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Silver PPO Plans
Individual and Family Plans

Blue Shield pays, on average, 70% of covered medical expenses


Effective January 1, 2016

We are excited to introduce two new Silver PPO plans available for purchase only through Blue Shield (off-exchange): the Silver Seven 3750 PPO and Silver 1850 PPO. These plans are aimed at non-subsidy eligible consumers looking for more affordable options than our existing Silver 70 PPO plan with great coverage.

Silver 70 PPO Plan   |   Silver 1850 PPO Plan    |   Silver Seven 3750 PPO Plan

We also offer three Silver cost-sharing reduction plans through Covered California for consumers who meet federal financial guidelines. These plans offer lower cost-sharing to reduce your clients' out-of-pocket costs when accessing medical care.
Silver 70 PPO Plan
Our Silver 70 PPO plan gives your clients affordable, comprehensive coverage and includes benefits like doctor visits and most generic drugs before meeting a moderate deductible.

Benefit Member pays
(with participating providers)1
Office visit – primary care doctor $45
Office visit – specialist doctor $70 
Urgent care visit  $90 
Preventive health benefits $0 
Inpatient hospitalization Deductible + 20%
Outpatient surgery 20% 
Lab $35 
X-ray  $65 
Emergency room services not resulting in admission $250
Maternity Deductible + 20%
Tier 1 drugs $15 
Tier 2 drugs $50
Tier 3 drugs $70
Acupuncture 
(from a licensed acupuncturist)
$45 
Pediatric dental exam $0
Pediatric eye exam $0 
Pediatric eyeglasses 1 pair per year
Calendar-year medical deductible $2,250 per individual/$4,500 per family
Calendar-year out-of-pocket maximum
(includes deductible)
$6,250 per individual/ $12,500 per family
Calendar-year pharmacy deductible $250 per individual/$500 per family
1. The amounts indicated are a percentage of the allowable amounts. Participating providers accept Blue Shield's allowable amounts as payment-in-full for covered services.
Silver 1850 PPO Plan
The Silver 1850 PPO2 plan is comparable to the Silver 70 PPO plan, but with lower rates and a lower deductible in exchange for paying a higher percentage of costs for some services.
Benefit Member pays
(with participating providers)1,2
Office visit – primary care doctor $45
Office visit – specialist doctor $70
Urgent care visit  $90
Preventive health benefits $0
Inpatient hospitalization Deductible + 30%
Outpatient surgery Deductible +30%
Lab Deductible + 30%
X-ray  Deductible + 30%
Emergency room services not resulting in admission Deductible + 30%
Maternity Deductible + 30%
Tier 1 drugs Pharmacy deductible + $15
Tier 2 drugs Parmacy deductible + $50
Tier 3 drugs Pharmacy deductible + $70
Acupuncture
(from a licensed acupuncturist)
$45
Pediatric dental exam $0
Pediatric eye exam $0
Pediatric eyeglasses 1 pair per year
Calendar-year medical deductible $1,850 per individual/$3,700 per family
Calendar-year out-of-pocket maximum
(includes deductible)
$6,500 per individual/ $13,000 per family
Calendar-year pharmacy deductible $250 per individual/$500 per family
1. The amounts indicated are a percentage of the allowable amounts. Participating providers accept Blue Shield's allowable amounts as payment-in-full for covered services.
2. This Blue Shield plan must be purchased through Blue Shield.
Silver Seven 3750 PPO Plan
Our Silver Seven 3750 PPO plan2 is comparable to the Silver 70 PPO plan, but with lower rates and lower copays – such as $7 for doctor visits, most generic drugs, and lab tests – in exchange for carrying a higher deductible.

We also offer three Silver cost-sharing reduction plans through Covered California for consumers who meet federal financial guidelines. These plans offer lower cost-sharing to reduce your clients' out-of-pocket costs when accessing medical care.
Benefit Member pays
(with participating providers)1
Office visit – primary care doctor $7
Office visit – specialist doctor $35
Urgent care visit  $70
Preventive health benefits $0
Inpatient hospitalization Deductible + 30%
Outpatient surgery Deductible + 30%
Lab $7
X-ray  $35
Emergency room services not resulting in admission Deductible + 30%
Maternity Deductible + 30%
Tier 1 drugs $7
Tier 2 drugs Pharmacy deductible + $35
Tier 3 drugs Pharmacy deductible + 70
Acupuncture
(from a licensed acupuncturist)
$7
Pediatric dental exam $0
Pediatric eye exam $0
Pediatric eyeglasses 1 pair per year
Calendar-year medical deductible $3,750 per individual/$7,500 per family
Calendar-year out-of-pocket maximum
(includes deductible)
$6,500 per individual/ $13,000 per family
Calendar-year pharmacy deductible $250 per individual/$500 per family
1. The amounts indicated are a percentage of the allowable amounts. Participating providers accept Blue Shield's allowable amounts as payment-in-full for covered services.
2. 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 or Covered California, unless indicated otherwise.
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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