Built to protect you against major medical costs in an emergency.
Get the lowest premium along with essential preventive care.
Before meeting the deductible, you’ll get three office visits for a $0 copay with an in-network doctor.
The Blue Shield Minimum Coverage PPO plan is available to people under age 30 or people who Covered California determines qualify for a hardship exemption.
This plan is available to buy direct from Blue Shield or from the Covered California marketplace.
The Exclusive PPO Network includes more than 71,000 doctors, 325 hospitals, and 1,000 urgent care centers statewide. Find in-network doctors, medical groups, and hospitals near you.
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 speak with a virtual doctor for $0 through Teladoc Health.
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.
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.
You can see any provider in our Exclusive PPO Network. You also have the option to use providers who do not participate in that network – but your out-of-pocket costs will be higher if you do.
The Minimum Coverage PPO has a higher deductible compared to other plans, which offsets the cost of a low monthly premium.
| Blue Shield Minimum Coverage PPO | ||
|---|---|---|
Deductible and maximum out-of-pocket | ||
| Calendar year medical deductible | $12,000 per individual / $24,000 per family1 | |
| Calendar year pharmacy deductible | Included in the medical deductible | |
| Calendar year out-of-pocket maximum2 | $12,000 per individual / $24,000 per family | |
Care from your providers (physician services) | ||
| Primary Care | Preventive care | $0 |
| Office visit (in-person or telehealth) | $0 for first 3 visits per calendar year prior to deductible, then $0 after deductible3 | |
| Specialist | Office visit (in-person or telehealth) | $0 (subject to deductible) |
| Mental health / substance use disorders | Office visit (in-person or telehealth) | $0 for first 3 visits per calendar year prior to deductible, then $0 after deductible3 |
Labs and tests (diagnostic X-ray, imaging, pathology, and laboratory services) | ||
| Laboratory and pathology services at a laboratory center | $0 (subject to deductible) | |
| Basic imaging services (including X-rays and ultrasounds) at an outpatient radiology center | $0 (subject to deductible) | |
Emergency and urgent care services | ||
| Emergency room | Physician services | $0 |
| Facility services (waived if admitted to the hospital) | $0 (subject to deductible) | |
| Urgent care center services | (in-person or telehealth) | $0 for first 3 visits per calendar year prior to deductible, then $0 after deductible3 |
Care at the hospital (inpatient and outpatient services in a hospital setting) | ||
| Inpatient | Physician services | $0 (subject to deductible) |
| Facility services | $0 (subject to deductible) | |
| Outpatient | Physician services | $0 (subject to deductible) |
| Facility services | $0 (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)4 | $0 (subject to deductible) | |
| Contacts (hard or soft, elective or non-elective) | $0 (subject to deductible) | |
Prescription drugs from your local network pharmacy or Amazon Pharmacy home delivery | ||
| Contraceptive drugs and devices | 30 day supply | $0 |
| 90 day supply home delivery | $0 | |
| Tier 1 | 30 day supply | $0 (subject to deductible) |
| 90 day supply home delivery | $0 (subject to deductible) | |
| Tier 2 | 30 day supply | $0 (subject to deductible) |
| 90 day supply home delivery | $0 (subject to deductible) | |
| Tier 3 | 30 day supply | $0 (subject to deductible) |
| 90 day supply home delivery | $0 (subject to deductible) | |
| Tier 4 | 30 day supply | $0 (subject to deductible) |
| 90 day supply home delivery | $0 (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 |
| Chiropractic services | Not covered | |
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. The first three visits are available prior to meeting the calendar-year medical deductible and include a combination of primary care physician, physician home visit, urgent care, acupuncture, outpatient mental health, outpatient substance use disorder, and other practitioner visits. Subsequent visits are subject to the calendar-year medical deductible.
4. 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.
* 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. 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.