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Oleg
Skurskiy (818) 987-5000 |
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Authorized
Agent for Blue Shield of California |
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Blue
Shield of California
Individual
and Family Plans 2014 |
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Blue
Shield of California
will offer PPO and EPO plans
for 2014 in all 19 California
pricing regions, available for
purchase directly through Blue
Shield or through Covered California.
The plans are categorized into
four metal levels of coverage
based on the percentage of costs
covered for an average population:
Summary
of Benefits
-
Platinum:
You pay 10% of health costs, BlueShield's plan
covers 90%
-
Gold:
You pay 20% of health costs,
BlueShield's plan covers
80%
-
Silver:
You pay 30% of health costs,
BlueShield's plan covers
70%
-
Bronze:
You pay 40% of health costs,
BlueShield's plan covers
60%
We
also offer a Catastrophic level
of coverage for those in the
individual and family plan market
under age 30, or those age 30
and above who can provide a
certification that they are
without affordable coverage,
or experiencing financial hardship.
On this plan, you pay 40% of
health costs, and the plan covers
60%.
We
also offer Native
American plans at each metal
level to eligible Native Americans.
Ultimate PPO/EPO
Plans
(Platinum
90) Benefits
Overview
Benefits1 |
Ultimate |
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With
participating providers,
you pay: |
Office
visit: primary care doctor |
$20 |
Office
visit: specialist doctor |
$40 |
Urgent
care visit |
$40 |
Preventive
health benefits |
$0 |
Inpatient
hospitalization |
10% |
Outpatient
surgery |
10% |
Lab |
$20 |
X-ray |
$40 |
Emergency
room services not resulting
in admission |
$150 |
Maternity |
10% |
Generic drugs |
$5 |
Preferred
brand drugs |
$15 |
Non-perferred
brand drugs |
$25 |
Chiropractic |
Not
covered |
Acupuncture
(from a licensed acupuncturist) |
$20 |
Pediatric
eye exam |
$0 |
Pediatric
eyeglasses |
$0 |
Calendar
year medical deductible |
$0 |
Calendar
year out-of-pocket
maximum (includes deductible) |
$4,000
per individual
and $8,000 per family |
Calendar
year brand drug deductible |
$0 |
return
to top
Preferred
PPO/EPO Plans
(Gold
80)
Benefit
Overview
Benefits1 |
Preferred |
|
With
participating providers,
you pay: |
Office
visit: primary care doctor |
$30 |
Office
visit: specialist doctor |
$50 |
Urgent care visit |
$60 |
Preventive
health benefits |
$0 |
Inpatient
hospitalization |
20% |
Outpatient
surgery |
20% |
Lab |
$30 |
X-ray |
$50 |
Emergency
room services not resulting
in admission |
$250 |
Maternity |
20% |
Generic drugs |
$19 |
Preferred
brand drugs |
$50 |
Non-perferred
brand drugs |
$70 |
Chiropractic |
Not
covered |
Acupuncture
(from a licensed acupuncturist) |
$30 |
Pediatric
eye exam |
$0 |
Pediatric
eyeglasses |
$0 |
Calendar
year medical deductible |
$0 |
Calendar
year out-of-pocket
maximum (includes deductible) |
$6,350
per individual
and $12,700 per family |
Calendar
year brand drug deductible |
$0 |
return
to top
Enhanced
PPO/EPO Plans
(Silver
70)
Benefit
Overview
Benefits1 |
Enhanced |
Enhanced
150 Subsidy |
Enhanced
200 Subsidy |
Enhanced
250 Subsidy |
|
With
participating providers,
after the deductible,
you pay: |
With
participating providers,
you pay: |
With
participating providers,
after the deductible,
you pay: |
With
participating providers,
after the deductible,
you pay: |
Office
visit: primary care doctor |
$452 |
$3 |
$152 |
$402 |
Office
visit: specialist doctor |
$652 |
$5 |
$202 |
$502 |
Urgent
care visit |
$902 |
$6 |
$302 |
$802 |
Preventive
health benefits |
$02 |
$0 |
$02 |
$02 |
Inpatient
hospitalization |
20% |
10% |
15% |
20% |
Outpatient
surgery |
20%2 |
10% |
15%2 |
20%2 |
Lab |
$452 |
$3 |
$152 |
$402 |
X-ray |
$652 |
$5 |
$202 |
$502 |
Emergency
room services not resulting
in admission |
$250 |
$25 |
$75 |
$250 |
Maternity |
20% |
10% |
15% |
20% |
Generic drugs |
$192 |
$3 |
$52 |
$192 |
Preferred
brand drugs |
$50 |
$5 |
$15 |
$30 |
Non-perferred
brand drugs |
$70 |
$10 |
$25 |
$50 |
Chiropractic |
Not
Covered |
Acupuncture
(from a licensed acupuncturist) |
$452 |
$3 |
$152 |
$402 |
Pediatric
eye exam |
$02 |
$0 |
$02 |
$02 |
Pediatric
eyeglasses |
$02 |
$0 |
$02 |
$02 |
Calendar
year medical deductible |
$2,000
per individual
and $4,000 per family |
$0 |
$500
per individual
and $1,000 per family |
$1,500
per individual
and $3,000 per family |
Calendar
year out-of-pocket
maximum (includes deductible) |
$6,350
per individual
and $12,700 per family |
$2,250
per individual
and $4,500 per family |
$2,250
per individual
and $4,500 per family |
$5,200
per individual
and $10,400 per family |
Calendar
year brand drug deductible |
$250
per individual/$500 per
family |
