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Bronze 60 PPO Plan
Individual and Family Plans

Blue Shield pays, on average, 60% of covered medical expenses


Effective January 1, 2016

We are excited to introduce a new Bronze PPO plan available for purchase only through Blue Shield (off-exchange): the Bronze 5550 PPO. This plan is aimed at non-subsidy eligible consumers looking for more affordable options than our existing Bronze 60 PPO plan.

Bronze 60 PPO Plan   |   Bronze 5550 PPO Plan
Bronze 60 PPO Plan
With low monthly rates in exchange for a higher deductible and more out-of-pocket costs when using services, our Bronze 60 PPO plan gives your clients coverage when you need it most.
Benefit After deductible, member pays
(with participating providers)1
Office visit – primary care doctor $70 for first 3 visits per calendar year prior to deductible,2 then $70 after deductible
Office visit – specialist doctor $90 for the first 3 visits per calendar year,2 then $90 after deductible
Urgent care visit 
$120 for first 3 visits per calendar year prior to deductible,2 then $120 after deductible
Preventive health benefits $0
Inpatient hospitalization Deductible + 100%
Outpatient surgery Deductible + 100%
Lab $40
X-ray  Deductible + 100%
Maternity Deductible + 100%
Emergency room services not resulting in admission Deductible + 100%
Tier 1 drugs Pharmacy deductible + 100% up to $500
Tier 2 drugs Pharmacy deductible + 100% up to $500
Tier 3 drugs Pharmacy deductible + 100% up to $500
Acupuncture
(from a licensed acupuncturist)
$70 for first 3 visits per calendar year prior to deductible,2 then $70 after deductible
Pediatric dental exam $0
Pediatric eye exam $0
Pediatric eyeglasses 1 pair per year
Calendar-year medical deductible $6,000 per individual/$12,000 per family
Calendar-year out-of-pocket maximum
(includes deductible)
$6,500 per individual/$13,000 per family
Calendar-year pharmacy deductible $500 per individual/$1,000 per family
1. The amounts indicated are a percentage of the allowable amounts. Network providers accept Blue Shield's allowable amounts as payment in full for covered services.
2. The three visits prior to meeting the calendar-year deductible include a combination of physician office visits, other practitioners, urgent care visits, and postnatal visits. Subsequent visits are subject to the calendar-year medical deductible.
Bronze 5550 PPO Plan
The Bronze 5550 PPO plan may be a good choice if your clients don't need health care often and want to spend less on your monthly premium.
Benefit After deductible, member pays
(with participating providers)1,4
Office visit – primary care doctor $70 for first 3 visits per calendar year prior to deductible,2 then $70 after deductible
Office visit – specialist doctor Deductible + 30%
Urgent care visit  $120 for first 3 visits per calendar year prior to deductible,2 then $120 after deductible
Preventive health benefits $0
Inpatient hospitalization Deductible + 30%
Outpatient surgery Deductible + 30%
Lab Deductible + 30%
X-ray  Deductible + 30%
Maternity Deductible + 30%
Emergency room services not resulting in admission Deductible + 30%
Tier 1 drugs Deductible + 30% up to $500 per prescription3
Tier 2 drugs Deductible + 30% up to $500 per prescription3
Tier 3 drugs Deductible + 30% up to $500 per prescription3
Acupuncture
(from a licensed acupuncturist)
$70 for 3 visits per calendar year prior to decuctible,2 then $70 after deductible
Pediatric dental exam $0
Pediatric eye exam $0
Pediatric eyeglasses 1 pair per year
Calendar-year medical deductible $5,500 per individual/$11,100 per family5
Calendar-year out-of-pocket maximum
(includes deductible)
$6,500 per individual/$13,000 per family
Calendar-year pharmacy deductible $03
1. This Blue Shield plan must be purchased through Blue Shield, and your broker can help you with the process. All other Blue Shield medical plans displayed on Producer Connection can be purchased through Blue Shield of California or Covered California unless indicated otherwise.
2. The three visits prior to meeting the calendar-year deductible include a combination of physician office visits, other practitioners, urgent care visits, and postnatal visits. Subsequent visits are subject to the calendar-year medical deductible.
3. Prescription drugs are subject to the calendar-year medical deductible.
4. The amounts indicated are a percentage of the allowable amounts. Network providers accept Blue Shield's allowable amounts as payment in full for covered services.
5. For family coverage, Blue Shield will pay benefits for an individual member 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 contribution of three more members reaches the family deductible limit.
For complete medical plan details, see the Benefit Summaries and Legal Disclosure.

Rates for our vision plans are available in our IFP rate books or through our Quote & Apply tool.
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