Which Blue Shield Health Plans is Right for You

Without health coverage, unexpected medical events can really add up. Did you know that an average day in the hospital can cost more than $12,000? But with the right plan you don’t need to worry, because that day in the hospital can cost you much less.

Given the importance of selecting a health plan that’s right for you, and knowing it can cause you some anxiety, we want you to think about a few simple questions to help guide your choice and make it easier.

Blue Shield offers seven main categories of health plans Vital Shield, Vital Shield Plus, Shield Spectrum, Balance Plans, Essential Plans, Shield Savings Plan and HMO Plans.

Vital Shield Plans are lowest-priced PPO plans for individuals. Blue Shield offers three Vital Shield plans, Vital Shield 900 and Vital Shield 2900.

Vital Shield plans cover you with basic benefits and a low or moderate deductible in case of hospitalization, surgery or other major medical events. These lower-priced PPO options cover two office visits and generic drugs, before you have to meet a deductible. They are available for individuals only and offer many popular benefits, so you don’t pay for services you don’t expect to use, such as maternity care or brand-name drug benefits.
Vital Shield advantages;

• Monthly rates as low as $52.
• Choice of low or moderate annual deductible ($900 or $2,900).
• You’re covered at 100% after you meet the copayment maximum.
• Low copayments for generic prescription drugs at network pharmacies ($10).
• Two calendar-year office visits before you have to meet the deductible.
• X-ray and laboratory outpatient services are $0 with preferred providers, only you meet the plan’s copayment maximum.

Vital Shield Plus plans offer option of generic and brand name drug benefit. Blue Shield offers six Vital Shield Plus plans, Vital Shield Plus 400, Vital Shield Plus 400 Generic Rx, Vital Shield Plus 900, Vital Shield Plus 900 Generic Rx, Vital Shield Plus 2900 and Vital Shield Plus 2900 Generic Rx.
You want the same coverage as our Vital Shield plans, plus more covered office visits in a calendar year, plus a lower deductible option, plus brand or generic prescription drug options, plus lower office visit and preventative care exam copayments. Vital Shield Plus plans offer you and your family the vital health coverage you need to protect yourself against the high costs of hospitalization, surgery, and other major medical events. And with no maternity coverage and generic prescription drug coverage options, you aren’t paying for services you don’t expect to use.
Vital Shield Plus advantages;

• Control your monthly rate by choosing a law annual deductible of$400, a moderate deductible of $900, or a higher deductible of $2,900.
• 5 calendar-year office visits, before you hate to meet the deductible, so you will get the care you need in case of injury.
• $10 generic prescription drug coverage right away, before you have to meet a deductible, at network pharmacies.
• You are covered at 100% after you meet the coinsurance maximum, so you’re protected when you need it most.
• Outpatient X-ray and laboratory services are $0 with preferred providers, once you meet the plan’s copayment maximum.
• If you do not meet your annual deductible in a calendar year, you can “carry over” the amount accrued, from October to December of that year, and apply it towards your annual medical deductible for the following year.

Single Shield Spectrum PPO 5000 is in its own category. Shield Spectrum PPO 5000 offers unlimited preventative care office visits to the doctors you want, along with maternity coverage.

Shield Spectrum PPO 5000 advantages;

• When 2 or more family members are on one plan, each covered individual has his or her own individual deductible, in case only one person needs expensive medical care.
• Brand-name prescriptions are only $35 per prescription after you meet the brand-name drug deductible.
• Copayment/coinsurance maximums help contain costs, because your family copayment maximums are only twice the individual amount, no matter how many people are covered.

Blue Shield offers three Balance Plans Balance Plan 1000, Balance Plan 1700 and Balance Plan 2500. These PPO plans offer a sensible balance of comprehensive benefits with relatively low deductible.

Balance Plan Advantages;

• A variety of deductibles to choose from.
• The plan’s copayment/coinsurance maximum includes your medical deductible, so you’ll pay only up to the copayment/coinsurance maximum in a calendar year.
• Doctor’s office visit and preventative care exam are provided for a fixed copayment ($30) before you need to meet the deductible.
• Generic drugs for $10.
• Includes benefits for chiropractic care and acupuncture.

Essential plans; Essential Plan 1750, Essential Plan 3000 and Essential Plan 4500

Essential plans simplify getting the coverage you need by combining medical, dental, and vision benefits all in one plan.
Is an Essential plan right for you?

You’re an individual who only wants coverage to protect you in case of major medical events, and also provides essential benefits for doctor visits. Our Essential plans allow you to control the total annual amount you spend on copayments and deductibles, and include dental and vision coverage at no added cost. They are available for individuals only and offer essential benefits, so you don’t pay for services you don’t expect to use, like maternity care or brand-name drug benefits. By providing you with affordable coverage, including dental and vision, these plans offer you the essential coverage you need.
Essential plan advantages

• Comprehensive coverage – includes medical, dental, and vision care.
• Affordable monthly rates.
• Manageable out-of-pocket medical costs.
• Your copayment maximum equals the deductible.
• You’re covered at 100% after the deductible is met (see Policy for details).
• Affordable copayments for the preventative care exam ($40) and generic prescription drugs at network pharmacies ($10).
• Choice of 3 annual deductibles ($1,750, $3,00, and $4,500).

Shield Savings plan; Shield Savings 1800/3600, Shield Savings 3500, Shield Savings 4000/8000 and Shield Savings 5200

These high-deductible health plans offer a preventative care exam before having to meet the deductible, are compatible with a Health Savings Account (HSA), and offer you protection against major healthcare expenses.

Shield Savings advantages
To help you stay healthy, the preventative care exam is provided right away, before meeting any deductible, for $0 with Shield Savings plans 3500, 4000/8000, and a fixed copayment with Shield Savings plan 1800/3600

Your out-of-pocket maximum includes your plan deductible, so you’ll pay only up to your plan’s out-of-pocket maximum in a calendar year.
No copayment for covered prescription drugs once you meet the out-of-pocket maximum, and convenient access to a mail service pharmacy benefit.

For Shield Savings plans 1800/3600 and 4000/8000:

• Once the family deductible is met, all remaining covered family members will have met their deductible. The family deductible can be met by any family member or combination of family members.
• For Shield Savings plans 3500 and 5200:
• When two or more family members are on one plan, each coverage individual has his or her own individual deductible, in case only one person needs expensive medical care.

Compare with Health Savings Accounts. A variety of deductible options.
Shield Savings plans 3500, 4000/8000, and 5200 provide critical services, like office visits, hospitalizations, outpatient X-ray and laboratory services with preferred providers, for $0 after you meet the plan’s deductible.

HMO plans; Access+ Value HMO and Access+ HMO

Our affordable HMO plans offer a predictable, cost-efficient way to manage your health care, especially if you or your dependents visit the doctor often. These plans may also help you to navigate the healthcare system.

Our HMO plan are perfect for those who like predictable out-of-pocket costs with minimal paperwork. Before having to meet a deductible, you’ll have easy access to a wide range of services for a small copayment, like a routine preventative and well-baby care.

Access+ Value HMO and Access HMO plan advantages;

• Affordable $20/$35 office visit copayments; $10 copayments for generic drug prescriptions.
• See a specialist in your Personal Physician’s participating medical group/IPA without a referral for a $35/$50 copayment.
• Basic dental services includes with Access+ HMO.
• No lifetime maximum on plan benefits
• Practically no claim forms.