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BAY AREA INSURANCE RATE
Blue Shield offers some of the largest
provider networks in the state.
All Blue Shield plans, emergency
services are covered anywhere in the world.
We’re here to help! If you have questions about finding
the right plan for you, please call (650)
580-6337.
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Starting Monthly Rate |
Annual Deductible |
Out-of-Pocket Maximum |
Preventive Care Exams |
Office Visits |
Inpatient Hospitalization |
Maternity? |
ER Visit |
Prescription Drugs |
Vital
ShieldSM
Plan 2900 |
$52* |
$2,900 |
$5,900 |
See Office Visits |
$40 for first 2 visits per calendar year1 |
40% after annual deductible is met |
No |
$100 + 40% after annual deductible is met |
$10 for generic; brand name drugs not covered |
| Shield
SavingsSM Plan 5200 |
$64* |
$5,200 |
$5,200 |
$0 |
$0 after annual deductible is met |
$0 after annual deductible is met |
No |
$0 after annual deductible is met |
$0 after annual deductible is met4 |
Shield
SavingsSM
4000 |
$64** |
$4,000 |
$4,000 |
$0 |
$0 after annual deductible is met |
$0 after annual deductible is met |
No |
$0 after annual deductible is met |
$0 after annual deductible is met4 |
Vital
ShieldSM
Plan 900 |
$65* |
$900 |
$4,900 |
See Office Visits |
$40 for first 2 visits per calendar year1 |
40% after annual deductible is met |
No |
$100 + 40% after annual deductible is met |
$10 for generic; brand name drugs are not
covered |
| Vital
Shield PlusSM Plan 2900
Generic Rx |
$66* |
$2,900 |
$4,900 |
See Office Visits |
$30 for the first 5 visits per calendar year2
|
40% after annual deductible is met |
No |
$100 + 40% after annual deductible is met |
$10 for generic; brand name drugs not covered |
| Shield
SavingsSM Plan 3500 |
$66* |
$3,500 |
$5,000 |
$0 |
$0 after annual deductible is met |
$0 after annual deductible is met |
No |
$100 after annual deductible is met |
$10 for generic; $35 for brand name drugs after
annual deductible is met4 |
| Vital
Shield PlusSM Plan 900
Generic Rx |
$78** |
$900 |
$3,900 |
See Office Visits |
$30 for first 5 visits per calendar year2 |
40% after annual deductible is met |
No |
$100 + $40% after annual deductible is met |
$10 for generic; brand name drugs not covered |
| Shield
Spectrum PPOSM Plan 5000
|
$81* |
$5,000 |
7,000 |
$35 |
$35 after annual deductible is met |
30% after annual deductible is met |
Yes |
$30% after annual deductible is met |
$10 for generic; $35 for brand name drugs after
a $500 Brand Rx deductible is met4 |
| BalanceSM
Plan 2500 |
$88** |
$2,500 |
$7,500 |
$30 |
$30 |
30% after annual deductible is met |
No |
$100 + 30% |
$10 for generic; $35 for brand name drugs after
a $500 Brand Rx deductible is met - up to $2,5004 |
| Vital
Shield PlusSM Plan 400
Generic Rx |
$101** |
$400 |
$2,900 |
See Office Visits |
$30 for the first 5 visits per calendar year2 |
40% after annual deductible is met |
No |
$100 + 40% after annual deductible is met |
$10 for generic; brand name drugs not covered |
| EssentialSM
Plan 4500 |
$101* |
$4,500 |
$4,500 |
$40 |
$40 for first 3 visits per calendar year3 |
$0 after annual deductible is met |
No |
$100 |
$10 for generic; brand name drugs not covered |
| BalanceSM
Plan 1000 |
$128* |
$1,000 |
$5,500 |
$30 |
$30 |
30% after annual deductible is met |
No |
$100 + 30% |
$10 for generic; $35 for brand name drugs after
a $500 Brand Rx deductible is met – up to $2,5004 |
| Active
StartSM Plan 35 |
$145*** |
no deductible |
$7,500 |
$35 |
$35 |
$500 + 40% |
No |
$100 + 40% |
$10 for generic; $35 for brand name drugs after
a $500 Brand Rx deductible is met4 |
| Access +
HMO® |
$350*** |
$2,000 |
$3,000 |
$20 |
$20 |
$250 after annual deductible is met |
Yes |
$75 |
$10 for generic; $35 for brand name drugs after
a $200 Brand Rx deductible is met4 |
-
1 Limited to first two visits
per calendar year for any combination of preventive
care and physician office visits. After two visits
have been used, the member pays 100% of the
allowable amount until the calendar year copayment
maximum is met, and costs for the visits do not
accrue to deductible or copayment maximum.
-
2 Limited to first five
visits per calendar year for any combination of
preventive care and physician office visits. After
five visits have been used, the member pays 100% of
the allowable amount until the calendar year
copayment maximum is met, and costs for the visits
do not accrue to deductible or copayment maximum.
-
3 Limited to first three
visits per calendar year (preventive care exams and
office visits not combined). After three visits have
been used, the member pays 100% of the allowable
amount until the calendar year deductible is met. No
charge after deductible is met.
-
4 Brand name benefit shown
applies to formulary drugs. Member’s costs may
increase for non-formulary brand name drugs if
covered by the benefit plan. You can check coverage
in the Pharmacy section on blueshieldca.com with our
Drug Database & Formulary search function.
- *
Monthly rates are for individual males age 19-29 in
good health, for the following counties: Alpine,
Butte, Colusa, Del Norte, Humboldt, Imperial, Inyo,
Kern, Kings, Madera, Mendocino, Plumas, San Benito,
San Joaquin, Santa Barbara, San Luis Obispo,
Siskiyou, Sonoma, Stanislaus, and Trinity counties.
Rates may vary by age and region.
- **
Monthly rates are for individual males age 19-29 in
good health, for the following counties: Alameda,
Contra Costa, and Santa Clara counties except ZIP
codes beginning with 940-943. Rates may vary by age
and region.
- ***
Monthly rates are for individual males age 19-29 in
good health, for the following counties: San
Bernardino; Riverside zip codes 91752, 92248 and zip
codes beginning with 923-28 except 92860, 92880,
92883; Orange except zip codes beginning with 926;
Los Angeles zip codes 90247-51, 90260-61, 90274-75,
90500-10 and zip codes beginning with 906-912, 915,
917-18, 935; Ventura except zip codes beginning with
913. Rates may vary by age and region.
All plans listed except Access+ HMO
and Shield Savings 2400 are underwritten by Blue Shield
of California Life & Health Insurance Company. Access+
HMO and Shield Savings 2400 are underwritten by Blue
Shield of California. Vital Shield Plus plans, Shield
Savings plans 3500 and 5200 are subject to regulatory
approval.
This information is not a contract and is only a partial
comparison of some of the benefits of the various Blue
Shield plans. For all plans except Access+ HMO, benefits
shown represent the member’s financial responsibility
when using Blue Shield preferred providers.
Non-preferred provider costs can be higher.
© 2009 Blue Shield of California. Health insurance
products are offered by Blue Shield of California Life &
Health Insurance Company. Health plans are offered by
Blue Shield of California, an Independent member of the
Blue Shield Association. |
