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Preferred plan (Gold)

Preferred plan (Gold)

Blue Shield pays, on average, 80% of covered medical expenses

Our Preferred plan offers exceptional coverage with manageable out-of-pocket costs, so it’s easier to predict additional expenses. There are no deductibles, so we start paying for covered benefits immediately, including popular benefits such as doctor visits, prescription drugs, and urgent care.

This plan is available for purchase directly through Blue Shield or through Covered California.

Preferred plan (Gold) – Benefit Overview

Benefit Participating providers1 (PPO and EPO): Non-participating providers1 (PPO only):
Office visit - primary care doctor $302 50%2
Office visit - specialist doctor $502 50%2
Urgent care visit $602 50%2
Preventive health benefits $02 Not covered
Inpatient hospitalization 20% 50%
Outpatient surgery 20%2 50%2
Lab $302 50%2
X-ray $502 50%2
Emergency room services not resulting in admission $250 $250
Maternity 20% 50%
Generic drugs $192 Not covered
Preferred brand drugs $50 Not covered
Non-preferred brand drugs $70 Not covered
Chiropractic Not covered Not covered
(from a licensed acupuncturist)
$302 $302
Pediatric eye exam $02 Up to $302
Pediatric eyeglasses $02 $55 single vision2
Calendar-year medical deductible $0 $0
Calendar-year out-of-pocket maximum
(includes deductible)
$6,350 per individual / $12,700 per family $9,350 per individual / $18,700 per family
Calendar-year brand drug deductible $0 Not covered

Get complete health plan details

For complete plan details on our Preferred PPO and Preferred EPO plans, see the Benefit Summaries and Legal Disclosures below:

Benefit Summary for Preferred PPO (PDF, 449KB)
Benefit Summary for Preferred EPO (PDF, 449KB)

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

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.

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We'll respond within 30 minutes Monday to Friday, 8 a.m. to 5:30 p.m. PST, or the next business day for requests made at all other times.