Our Blue Shield Silver 70 Trio HMO, Blue Shield Gold 80 Trio HMO, and Blue Shield Platinum 90 Trio HMO plans use the same network of doctors and hospitals but offer different monthly premiums, annual deductibles, and out-of-pocket costs for care.
You can buy these plans direct from Blue Shield or from the Covered California marketplace.
Designed to balance premium and predictable costs (like copays) for unplanned care. Blue Shield pays approximately 70% of expenses with this plan.
Designed for those with moderate to frequent plan usage. No medical or prescription drug deductibles means lower costs. Blue Shield pays approximately 80% of expenses with this plan.
Offers the lowest out-of-pocket costs for services with low copays and no medical or prescription drug deductibles. Blue Shield pays approximately 90% of expenses with this plan.
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.
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.
| Blue Shield Silver 70 Trio HMO | Blue Shield Gold 80 Trio HMO | Blue Shield Platinum 90 Trio HMO | ||
|---|---|---|---|---|
Deductibles and maximum out-of-pocket | ||||
| Calendar year medical deductible | $4,700 per individual / $9,400 per family1 | $0 | $0 | |
| Calendar year medical deductible | $50 per individual / $100 per family1 | $0 | $0 | |
| Calendar year out-of-pocket maximum2 | $11,650 per individual / $23,300 per family | $9,600 per individual / $19,200 per family | $5,500 per individual / $11,000 per family | |
Care from your providers (physician services) | ||||
| Primary Care | Preventive care | $0 | $0 | $0 |
| Office visit (in-person or telehealth) | $50 | $40 | $20 | |
| Specialist | Office visit (in-person or telehealth) | $100 | $80 | $45 |
| Mental health / substance use disorders | Office visit (in-person or telehealth) | $50 | $40 | $20 |
Labs and tests (diagnostic X-ray, imaging, pathology, and laboratory services) | ||||
| Laboratory and pathology services at a laboratory center | $50 | $40 | $25 | |
| Basic imaging services (including X-rays and ultrasounds) at an outpatient radiology center | $95 | $85 | $35 | |
Emergency and urgent care services | ||||
| Emergency room | Physician services | $0 | $0 | $0 |
| Facility services (waived if admitted to the hospital) | $400 per visit | $350 per visit | $225 per visit | |
| Urgent care center services | (in-person or telehealth) | $50 per visit | $40 per visit | $20 per visit |
Care at the hospital (inpatient and outpatient services in a hospital setting) | ||||
| Inpatient | Physician services | 30% | $0 | $0 |
| Facility services | 30% (subject to deductible) | $375 per day (up to 5 days per admission) | $325 per day (up to 5 days per admission) | |
| Outpatient | Physician services | 30% | $75 per visit | $50 per visit |
| Facility services | 30% | 20% | 10% | |
Dental and vision care for kids (pediatric dental and vision for children up to age 19) | ||||
| Dental | Oral exam | $0 | $0 | $0 |
| Preventive cleaning | $0 | $0 | $0 | |
| Topical fluoride | $0 | $0 | $0 | |
| Vision | Comprehensive eye exam | $0 | $0 | $0 |
| Glasses (collection frames)3 | $0 | $0 | $0 | |
| Contacts (hard or soft, elective or non-elective) | $0 | $0 | $0 | |
Prescription drugs from your local network pharmacy or Amazon Pharmacy home delivery | ||||
| Contraceptive drugs and devices | 30 day supply | $0 | $0 | $0 |
| 90 day supply home delivery | $0 | $0 | $0 | |
| Tier 1 | 30 day supply | $20 per prescription | $19 per prescription | $10 per prescription |
| 90 day supply home delivery | $60 per prescription | $57 per prescription | $30 per prescription | |
| Tier 2 | 30 day supply | $65 per prescription (subject to pharmacy deductible) | $60 per prescription | $25 per prescription |
| 90 day supply home delivery | $195 per prescription (subject to pharmacy deductible) | $180 per prescription | $75 per prescription | |
| Tier 3 | 30 day supply | $95 per prescription (subject to pharmacy deductible | $90 per prescription | $45 per prescription |
| 90 day supply home delivery | $285 per prescription (subject to pharmacy deductible | $270 per prescription | $135 per prescription | |
| Tier 4 | 30 day supply | 20% (up to $250 per prescription and subject to pharmacy deductible) | 20% (up to $250 per prescription) | 10% (up to $250 per prescription) |
| 90 day supply home delivery | 20% (up to $750 per prescription and subject to pharmacy deductible) | 20% (up to $750 per prescription) | 10% (up to $750 per prescription) | |
Additional features | ||||
| Health savings account (HSA) eligible | Consult with your financial or tax advisor if you have questions about HSAs. | No | No | No |
| Out of state care coverage | BlueCard® service area | Limited coverage - refer to the Evidence of Coverage | Limited coverage - refer to the Evidence of Coverage | Limited coverage - refer to the Evidence of Coverage |
| Other professional services | Teladoc Health consultation | $0 | $0 | $0 |
| Chiropractic services | Not covered | Not covered | 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. 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.
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.