Blue Shield of California Active Start PPO Plans

Blue Shield of California offers two PPO plans in the Active start category, the Plan 25 and the Plan 35. These plans are only available to individuals and are designed to provide coverage for young, active adults that are in good health. Children and spouses may not be included on an Active Start PPO plan. Both plans offer $0 deductibles and low copayments for the covered services that are most utilized by young adults. Maternity benefits are not covered under these plans because they are not designed as family health plans. The monthly rates are among the least costly of all Blue Shield of California PPO plans and are primarily designed to provide protection against a catastrophic illness or injury. The coinsurance percentages and annual out-of-pocket maximums are a bit on the high side. Part of the reason that these plans have lower monthly premiums is that they require you to use preferred Blue Shield providers in order to maximum your benefits. These preferred providers have the lowest negotiated rate agreements with Blue Shield on covered medical expenses, which allow them to pass the saving on to you in the form of a reduced monthly health insurance premium.

Blue Shield of California Active Start Plan 25

This is the more expensive of the two Active Start Plans, but it offers the lowest copayments and coinsurance maximum. There is no deductible, so all medical covered medical expenses receive a first-dollar benefit. Office visits have a $25 copayment when using the preferred provider network, but outside of that network you will pay 50% in addition to any fees above the allowable amount. This is the amount that is accepted as payment in-full by the preferred providers and charges you are required to pay above this allowable amount will not be applied to your coinsurance annual maximum of $8,000. When receiving medical treatment from preferred providers only, your coinsurance maximum is reduced to $6,000. Routine physical and OB/GYN exams are $25 and include Pap test, mammogram and immunizations. Most other medical expenses, such as inpatient hospital, outpatient surgery and lab and x-ray, require a 40% coinsurance. There is an additional hospital admittance fee of $500, which also applies to admittance for mental health disorders and chemical dependency. Acupuncture and chiropractic services are also covered, but both are limited to 12 visits per year. The Active Start Plan 25 medical insurance policy has a lifetime maximum benefit of $6 million. Bariatric surgery is covered under this plan if pre-authorization is received and your physician convinces Blue Shield that this procedure is medically necessary.

Blue Shield of California Active Start Plan 35

This plan is very similar to the Active Start Plan 25, with office visits $10 higher at a $35 copayment. The premiums are less expensive on this plan because the coinsurance maximum is 25% higher. Besides that, the two plans are identical. Both plans offer prescription drug coverage, but with limited benefits. Generic drugs are $10, brand formulary is $35 and brand non-formulary is $50. Plan 25 has a $500 deductible for brand name drugs, and the Active Start Plan 35 has a $750 deductible. For non-formulary brand drugs, the coinsurance is 50% if that amount exceeds the copayment of $50. Some medical treatments are subject to maximum benefit levels. Outpatient office visits for non-sever mental health conditions are limited to 20 visits per year, but severe mental health conditions, as defined by the California mental health parity act, are not limited and must be treated like any other physical illness. Maternity benefits, including prenatal and postnatal care, are excluded from coverage on this PPO health insurance plan. Out-of-state health care is available through the BlueCard network, which provides access to Blue Cross Blue Shield participating physicians nationwide.

The information provided on this page is subject to change and my not be current. Check with the insurance company or your insurance agent for verification of details. The information provided is for comparison purposes only and is not legally binding. Always review the plan brochure or your policy details for complete and accurate details about this policy.