IFP Home-Shop 2022 health plans | Blue Shield of CA
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 Deductible & Out-Of-Pocket Maximum

Calendar year deductible

Calendar year pharmacy deductible

Calendar year out-of-pocket maximum

$7,000 per individual / $14,000 per family

N/A

$7,000 per individual / $14,000 per family

 

 No Cost Preventive Care

Preventive Care

Well Baby Care

Prenatal Office Visits

Pediatric Dental Benefits: Preventive

Pediatric Vision Benefits: Exams

$0

 

$0

 

$0

 

$0

 

$0

 

 No Cost Extras

24/7 Nurse Hotline

Shield Concierge

Healthy Savings

Health and Wellness Discounts (gym, weight loss programs, and more)

No additional cost

Not available

Not available

No additional cost

 

 Prescription Drugs

Retail Prescription Drugs

Before deductible:

Tiers 1-4: Full cost

After deductible:

Tiers 1-4: $0

 

 Physician & Medical Services

Office Visit - Primary Care (internal medicine, family practice, OB/GYN, pediatrics)

Office Visit - Specialist Care

Teladoc

Retail clinics

Acupuncture (from an American Specialty Health Plans network acupuncturist)

Chiropractic (from an American Specialty Health Plans network chiropractor)

Before deductible:

Full cost

After deductible:

$0

Before deductible:

Full cost

After deductible:

$0

$0

Cost depends on the service performed. Cost is the same as if the service was performed elsewhere.

Before deductible:

Full cost

After deductible:

$0

Not covered

 

 Lab & X-ray Diagnostics

Laboratory Tests

X-rays

Imaging (CT / PET scan, MRI) from an outpatient radiology center

Before deductible:

Full cost

After deductible:

$0

Before deductible:

Full cost

After deductible:

$0

Before deductible:

Full cost

After deductible:

$0

 

 Urgent & Emergency Care

Urgent care

Emergency Room Services

Ambulance

Before deductible:

Full cost

After deductible:

$0

Before deductible:

Full cost

After deductible:

$0

Before deductible:

Full cost

After deductible:

$0

 

 Maternity Care

Maternity - Prenatal Office Visits

Maternity - Other professional services

Maternity - hospital stay

$0

Before deductible:

Full cost

After deductible:

$0

Before deductible:

Full cost

After deductible:

$0

 

 Hospital & Outpatient

Outpatient Surgery Services

Hospital Stays

Before deductible:

Full cost

After deductible:

$0

Before deductible:

Full cost

After deductible:

$0

 

 Dental & Vision

Pediatric Dental Benefits: Preventive

Pediatric Dental Benefits: Restorative Procedures

Pediatric Dental Benefits: Medically Necessary Orthodontics

Pediatric Vision Benefits: Exams

Pediatric Vision Benefits: Eye Glasses

$0

 

20%

 

50%

 

$0

 

1 pair per year

 

New financial help for more Californians

New federal financial help is available to help lower the monthly cost of health coverage for millions of Californians. Check to see how much you qualify for today.

Need a 2021 plan through Special Enrollment?

New financial help for more Californians

New federal financial help is available to help lower the monthly cost of health coverage for millions of Californians. Check to see how much you qualify for today.

Need a 2021 plan through Special Enrollment?

Hero Banner
Hero Banner

Fill out the fields below to see if you’re eligible for financial assistance to help pay your plan premium.

Important: This calculator is a tool for informational purposes only and does not confirm eligibility. It is not a contract. Covered California determines eligibility and the amount of the subsidy. Eligibility requirements are only partially described. It is not intended for personalized financial or legal advice.

Here's where to start:

Learn about the difference between HMO and PPO plans.

PPO plans overview

Preferred provider organization

Care on your terms

Enjoy the flexibility to see doctors in a larger network and ability to customize your care.

Get primary, urgent, or emergency care statewide
Preventive care covered at 100%
Connect with doctors inside or outside the network
Get primary, urgent, or emergency care statewide
Preventive care covered at 100%
Connect with doctors inside or outside the network

*HMO not available in all areas *Los planes HMO no están disponibles en todas las áreas.

Health maintenance organization

Guided care with your doctor

Partner with a doctor in your local area to coordinate your care at lower costs.

Access a quality network of providers
Preventive care covered at 100%
Feel protected with emergency care inside and outside your network
Access a quality network of providers
Preventive care covered at 100%
Feel protected with emergency care inside and outside your network

Which plan is right for you?

Here are the details about each plan to help make your decision.

