Blue Shield Bronze PPO 60

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Calendar year deductible $6,300 per individual / $12,600 per family
Calendar year pharmacy deductible $500 per individual / $1,000 per family
Calendar year out-of-pocket maximum $8,200 per individual / $16,400 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 pharmacy deductible:
  Tier 1 = $18
  Tiers 1-4 = 35% up to $250 per prescription

Office Visit - Primary Care (internal medicine, family practice, OB/GYN, pediatrics) Before deductible:
  Visits 1-3 = $65
  Visits 4+ = Full cost
Office Visit - Specialist Care After deductible:
  $65
Teladoc Before deductible:
  Visits 1-3 = $95
  Visits 4+ = Full cost
Retail clinics After deductible:
  $95
Acupuncture (from an American Specialty Health Plans network acupuncturist) $0
Chiropractic (from an American Specialty Health Plans network chiropractor) Cost depends on the service performed. Cost is the same as if the service was performed elsewhere.
  Before deductible:
  Visits 1-3 = $65
  Visits 4+ = Full cost
  After deductible:
  $65
  Not covered

Laboratory Tests Before and after deductible:
  $40
X-rays Before deductible:
  Full cost
Imaging (CT / PET scan, MRI) from an outpatient radiology center After deductible:
  40%
  Before deductible:
  Full cost
  After deductible:
  40%

Urgent care Before deductible:
  Visits 1-3 = $65
  Visits 4+ = Full cost
Emergency Room Services After deductible:
  $65
Ambulance Before deductible:
  Full cost
  After deductible:
  40%
  Before deductible:
  Full cost
  After deductible:
  40%

Maternity - Prenatal Office Visits $0
Maternity - Other professional services Before deductible:
  Full cost
   
Maternity - hospital stay After deductible:
  40%
  Before deductible:
  Full cost
  After deductible:
  40%

Outpatient Surgery Services Before deductible:
  Full cost
Hospital Stays After deductible:
  40%
  Before deductible:
  Full cost
  After deductible:
  40%

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


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You may be eligible for financial assistance from the government to help you pay for a plan. Now that you’ve browsed our plans, please call us at the number listed below to get a quote.

To learn about your options, call our health experts.

(888) 273-0010
Monday through Friday: 8 am to 5:30 pm