The Silver 2800 HDHP PPO plan combines a moderate deductible, nationwide access to a large network of doctors, and the option to open a health savings account (HSA) for tax advantages.

The plan is only available for purchase direct from Blue Shield.

Our Exclusive PPO Network

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.

See any doctor in our network

You won’t need to choose a primary care doctor, and you can see any doctor in the network without a referral. Choose from in-person and virtual doctors.

Virtual care with the Virtual Blue℠ program

You’ll pay a $0 copay per visit when you see a virtual doctor from AccoladeCare.

Coverage that travels with you

With the BlueCard® Program, you’ll have access to more covered services nationwide.*

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

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.

Healthcare in a PPO network
What you’ll pay
Learn about health plan costs

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

 Silver 2800 HDHP PPO
Deductibles and maximum out-of-pocket
Calendar year medical deductibleIndividual plan: $2,800
Family plan: $3,500 for an individual / $5,600 for the family1
Calendar year pharmacy deductibleIncluded in the medical deductible
Calendar year out-of-pocket maximum2$8,700 per individual / $14,700 per family
Care from your providers (physician services)
Primary Care Preventive care
$0
Office visit
(in-person or telehealth)		35%
(subject to deductible)
Virtual Blue℠ program$0
SpecialistOffice visit
(in-person or telehealth)		35%
(subject to deductible)
Virtual Blue℠ program$0
Mental health / substance use disordersOffice visit
(in-person or telehealth)		35%
(subject to deductible)
Virtual Blue℠ program$0
Labs and tests (diagnostic X-ray, imaging, pathology, and laboratory services)
Laboratory and pathology services at a laboratory center35%
(subject to deductible)
Basic imaging services (including X-rays and ultrasounds) at an outpatient radiology center35%
(subject to deductible)
Emergency and urgent care services
Emergency roomPhysician services$0
(subject to deductible)
Facility services (waived if admitted to the hospital)$150 per visit + 40
(subject to deductible)
Urgent care center services(in-person or telehealth)35%
(subject to deductible)
Care at the hospital (inpatient and outpatient services in a hospital setting)
InpatientPhysician services35%
(subject to deductible)
Facility services
40%
(subject to deductible)
OutpatientPhysician services35%
(subject to deductible)
Facility services35%
(subject to deductible)
Dental and vision care for kids (pediatric dental and vision for children up to age 19)
DentalOral exam$0
Preventive cleaning$0
Topical fluoride$0
VisionComprehensive 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 devices30 day supply$0
90 day supply home delivery$0
Tier 130 day supply$20 per prescription
(subject to deductible)
90 day supply home delivery$60 per prescription
(subject to deductible)
Tier 230 day supply40%
(up to $250 per prescription and subject to deductible)
90 day supply home delivery40%
(up to $750 per prescription and subject to deductible)
Tier 330 day supply40%
(up to $250 per prescription and subject to deductible)
90 day supply home delivery40%
(up to $750 per prescription and subject to deductible)
Tier 430 day supply40%
(up to $250 per prescription and subject to deductible)
90 day supply home delivery40%
(up to $750 per prescription and subject to deductible)
Additional features
Health savings account (HSA) eligibleConsult with your financial or tax advisor if you have questions about HSAs.Yes
Out of state care coverageBlueCard® service areaAll covered services - refer to the Evidence of Coverage
Other professional servicesTeladoc Health consultation$0
Chiropractic services35%
(subject to deductible, 15 visits per member per calendar year)

1. For individual plans, you pay the full contracted rate (or "allowable amount") for services subject to the deductible until you reach the $2,800 individual deductible, after which Blue Shield shares costs. For family plans, each person has a $3,500 embedded individual deductible. Blue Shield begins sharing costs for that person once they meet it. Blue Shield begins sharing costs for all family members once the $5,600 family deductible is met, whether by one person or combined family spending.

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.

† 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, 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.