Some benefits are available before the deductible is satisfied, including preventive health services, office visits, most generic prescription drugs (Tier 1), diagnostic labs, diagnostic X-rays at an outpatient radiology center, urgent care center services, chiropractic services, and pediatric dental and vision care. For most other covered services received from an in-network provider, you pay the allowable amount until the deductible is satisfied. After that, Blue Shield will pay 50% of the allowable amount for most covered services and you’ll pay the rest. Once you reach your out-of-pocket maximum for the year, Blue Shield will pay 100% of the allowable amount for covered services.

Bronze 7500 Trio HMO

Q: Healthcare in an HMO network

With an HMO plan, you choose a primary care physician to direct your care. Your primary care physician will refer you to other specialists within the same medical group when needed. Services are covered when provided by doctors within the IFP Trio HMO network and your medical group.

Q: Learn about health plan costs

Some costs are fixed, like monthly premiums. This is the amount you pay Blue Shield every month for health coverage. Other costs – like copays – are paid when you use covered healthcare services like doctor’s visits or prescription drugs. Allowable amount This is the maximum amount Blue Shield will pay for a service or benefit. Copay and coinsurance A covered service can have a copayment (copay) or coinsurance that you pay each time you get the service. A copay is a specific dollar amount you pay for the service. Coinsurance is a percentage of the allowable amount of a service you’re expected to pay. Deductible A deductible is the amount you pay out-of-pocket for covered services each year before Blue Shield starts to pay. Out-of-pocket maximum An out-of-pocket maximum is the most you pay for covered services each year. Most costs count toward the out-of-pocket maximum. Once you reach your out-of-pocket maximum for the year, Blue Shield will pay 100% of the allowable amount for covered services.

Low premiums with protection from major expenses

The Bronze 7500 Trio HMO plan offers coverage for major medical services (like surgeries) and potential tax advantages when paired with a health savings account (HSA).

The plan is designed to give you coverage, access to care with the predictability of copays for most covered services, and financial protection against unexpected healthcare costs.

This plan can only be purchased direct from Blue Shield.

Our IFP Trio HMO network

The IFP Trio HMO network connects you with more than 9,000 primary care doctors and 33,000 specialists who can help manage your care in person or virtually. Find network doctors, medical groups, and hospitals near you.

More ways to see your doctor, same copay

You’ll pay the same copay for a primary care visit whether it’s in person or virtual.

Teladoc virtual visits for $0

Get quick care from a doctor or mental health professional at Teladoc Health. Appointments are by phone or video at no added cost.

Coverage that travels with you

You’re covered for urgent and emergency care anywhere in the world.

In-person vs. virtual care

Some doctors offer both in-person and virtual visits. You can even choose a virtual-only doctor to be your primary care physician.

A primary care doctor is one you see regularly for ongoing care.* For urgent needs, you can choose to speak with a virtual doctor at Teladoc Health for $0.

Learn about HSAs

This plan is designed to be a health savings account (HSA) eligible plan. Once you enroll in an HSA, you can use it as a personal savings account to pay for qualified medical, dental, and vision expenses.

How an HSA helps you save†

HSAs offer potential tax advantages. Contributions are generally made on a pre-tax or tax-deductible basis. Earnings may grow tax-free, and you may use the funds tax-free when paying for IRS-qualified medical expenses.

Keep what you don’t spend

Unused funds in your HSA roll over year after year if you don't spend them. All the money in your HSA is owned by you.

How this plan works

Healthcare in an HMO network

What you’ll pay

Learn about health plan costs

Plan benefits in detail

Benefit amounts reflect member costs when receiving care from in-network providers.

