8/7/2019 Blue Shield of California Balance Plans IFP 1-2011

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Balance plansIndividual and Family Plans

Offering you a sensible balance of affordability and great benefits.

If you want the balance of solid coverage with relatively low deductibles and rates, a Balance SM plant may be

right for you. Balance plans provide coverage for preventive care, doctor’s office visits, generic drugs, and

emergency room care right away before you meet your deductible. Additionally, they offer easy access to

chiropractic care and acupuncture, and a wide range of other quality benefits. All Balance plans feature the

same copayments, so you only need to choose the deductible that best suits your needs.

Four great reasons to choose a Balance plan today:

• Lowcopaymentforphysicianofficevisits

• Asmanymedicaldoctorvisitsasyouneed,withouthavingtomeetadeductible

• Comprehensivegenericandbrand-nameprescriptiondrugcoverage

• Chiropracticandacupuncturebenefits

See for yourself all the great benefits of Balance plans

Balance Plan 1000 Balance Plan 1700 Balance Plan 2500

Office visits $30

Preventive care exam $0

Mammogram and

GYN screening

$0

Inpatient hospitalization 30% after deductible

Outpatient surgery $250 + 30% after deductible

Lab and X-ray 30% after deductible

Emergency room1 $100 (waived if admitted) + 30%

Maternity Not covered

Generic Rx $10

Brand formulary Rx $35 after $500 brand Rx deductible

Annual deductible $1,000 per member and

$2,000 per family

$1,700 per member and

$3,400 per family

$2,500 per member and

$5,000 per family

Annual out-of-pocket

maximum (includes

deductible)

$5,500 per member and

$11,000 per family

$6,500 per member and

$13,000 per family

$7,500 per member and

$15,000 per family

Amounts shown represent the member’s financial responsibility when using Blue Shield network providers, unless otherwise indicated. This document is a

summary only. For a detailed description of plan benefits and exclusions, request a copy of the PolicybycallingMemberServicesat(800)431-2809.

Balance Plan 1000

Balance Plan 1700

Balance Plan 2500

8/7/2019 Blue Shield of California Balance Plans IFP 1-2011

http://slidepdf.com/reader/full/blue-shield-of-california-balance-plans-ifp-1-2011 2/2

     A   n

     I   n     d   e   p   e   n     d   e   n     t     L     i   c   e   n   s   e   e

   o     f     t     h   e

     B     l   u   e

     S     h     i   e     l     d

     A   s   s   o   c     i   a     t     i   o   n

   A   3   6   8   0   8   (   1   /   1   1   )

Advantages of Blue Shield Individual and Family plans

• Affordable–we’venegotiatedwithprovidersfor  

lower fees, so you’ll pay less for covered medical

services. A lot less.

• Withmorethan60,000doctors,BlueShieldhassome  

ofthelargestPPOprovidernetworksinCalifornia.If 

you already have a doctor, chances are your doctor

is in one of our networks.

• Lotsofextrassuchasaround-the-clockaccesstoaregistered nurse, wellness programs and discounts,

andout-of-statecoverageatnoadditionalcost.

• 20%visiondiscountsforeyeexams,framesandlenses,

and other products.2

Understanding your plan

To make health coverage easier for you, here is a simple

description of how these plans work:

• Mostbenefitsaresubjecttoyourannualmedical

deductible,butsomebenefits–likeofficevisitsand

genericprescriptiondrugs–youreceiverightaway 

for a copayment.

• Formostothermedicalservices,you’llpaythe

reduced fee we negotiated with your provider until

you’ve reached your annual deductible amount. After

that, you’ll pay only the amount shown on the previous

page, and we’ll pay the rest.

• Ifyoureachyourannualout-of-pocketmaximum,  

then we’ll pay 100% of your costs for most covered

medical services.3

t UnderwrittenbyBlueShieldofCaliforniaLife&HealthInsuranceCompany.

1 Emergency room physician is 30% after deductible.

2 The network of practitioners and facilities in the Discount Vision Program are managed by a contracted vision plan administrator (includ ing any

screening and credentialing of provider). Blue Shield does not review the services provided by discount program providers for medical necessity or

efficacy. Nor does Blue Shield make any recommendations, representations, claims, or guarantees regarding the practitioners, their availability, fees,

services, or products. Some services offered through the discount program may already be included as part of the Blue Shield health plan covered

benefits. Members should access those covered services prior to using the discount program. Members who are not satisfied with products or services

received from the discount program may use the Blue Shield grievance process described in the Grievance Process section of the Policy. Blue Shield

reserves the right to terminate this program at any time without notice.

3 Memberpaymentsforofficevisitsandprescriptiondrugsdonotcounttowardthedeductibleorout-of-pocketmaximum,andcontinuetobecharged

oncetheout-of-pocketmaximumhasbeenmet.SeethePolicy for more details.

Balance your healthcare needswith a Balance plan today!

Tips for families

Families can save money by enrolling as a family (versus enrolling individually)

• Ratesareoftenlower

• Ifyouhavethreeormorefamilymembers,yourtotalfamilydeductiblesandout-of-pocketmaximumsarelower 

on a family plan versus individual plans

• Eachfamilymemberonlyhastomeetthememberdeductible,andthatamountaccumulatestothetotal family deductible