$0 |
$50
per individual/$100 per
family |
$250
per individual/$500 per
family |
return
to top
Basic
PPO/EPO Plans
(Bronze
60)
Benefit
Overview
Summary
of Benefits
Benefits1 |
Basic |
Basic
for HSA* |
|
With
participating providers,
after the deductible,
you pay: |
With
participating providers,
after the deductible,
you pay: |
Office
visit: primary care doctor |
$60
for first 3 visits per
calendar year prior to
deductible2
, then $60 after deductible3 |
40% |
Office
visit: specialist doctor |
$70 |
40% |
Urgent
care visit |
$120
for first 3 visits per
calendar year prior to
deductible2
, then $120 after deductible
3 |
40% |
Preventive
health benefits |
$02 |
$02 |
Inpatient
hospitalization |
30% |
40% |
Outpatient
surgery |
30% |
40% |
Lab |
30% |
40% |
X-ray |
30% |
40% |
Emergency
room services not resulting
in admission |
$300 |
40% |
Maternity |
30% |
40% |
Generic drugs |
$19 |
40% |
Preferred
brand drugs |
$50 |
40% |
Non-perferred
brand drugs |
$75 |
40% |
Chiropractic |
Not
covered |
Not
covered |
Acupuncture
(from a licensed acupuncturist) |
$60 |
40% |
Pediatric
eye exam |
$02 |
$02 |
Pediatric
eyeglasses |
$02 |
$02 |
Calendar
year medical deductible |
$5,000
per individual and
$10,000 per family |
$4,500
per individual and
$9,000 per family |
Calendar
year out-of-pocket
maximum (includes deductible) |
$6,350
per individual
and $12,700 per family |
$6,350
per individual and
$12,700 per family |
Calendar
year brand drug deductible4 |
$0 |
$0 |
return
to top
Get
Covered
PPO/EPO Plans
(Catastrophic/Minimum
Coverage)
Benefit
Overview
Benefits1 |
Get
Covered |
|
With
participating providers,
after the deductible,
you pay: |
Office
visit: primary care
doctor |
$0
for first 3 visits per
calendar year prior to
deductible2,
then $0 after deductible3 |
Office
visit: specialist doctor |
0% |
Urgent
care visit |
$0
for first 3 visits per
calendar year prior to
deductible2,
then $0 after deductible3 |
Preventive
health benefits |
$02 |
Inpatient
hospitalization |
0% |
Outpatient
surgery |
0% |
Lab |
0% |
X-ray |
0% |
Emergency
room services not resulting
in admission |
0% |
Maternity |
0% |
Generic drugs |
0% |
Preferred
brand drugs |
0% |
Non-perferred
brand drugs |
0% |
Chiropractic |
Not
covered |
Acupuncture
(from a licensed acupuncturist) |
0% |
Pediatric
eye exam |
$02 |
Pediatric
eyeglasses |
$02 |
Calendar
year medical deductible |
$6,350
per individual / $12,700
per family |
Calendar
year out-of-pocket
maximum (includes deductible) |
$6,350
per individual / $12,700
per family |
Calendar
year brand drug deductible4 |
$0 |
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Summary
of Benefits
Native
American
Plans
We also offer Native
American plans at each metal level
to eligible Native Americans. These
plans provide the same benefits as
the standard metal level plans when
accessing covered services from network
and non-network providers, but also
allow Native American members to access
covered services from Native American
providers for $0 out of pocket.
In addition to the Native American
metal level plans, we also offer Native
Americans the Native American 300
Subsidy plan. This plan allows Native
American members to access covered
services from Native American providers,
Blue Shield network providers – and
in some locations, even non-network
providers – for $0 out of pocket.
return
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Blue
Shield of California Life &
Health Insurance Company Life was formed
in 1954 as a wholly owned subsidiary
of Blue Shield of California to provide
a full range of insurance products for
their customers. With 3.3 million members
and $7.5 billion in annual revenue,
Blue Shield of California is the state's
third largest health plan. Founded in
1939 and headquartered in San Francisco,
Blue Shield is a not-for-profit corporation
with approximately 4,300 employees and
more than 20 offices throughout California.
Blue
Shield of California Life &
Health Insurance Company Life has
grown by offering competitive insurance
products including Group Term Life,
Accidental Death & Dismemberment,
Blue Shield of California Life &
Health Insurance Company Life Vision
Plan, Stop Loss and Exec-U-Med medical
reimbursement plans in tandem with
Blue Shield of California health plans
or on a stand-alone basis . In the
early 1980s, introduced their Short-Term
Health products. The Option One and
Option Twelve plans remain one of
the leading products of their kind
in California |
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* Underwritten by Blue Shield of California
Life & Health Insurance Company (Blue
Shield Life). |
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Copyright © 2005 Oleg Skurskiy Authorized
Independent Agent, CA License 0E50389 |
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