Blue Cross Blue Shield Experts

Blue Cross of California is the largest insurer in the state of California, offering traditional plans that can include co-payments for doctor visits and prescriptions, economical major medical plans, and coverage that qualifies to work with a Health Savings Account (HSA).

Before applying please read the Exclusions and Limitations, and
Enrollment Guidelines on the plan brochure.

Plans at a Glance:           Select a plan name below to view its brochure

Plans RIght Plan 40 PPO PPO Share 3500 PPO Lifetime Max $5 Million per Member $5 Million per Member $5 Million per Member Dr. Co-Pay $40 $25 100% after Deductible Rx   Three Options:   1) 2) 3) No Rx Coverage $10 co-pay for generics only $10 co-pay for generics, $30 for brand name, after $500 per year deductible   Co-payment is $10 for Generic Drug, $35 for Brand Name Drugs, after $750 Brand Name deductible.   Co-payment is $10 for Generic Drug, $30 for Preferred Brand Name Drug, 50% off Non-Preferred Brand Name Drug. Wellness Services   Routine mammograms and well baby and child visits - $40 plus 40% of negotiated fee. $25 or $75 co-pay for basic one basic screening per year (deductible waived) for adults and children over age 7.   Healthy Check Centers: $25 or $75 copay for basic screenings. Routine mammogram, PAP and PSA tests ordered by physician: 30% of negotiated fee; well-baby and well-child through age 6, 40% of negotiated fee (deductible waived).   100% after Deductible. $25 or $75 co-pay for basic one basic screening per year (deductible waived) for adults and children over age 7. Deductibles   $0   $500, $1,000, $1,500, $2,500, $5,000 per individual. The family deductible is three times the individual deductible.   $3,500 for single; individual; 2 family max Network Co-insurance 60% + $0 deductible per hospital stay or outpatient surgery 70% after deductible 100% after deductible Non-Network Co-insurance 50% of negotiated fee, member pays 100% of excess. 50% of negotiated fee, member pays 100% of excess. After deductible 50% of negotiated fee, plus 100% of charges in excess of negotiated feee. Out-of-Pocket Maximum (in addition to the deductible) $7,500   $5,000 ($500 and $1,000 deductible), $6,000 ($1,500 deductible), or $7,500 ($2,500 and $5,000 deductibles) /single (2-member maximum) Participating and non-participating combined. Note: Non-participating charges in excess of the negotiated fee will not be paid and do not apply to the out-of-pocket maximum. $5,000 single; individual; $10,000 aggregate family Emergency Services 60% 70%, plus $100 co-pay per visit After deductible, $100 co-pay Acupuncture/ Acupressure After deductible, $25 co-pay - 24 visits per year max $25 co-pay - 24 visits per year max, deductible waived. After deductible, $25 co-pay - 24 visits per year max Other Covered Services 60% 70% after deductible 100% after deductible

Plans 3500 PPO HSA Compatible HMO Lifetime Max $5 Million per Member Unlimited Dr. Co-Pay 100% after Deductible $10 Rx   Co-payment is $10 for Generic Drug, $30 for Preferred Brand Name Drug, 50% off Non-Preferred Brand Name Drug.   Co-payment is $10 for Generic Drug, $30 for Brand Name Drugs, after $250 Brand Name deductible. Wellness Services   100% after Deductible. $25 or $75 co-pay for basic one basic screening per year (deductible waived) for adults and children over age 7. $10 co-pay Deductibles   $3,500 for single; individual; $7,000 aggregate family   $1,500 per member Inpatient Hospital, Outpatient Ambulatory Surgical Center Visit. Network Co-insurance 100% after deductible 80% Non-Network Co-insurance After deductible 50% of negotiated fee, plus 100% of charges in excess of negotiated feee. Not Covered. Out-of-Pocket Maximum (in addition to the deductible) $5,000 single; individual; $10,000 aggregate family $3,000 / single (2-member maximum) Emergency Services After deductible, $100 co-pay   Inpatient and professional services no charge when authorized by a medical group within 48 hours of emergency care. Outpatient you pay $50 emergency room co-payment plus 20%. Acupuncture/ Acupressure After deductible, $25 co-pay - 24 visits per year max Not Covered Other Covered Services 100% after deductible   Subject to $1,500 deductible. Inpatient no charge. Outpatient you pay 20% of negotiated fee (for non-emergency services).

Coverage Synopsis:

Blue Cross of California generally offers the best value for full coverage.  They cover doctor visits, prescription drugs, vision, accident benefit, and of course, hospitalization.  The coverage and rates are excellent, and they have what is probably the widest PPO network in the state of California.  Complete details can be seen by opening the"Outline of Coverage" brochure for the plan you are interested in:

• RIght Plan 40 PPO
• PPO Share
• 3500 PPO
• 3500 PPO HSA Compatible
• HMO

You can also refer to the chart above for a coverage overview.

Notes on Blue Cross of California HMO plan:

A Health Maintenance Organization (HMO) is a plan that provides health care from specific doctors and hospitals that contract with the plan.  While the plans comes with low co-payments for Doctor Visits ($10) and coverage for maternity benefits, your geographical service area is often limited, and you have no coverage if seen by a doctor or hospital that does not participate with the plan.

With an HMO, you must first chose a Primary Care Physician (PCP), from whom you must obtain a referral prior to seeking care from a specialist.  You will not receive coverage for any (non-emergency) care not authorized by your Primary Care Physician at your Participating Medical Group.

Rates:

Rates vary based upon zip code, age, and effective date.  You can get an instant quote online.

PPO Network:

Blue Cross of California gives you access to one of the largest networks in California, with thousands of health care providers throughout the state.  The large list of doctors and hospitals can be viewed at their online directory.

Underwriting:

Blue Cross has one of the easiest, most efficient underwriting teams in the industry.  The process is very fast if no medical records are needed.  While it is always a good idea to apply at least three weeks prior to the time you need your new coverage to take effect, some applications that are done online are approved by BC within 24 hours.  

The company does have the right to accept or decline any individual or family application.  Certain conditions may be waivered with a temporary rider (usually for one to two years), or an indefinite rider.  If you are currently being treated for depression, anxiety, or high cholesterol, please let us know before you apply so we can make sure there are no delays in getting you covered.

Effective dates:

The coverage can go into effect in as quickly as 24 hours, though the applicant risks being declined if claims are submitted before the underwriting process is completed.  You may request an effective date any time the date after you sign the application and 60 days later.  Please note that you will be billed starting on your requested effective date, even if you have not yet been notified that you have been approved.  This is very good for someone who does not have any present coverage and would like for their benefits to begin right away.  For those who are already covered, it is suggested that you maintain your current coverage in force until you have received notice from either Health Insurance for America or directly from Blue Cross that your coverage has been approved and is in force.

Your earliest possible effective date will be the day after Blue Cross has received all the necessary documents and information needed to process your application.

About Blue Cross of California:

Blue Cross of California has been serving the health care needs of Californians since 1937.  Blue Cross of California, together with its branded affiliates, provides health care services to more than 6.8 million members.