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.
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.
| Silver 1850 PPO | ||
|---|---|---|
Deductibles and maximum out-of-pocket | ||
| Calendar year medical deductible | $1,850 per individual / $3,700 per family1 | |
| Calendar year pharmacy deductible | $350 per individual / $700 per family1 | |
| Calendar year out-of-pocket maximum2 | $11,500 per individual / $23,000 per family | |
Care from your providers (physician services) | ||
| Primary Care | Preventive care | $0 |
| Office visit (in-person or telehealth) | $55 | |
| Virtual Blue℠ program | $0 | |
| Specialist | Office visit (in-person or telehealth) | $85 |
| Virtual Blue℠ program | $0 | |
| Mental health / substance use disorders | Office visit (in-person or telehealth) | $55 |
| Virtual Blue℠ program | $0 | |
Labs and tests (diagnostic X-ray, imaging, pathology, and laboratory services) | ||
| Laboratory and pathology services at a laboratory center | $50 | |
| Basic imaging services (including X-rays and ultrasounds) at an outpatient radiology center | 35% (subject to deductible) | |
Emergency and urgent care services | ||
| Emergency room | Physician services | 35% (subject to deductible) |
| Facility services (waived if admitted to the hospital) | $300 per visit + 40% (subject to deductible) | |
| Urgent care center services | (in-person or telehealth) | $55 per visit |
Care at the hospital (inpatient and outpatient services in a hospital setting) | ||
| Inpatient | Physician services | 35% (subject to deductible) |
| Facility services | 40% (subject to deductible) | |
| Outpatient | Physician services | 35% (subject to deductible) |
| Facility services | 35% (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 |
| 90 day supply home delivery | $0 | |
| Tier 1 | 30 day supply | $20 per prescription |
| 90 day supply home delivery | $60 per prescription | |
| Tier 2 | 30 day supply | $75 per prescription (subject to pharmacy deductible) |
| 90 day supply home delivery | $225 per prescription (subject to pharmacy deductible) | |
| Tier 3 | 30 day supply | $150 per prescription (subject to pharmacy deductible) |
| 90 day supply home delivery | $450 per prescription (subject to pharmacy deductible) | |
| Tier 4 | 30 day supply | 35% (up to $250 per prescription and subject to pharmacy deductible) |
| 90 day supply home delivery | 35% (up to $750 per prescription and subject to pharmacy deductible) | |
Additional features | ||
| Health savings account (HSA) eligible | Consult with your financial or tax advisor if you have questions about HSAs. | No |
| 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 | $15 per visit (15 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.
* The BlueCard® program enables members to access providers for care outside of California in another BlueCard Service Area and either receive Covered Benefits or limited coverage, depending on the plan. Limited coverage means coverage only for urgent care, emergency care, and follow up urgent and emergency Care. Refer to the Evidence of Coverage for more information.
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, including non-network benefits, refer to the Evidence of Coverage (EOC) available under Individual and Family plan documents, or call us at (888) 256-3650.