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Get Covered is designed specifically for people under age 30, or those age 30 and over who can provide a certification that they are without affordable coverage or are experiencing financial hardship, and need to purchase a low-cost plan option. The plan carries a high deductible. Most services are subject to the medical deductible, but you’ll still receive important benefits like preventive care and three doctor visits for no additional cost 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||$0 for first 3 visits per calendar year prior to deductible2, then $0 after deductible||50%|
|Office visit - specialist doctor||0%||50%|
|Urgent care visit||$0 for first 3 visits per calendar year prior to deductible2, then $0 after deductible||50%|
|Preventive health benefits||$02||Not covered|
|Emergency room services not resulting in admission||0%||0%|
|Generic drugs||0%4||Not covered|
|Preferred brand drugs||0%4||Not covered|
|Non-preferred brand drugs||0%4||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||$6,350 per individual / $12,700 per family||$6,350 per individual / $12,700 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 Get Covered PPO and Get Covered 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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