		Bronze 7500 Trio HMO
Deductibles and maximum out-of-pocket
Calendar year medical deductible		$7,500 per individual / $15,000 per family¹
Calendar year pharmacy deductible		Included in the medical deductible
Calendar year out-of-pocket maximum²		$11,650 per individual / $23,300 per family
Care from your providers (physician services)
Primary Care	Preventive care	$0
Primary Care	Office visit (in-person or telehealth)	$65
Specialist	Office visit (in-person or telehealth)	$95
Mental health / substance use disorders	Office visit (in-person or telehealth)	$65
Labs and tests (diagnostic X-ray, imaging, pathology, and laboratory services)
Laboratory and pathology services at a laboratory center		$65
Basic imaging services (including X-rays and ultrasounds) at an outpatient radiology center		$115
Emergency and urgent care services
Emergency room	Physician services	50%
Emergency room	Facility services (waived if admitted to the hospital)	50% (subject to deductible)
Urgent care center services	(in-person or telehealth)	$65 per visit
Care at the hospital (inpatient and outpatient services in a hospital setting)
Inpatient	Physician services	50%
Inpatient	Facility services	50% (subject to deductible)
Outpatient	Physician services	$150 per surgery
Outpatient	Facility services	50% (subject to deductible)
Dental and vision care for kids (pediatric dental and vision for children up to age 19)
Dental	Oral exam	$0
	Preventive cleaning	$0
	Topical fluoride	$0
Vision	Comprehensive eye exam	$0
	Glasses (collection frames)³	$0
	Contacts (hard or soft, elective or non-elective)	$0
Prescription drugs from your local network pharmacy or Amazon Pharmacy home delivery
Contraceptive drugs and devices	30 day supply	$0
Contraceptive drugs and devices	90 day supply home delivery	$0
Tier 1	30 day supply	$15 per prescription
Tier 1	90 day supply home delivery	$45 per prescription
Tier 2	30 day supply	$115 per prescription (subject to deductible)
Tier 2	90 day supply home delivery	$345 per prescription (subject to deductible)
Tier 3	30 day supply	50% (up to $500 per prescription and subject to deductible)
Tier 3	90 day supply home delivery	50% (up to $1,500 per prescription and subject to deductible)
Tier 4	30 day supply	50% (up to $500 per prescription and subject to deductible)
Tier 4	90 day supply home delivery	50% (up to $1,500 per prescription and subject to deductible)
Additional features
Health savings account (HSA) eligible	Consult with your financial or tax advisor if you have questions about HSAs.	Yes
Out of state care coverage	BlueCard® service area	Limited coverage - refer to the Evidence of Coverage
Other professional services	Teladoc Health consultation	$0
Other professional services	Chiropractic services	$20 per visit (12 visits per member per calendar year)

1. Family coverage has an individual deductible within the family deductible. Blue Shield will pay benefits for an individual member on the family plan once the member meets the individual deductible amount. Blue Shield will pay benefits for all covered family members once the family deductible is satisfied. The family deductible can be satisfied when two family members meet their individual deductibles, or when the combined deductible contributions of three or more members reaches the family deductible limit.

2. Family coverage includes an individual out‑of‑pocket maximum (OOPM) within the overall family OOPM. Blue Shield pays 100% for covered services for a family member once that person meets their individual OOPM. Blue Shield pays 100% for all covered family members once the family OOPM is met. The family OOPM can be reached when two members meet their individual OOPM or when the combined OOPM amounts of three or more members reach the family limit.

3. Collection frames are pre-selected frames by insurance providers which are fully covered with no out of pocket costs. Non-collection frames are other standard retail or designer frames with a fixed allowance.

* A referral from your PCP is required to see virtual and in-person providers and specialists.

† Blue Shield does not offer HSAs or tax advice. HSAs are offered through unaffiliated financial institutions. Tax treatment and eligibility are subject to IRS rules and individual circumstances. Residents of California pay full state income tax on HSA contributions, growth and distributions. Consult IRS Publication 969 or your tax advisor for guidance.

This page provides details on plan deductibles, copayments, and coinsurance amounts for common services when using in-network providers. It is not a contract. Plan benefits are only available when using providers in the IFP Trio HMO network. Services received from providers outside of your network and medical group are not covered, except for emergency, urgent, and follow-up care. For complete plan details, refer to the Evidence of Coverage (EOC) available under Individual and Family plan documents, or call us at (888) 256-3650.

Bronze 7500 Trio HMO

Low premiums with protection from major expenses

In-person vs. virtual care

Plan benefits in detail

Deductibles and maximum out-of-pocket

Care from your providers (physician services)

Labs and tests (diagnostic X-ray, imaging, pathology, and laboratory services)

Emergency and urgent care services

Care at the hospital (inpatient and outpatient services in a hospital setting)

Dental and vision care for kids (pediatric dental and vision for children up to age 19)

Prescription drugs from your local network pharmacy or Amazon Pharmacy home delivery

Additional features