Blue Shield of California Spectrum PPO Plans

There are five Blue Shield PPO plans available under the Spectrum series; 500, 750, 1500, 2000 and 5000. All Spectrum PPO Plans provide you with the freedom to choose your own physicians, but your share of cost and coinsurance maximums are substantially reduced if you access all of your health care through providers that participate in the Blue Shield Preferred Provider Network. These physicians and medical facilities have specially negotiated rates with Blue Shield that allow the insurance company to monitor medical fees, keep them at a discounted rate and pass the savings on to their plan members. When using this exclusive list of providers, your coinsurance amount will be based on these discounted rates, as will the amount that Blue Shield of California will pay to out-of-network physicians. All of the Spectrum plan offer office visits and preventive health care without having to meet your plan deductible. The copayment varies based on the plan you select. Annual OB/GYN exams include Pap test, routine mammogram and immunizations if performed as part of the annual preventive exam. Each plan offers a lifetime maximum benefit of $6 million. There is a separate annual deductible for brand name prescription drugs, which is $250 on the 500 and 750 Plans, and $500 on the 1500, 2000 and 5000 Spectrum PPO Plans. For all plans, generic prescriptions are $10 and not subject to a deductible. The family deductibles and coinsurance maximums can be met accumulative, but each family member will not exceed the individual deductible amount.

Blue Shield of California Spectrum PPO 500 Plan

This is plan has the highest monthly premium of the five Spectrum PPO plans, but offers the lowest coinsurance, office visit copayment and coinsurance maximum. Office visits with Blue Shield providers are $30 and not subject to the plan deductible. The coinsurance percentage for other covered services is 25%. The annual deductible is $500 per individual, or $1,000 for a family, with a coinsurance maximum of $3,500. Once you meet the plan deductible, you will pay 30% of health care charges until your 30%, along with your deductible, reaches this maximum. Once you have reached that amount, you are covered in full for the remainder of the calendar year, excluding treatment out-of-network and services requiring a flat copayment amount.

Blue Shield of California Spectrum PPO 750, 1500 and 2000 Plans

Each of these Spectrum PPO plans has a 30% coinsurance after the annual deductible. The PPO 750 Plan has a deductible of $750, the 1500 Plan deductible is $1,500 and the Spectrum 2000 Plan has a $2,000 annual deductible. The family deductible for each of these plans is two times the individual deductible. The coinsurance maximum for each of these plans is as follows; Spectrum 750 is $4,000, Spectrum 1500 is $4,500 and the Spectrum 2000 is $5,000. These maximums are doubled for medical services received outside of the Blue Shield preferred provider network. Out-patient surgery and inpatient hospitalization each have a separate $250 copayment per visit. At non-participating hospitals, Blue Shield will not pay more than $250 toward your stay. There is a $35 copayment for brand name formulary drugs, after the applicable brand deductible has been met. For non-formulary drugs, Blue Shield will pay a maximum of 50% of the cost of filling that prescription, even if it is done through a participating pharmacy.

Blue Shield of California Spectrum PPO 5000 Plan

This is the least expensive of the Spectrum Plans, with an annual deductible of $5,000 and a coinsurance maximum of $7,000 for individuals. Office visits are $35 and the coinsurance for other covered services is 30%, up to an annual maximum of $10,000. Unlike the other Spectrum PPO plans, the 5000 plan does not waive the deductible for office visits, unless it is part of an annual preventive care exam. There is one added benefit that is exclusive to this plan, which is the inclusion of $10,000 of Critical Condition Protection. This is written as a separate indemnity policy, but included in your monthly premium. In the event of a first time incident of a sever heart attack, stroke of certain cancers, you will receive a cash payment of $10,000 that will assist you in meeting the plans coinsurance maximum, thus reducing your annual share of cost to a minimal amount for these catastrophic occurrences.

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.