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BC Life & Health
CORE 5000 |
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Plan Highlights
- Our lowest rates available
- $5,000 annual deductible
- $7,500 annual out-of-pocket maximum
(includes deductible)
- Benefits for hospitalization and
emergency services (after deductible
is met)
- Doctors’ office visits (after
out-of-pocket maximum is met)
- $10 copay for generic prescription
drugs (no deductible)
- Annual routine mammogram, Pap and
PSA tests, as well as HealthyCheckSM
basic or premium screening (deductible
waived)
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CORE
5000 |
In-Network |
Out-Of-Network |
Annual
Deductible |
Individual:
$5,000 Family: $10,000 (Hospital
Only) |
Individual:
$5,000 Family: $10,000 (Hospital
Only) |
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Annual
Out-Of-Pocket Limit |
Individual:
$7,500 Family: $15,000 (Hospital
Only) |
Individual:
$7,500 Family: $15,000 (Hospital
Only) |
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Lifetime
Maximum |
$5,000,000 |
$5,000,000 |
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Office
Visits |
No
Charge After $7,500 Co-Insurance
is Met |
No
Charge After $7,500 Co-Insurance
is Met |
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Prescription
Drugs |
$10
Generic |
$10
Generic |
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Laboratory
and Radiology |
30%
In-Hospital |
50%
In-Hospital |
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Annual
Physical Exam |
$25
or $75 Co-Pay at HealthyCheck
Centers for Basic Screening |
Not
Covered |
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Annual
OB-GYN Exam |
30%
- Deductible Waived |
50%
- Deductible Waived |
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Well
Baby Care |
No
Charge After $7,500 Co-Insurance
is Met |
No
Charge After $7,500 Co-Insurance
is Met |
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Outpatient
Surgery |
30% |
All
Charges Except $380 per day |
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Emergency
Room |
30%
plus $100 (waived if admitted) |
30%
of customary and reasonable plus
$100 (waived if admitted) |
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Ambulance |
30%
($750 Maximum group trip) |
50%
($750 Maximum group trip) |
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Home
Health Care |
See
Benefit Contract |
See
Benefit Contract |
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Mental
Health Services |
See
Benefit Contract |
See
Benefit Contract |
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Chiropractic
Care |
Covered
as In-Patient Only |
Covered
as In-Patient Only |
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Acupuncture
/ Acupressure |
Not
Covered |
Not
Covered |
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Inpatient
Co-payment |
30% |
All
Charges Except $650 per day |
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Maternity
Care |
Not
Covered |
Not
Covered |
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Mental
Health |
See
Benefit Contract |
See
Benefit Contract |
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Chemical
Dependency |
See
Benefit Contract |
See
Benefit Contract |
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| New BC Life &
Health CORE 5000 , BC Life & Health Basic
PPO 1000 blue cross of california CORE 5000
Blue Cross of California (BCC) and BC Life
& Health Insurance Company (BCL&H) are
Independent Licensees of the Blue Cross Association
(BCA). The Blue Cross name and symbol are registered
service marks of the BCA. The following plans
are offered by BCC: PPO Share 2500/1500/1000/500,
Individual HMO, HMO Saver, Select HMO, EPO and
Dental SelectHMO. The following plans are offered
by BCL&H: CORE 5000, Basic PPO 1000/2500,
PPO Saver, PPO Share 5000/1000/500, RightPlan
PPO 40, 3500 Deductible PPO, PPO 3500 (HSA-Compatible),
Short-Term PPO, Tonik, Individual PPO Dental
and Term Life
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