Individual & family health plans

Understand your coverage. Choose confidently.

Insurance terms
Premium

A premium is a fixed monthly payment for your coverage. Includes preventive care and protection from major medical expenses.

Calendar year deductible

The calendar year deductible is the amount you pay for covered services before Blue Shield contributes. Some services, like preventive care, are covered before meeting the deductible.

Cost sharing

Cost sharing is the amount you pay after meeting your deductible. It can include:

 

  • Copays: Fixed fees for services like office visits or prescriptions.

 

  • Coinsurance: A percentage of the cost for procedures or hospital visits. In-network coinsurance is based on negotiated rates.
Out-of-pocket maximum

The out-of-pocket maximum is the most you’ll pay in a year for covered services. Once reached, your plan covers 100% of eligible costs.

 

PPO plans have separate costs for in-network versus out-of-network care. Using in-network providers is usually more cost-effective.

Choosing the right plan tier
Bronze plans
Best for: You rarely use healthcare and want to pay as you go.
Silver plans
Best for: Moderate healthcare use or if you qualify for Covered California benefits.
Gold plans
Best for: If you visit doctors often or take multiple medications.
Platinum plans
Best for: Managing chronic conditions or expected procedures.
PPO network

Blue Shield of California’s PPO network is the largest in California. Our network offers flexibility in choosing providers, typically at a higher cost.

Trio HMO network

Blue Shield’s Trio HMO network has a smaller, curated network, which offers high-quality care at lower costs when used in-network.

 

If you’re happy with your current Trio HMO providers, you’re all set. If you expect to need specific specialists or facilities, a PPO plan may offer better access.

Use our Find a Doctor tool to explore providers and facilities in your network.*

* We make efforts to ensure that our list of providers is current and accurate. However, because providers leave networks from time to time, this list is subject to change, and you are encouraged to check with the provider before using their services.