Blue Shield of California Balance Plans
The newest option in the Blue Shield of California list of individual and family health insurance plans are the Balance Plans. These plans are underwritten by Blue Shield of California Life & Health Insurance Company and offer three different deductibles to choose from: $1,000, $1,750 and $2,500. They are called the "Balance Plans" because, according to the Blue Shield February 1, 2007 plan brochure, they "balance coverage and cost and offer a sensible blend of comprehensive benefits and relatively low deductibles." Regardless of the Balance Plan that you select, they all provide coverage for preventive care, physician visits, generic drugs and emergency room care, which are the medical care necessities needed most frequently. The Basic Plans emphasize the use of Blue Shield's preferred provider network of physicians, offering a lower out-of-pocket maximum when you receive medical treatment from this select network.
Blue Shield of California Balance PPO 1000
Of the three Blue Shield Balance PPO Plans, this is the one that has the lowest deductible. It is also the most expensive of the three medical insurance plans in this portfolio category. The monthly premium for the other health plans decreases as your selected deductible increases. The annual deductible is $1,000, but does not apply to office visits and preventive care, both of which are offered at a $30 copayment. This copayment does not apply to the $5,500 annual out-of-pocket maximum, so you will still be required to make this office visit copayment, even after reaching your maximum. Other benefits are provided at a 30% coinsurance, some of which have additional admittance fees or limitations. Out-patient surgery is $250 plus the coinsurance when preformed in a participating hospital, but limited to $300 if performed and a non-participating ambulatory surgery center. Emergency room visits are $100 plus 30%, both in and out-of-network. Chiropractic services and acupuncture is available with preferred providers for a 50% coinsurance, but only chiropractic is not applicable to the plan deductible. Both services are limited maximum payable benefits of $25 per visit. All Blue Shield Balance PPO health insurance plans provide out-of-state coverage, as long as you remain a resident of the state of California and do not permanently relocate to another state. Prescription drugs are covered at $10 generic, $35 brand formulary and $50 non-formulary brand. For non-formulary drugs, you will pay 50% of the cost of the drug, if the cost is over $100.
Blue Shield of California Balance PPO 1700
This Blue Shield Balance plan has the mid-range premium and deductible and offers identical coverage identical to the Balance PPO 1000 plan, with a few exceptions. The annual deductible is $1,700 for individuals and $3,400 for families. The coinsurance is still 30% when using preferred health care providers, but the coinsurance maximum is $6,500 for individuals and $13,000 for families. The calendar year copayment maximum includes the plan deductible. For a summary of the covered benefits under this plan, refer to the description of the Balance PPO 1000 plan above. All three Balance PPO plans provide family planning benefits, but do not coverage services related to pregnancy, such as prenatal and postnatal care or hospital delivery and other necessary charges. Non-severe mental conditions are limited to 20 out-patient visits per year, as are visits related to the treatment of alcohol or drug abuse. Brand name drugs are covered under these plans, but are subject to a separate annual deductible of $500. Mail order generic drugs are $20 for a 60 day supply. As with all Blue Shield PPO plans, the Balance Plans provide coverage for Bariatric surgery if is authorized by a preferred provider who can verify that the procedure if medically necessary to control obesity. Hospital stays at medical facilities that are not on the Blue Shield preferred list are limited to a maximum benefit of $250 per day.
Blue Shield of California Balance PPO 2500
This plan has the highest deductible of the three Balance PPO plans, and the lowest monthly premium. The annual deductible is $2,500 for individuals and $5,000 for families. When using Blue Shield's network of preferred health care providers, your annual out-of-pocket maximum is $7,500 for individuals and $15,000 for a family. The lifetime maximum benefit is $6,000,000. If you ever reach this limit, your medical insurance policy will not longer provide you with coverage for future illnesses and will be terminated. Other than these minor differences, the benefits for this higher deductible health plan are the same as the $1,000 and $1,750 plans. Other limitations that apply to all three plans include a limit of 90 visits per year for home health care services and 20 visits per year for rehabilitation services. For medical services provided by a non-preferred provider, the 50% coinsurance is based on the negotiated rate available through preferred providers. You will pay 50% of this amount, plus 100% of all charges in excess of this amount.
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.