PPO plans overview

Here are the details about each plan to help make your decision.

Trio HMO
PPO
What you pay per month (premium) 1
lower premium
medium premium
See a specialist without a doctor referral
yes
In-state doctors and hospitals that accept your insurance
17,902 doctors 303 hospitals
56,212 doctors 329 hospitals
Emergency care available worldwide
Non-emergency care access
Local
yes
yes
California
yes
yes
United States
What you pay per visit 2
lower premium
medium premium
Virtual doctor and telehealth appointments 3
yes $0 copay
yes $0 copay
Tax-savings options to help pay for care 4
yes
Preventive care covered at 100%
yes
yes
Access to a wellness platform to manage your health
yes
yes
Additional support & Benefits
24/7 access to registered nurses, doctors, and mental health support
yes
yes
Dedicated support line to help you navigate your care (Shield Concierge)
yes
Discounts at local business 5
yes
yes
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Choose the level of coverage that's right for you

Each plan includes the same benefits, but your cost depends on how you use your plan.

 

Platinum

You’ll pay a high monthly rate for your plan, and pay a low amount when you need care.

Great for those who see a doctor often

We pay 90% of covered medical expenses

$0 deductible

 

Gold

You’ll pay a little more each month for your plan, and pay less when you get care.

Great for those who see a doctor often

We pay 80% of covered medical expenses

$0 deductible

 

Silver

You’ll find an affordable balance between your monthly premiums and the cost when you see a doctor.

Great for those who want to be prepared for an emergency

Moderate deductible

We pay 70% of covered medical expenses after you pay the deductible

 

Bronze

You’ll pay a low amount each month for your plan, and pay a high cost share when you get care.

Great for those who want coverage in case of emergencies but don’t expect to see a doctor often

Highest deductible

We pay 60% of covered medical expenses after you pay the deductible

 

Platinum

You’ll pay a high monthly rate for your plan, and pay a low amount when you need care.

Great for those who see a doctor often

We pay 90% of covered medical expenses

$0 deductible

 

Gold

You’ll pay a little more each month for your plan, and pay less when you get care.

Great for those who see a doctor often

We pay 80% of covered medical expenses

$0 deductible

 

Silver

You’ll find an affordable balance between your monthly premiums and the cost when you see a doctor.

Great for those who want to be prepared for an emergency

Moderate deductible

We pay 70% of covered medical expenses after you pay the deductible

 

Bronze

You’ll pay a low amount each month for your plan, and pay a high cost share when you get care.

Great for those who want coverage in case of emergencies but don’t expect to see a doctor often

Highest deductible

We pay 60% of covered medical expenses after you pay the deductible

Ready to shop now

Explore doctors and hospitals

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.

New federal financial help is available to lower the cost of Individual and Family health coverage!

Watch this video to learn more!

New federal financial help is available to lower the cost of Individual and Family health coverage!

Watch this video to learn more!

 

Looking for 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*.

Looking for dental, vision, and life insurance coverage?

 

Dental coverage

Protect your smile with one of our PPO or HMO dental plans.

 

Vision coverage

Vision plans starting at only $6.90 per month.

 

Life coverage

Protect your loved ones’ financial security.

Learn more about health insurance Show all FAQs

  • How does health insurance work?

    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. 

     

  • What do I pay monthly?

    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.

     

  • What do I pay when I see a doctor?

    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.

  • Benefits or covered services

    The medically necessary services and supplies covered by Blue Shield.

  • Allowed charges

    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.

  • Coinsurance

    A fixed percentage of the cost of your services that you’re responsible for. This is usually after you’ve met your deductible.

  • Copayment

    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.

  • Deductible

    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.

  • HMO

    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. 

  • 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.

  • PPO

    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.

  • Out-of-pocket maximum

    The most you are required to pay in combined deductible, copayment, and coinsurance amounts for all of the covered services each year.

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Disclosures

  1. The average premium of all Trio HMO plans for 2021 is lower than the average premium of all PPO plans.
  2. The average out-of-pocket cost of all Trio HMO plans for 2021 is lower than the average out-of-pocket cost of all PPO plans.
  3. Primary care and behavioral health consultations provided remotely via virtual doctor and telehealth appointments available through Teladoc.
  4. Blue Shield does not offer tax advice. For information or questions, consult a financial or tax advisor.
  5. Discounts are not covered services or benefits under a Blue Shield of California health plan.

* This is for informational purposes only. * Underwritten by Blue Shield Life & Health Company