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With low monthly rates in exchange for a higher deductible and more out-of-pocket costs when accessing services, the Basic plan is a good choice if you want to know you’ve got the coverage you need when you need it most. Most services are subject to the medical deductible, but you’ll still receive important benefits like preventive care and three doctor visits for a fixed copayment before meeting the deductible.
This plan is available for purchase directly through Blue Shield or through Covered California.
|Benefit||Participating providers1 (PPO and EPO):||Non-participating providers1 (PPO only):|
|Office visit - primary care doctor||$60 for first 3 visits per calendar year prior to deductible, then $60 after deductible2||50%|
|Office visit - specialist doctor||$70||50%|
|Urgent care visit||$120 for first 3 visits per calendar year prior to deductible, then $120 after deductible2||50%|
|Preventive health benefits||$02||Not covered|
|Emergency room services not resulting in admission||$300||$300|
|Generic drugs||$194||Not covered|
|Preferred brand drugs||$504||Not covered|
|Non-preferred brand drugs||$754||Not covered|
|Chiropractic||Not covered||Not covered|
(from a licensed acupuncturist)
|Pediatric eye exam||$02||Up to $302|
|Pediatric eyeglasses||$02||$55 single vision2|
|Calendar-year medical deductible3||$5,000 per individual / $10,000 per family||$5,000 per individual / $10,000 per family|
Calendar-year out-of-pocket maximum
|$6,350 per individual / $12,700 per family||$9,350 per individual / $18,700 per family|
|Calendar-year brand drug deductible||$04||Not covered|
For complete plan details on our Basic PPO and Basic EPO plans, see the Benefit Summaries and Legal Disclosures below:
Legal Disclosure (PDF, 916KB)
We also have Summary of Benefits and Coverage Forms that can help you make a decision by providing you with an easy to understand overview of what these plans cover. Visit blueshieldca.com/sbc to obtain the forms.
Pediatric dental is an essential health benefit for children under age 19, and must be purchased when applying for a medical plan directly through Blue Shield. We offer four pediatric dental plans to choose from. Download our pediatric dental plans flier for more information.
Individual / Family Plans
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