with L.A. Care Health Plan and the Department of Health Care Services.
Visit www.dhcs.ca.gov/services/medi-cal/pages/applyformedi-cal.aspx to learn how to apply for coverage.
If you have questions or need help, call us toll-free at (866) 820-6009 [TTY: 711], Monday through Friday, 8 a.m. – 6 p.m. Or, visit www.dhcs.ca.gov/services/medi-cal/pages/applyformedi-cal.aspx to learn how to apply for coverage.
Explore our individual and family plans
You may qualify for the maximum amount of federal financial assistance to lower the cost of health coverage.
Shop plansTo learn about your options, call our health experts
Looking for a Medicare plan?
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Explore 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.
Use Teladoc to connect with a national network of U.S. board-certified physicians, nurses, and mental health professionals by phone or video-chat, from the convenience of your home.
WellvolutionSM offers online and in-person health and wellness programs designed to support well-being and disease reversal, all for no extra charge.
You can access our high-quality network of doctors and hospitals and enjoy the freedom to choose from a variety of care options.
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!
Looking for dental, vision, and life insurance 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.
You’ll pay a fixed monthly rate for your health insurance policy. The amount depends on the plan you choose, where you live, and the age of each person on the policy. The lower your plan’s monthly rate, the more you typically pay when you see the doctor, and vice versa. Identifying how often you see a doctor can help you choose the right plan for you.
Depending on your household size and income, you may be eligible for financial assistance through Covered California to lower your plan’s monthly rate or even your costs for medical care.
Your bill for visiting the doctor will depend on the reason for your appointment and your plan’s benefits. Some services have a copay (a fixed dollar amount) and other services have coinsurance (a fixed percentage amount). When you pay a copay or coinsurance, Blue Shield of California will pay the rest of the charges for your visit. You should check to see if your health plan has an annual deductible, which is the amount of money you pay for services before the coinsurance and health plan begins paying for them. A high deductible could affect what you pay at each doctor’s visit.
To protect you and your family from unexpected costs, most plans have an annual out‑of‑pocket maximum. Once you reach the out-of-pocket maximum, your health plan covers 100% up to the allowed charges for most covered medical services.
The approved amount Blue Shield will pay for a service or benefit. If your doctor charges more than what’s allowed by your health insurance policy, you may be responsible for the difference.
The medically necessary services and supplies covered by Blue Shield.
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