Rich Benefits Plans
| Shield Savings Plan 2400 |
Shield Spectrum PP0 Plan 2000 | Active Start Plan 35 |
Access+ HMO® | |
| Starting Monthly Rate | $129* | $130** | $145** | $350** |
| Annual Deductible | $2,400 | $2,000 | no deductible | $2,000 |
| Out-of-Pocket Maximum | $4,000 | $7,000 | $7,500 | $3,000 |
| Preventive Care Exams | $35 | $45 | $35 | $20 |
| Office Visits | $35 after annual deductible is met | $45 | $35 | $20 |
| Hospitalization | 30% after annual deductible is met | $250 + 30% after annual deductible is met | $500 + 40% | $250 after annual deductible is met |
| Maternity? | Yes | Yes | No | Yes |
| ER Visit | $75 + 30% after annual deductible is met | $100 + 30% after annual deductible is met | $100 + 40% | $75 |
| Prescription Drugs | $10 for generic; $35 for brand name drugs1 | $10 for generic; $35 for brand name drugs after a $500 brand Rx deductible is met1 | $10 for generic; $35 for brand name drugs after $750 Brand Rx deductible is met 1 - Blue Shield pays up to $2,000 per calendar year | $10 for generic; $35 for brand name drugs after $200 Brand Rx deductible is met 1 |
| Download Plan Details | Shield Savings Plan 2400 Details | Shield Spectrum PPO Plan 2000 Details | Active Start Plan 35 Details | Access+ HMO Plan Details |
Active Start Plan 35 is available for individuals only.
* Monthly rates are for individual males age 19-29 in good health, for the following counties: Alpine, Butte, Colusa, Del Norte, Humboldt, Imperial, Inyo, Kern, Kings, Madera, Mendocino, Plumas, San Benito, San Joaquin, Santa Barbara, San Luis Obispo, Siskiyou, Sonoma, Stanislaus, and Trinity counties. Rates may vary by age and region.
** Monthly rates are for individual males age 19-29 for the following counties: San Bernardino; Riverside zip codes 91752, 92248 and zip codes beginning with 923-28 except 92860, 92880, 92883; Orange except zip codes beginning with 926; Los Angeles zip codes 90247-51, 90260-61, 90274-75, 90500-10 and zip codes beginning with 906-912, 915, 917-18, 935; Ventura except zip codes beginning with 913. Rates may vary by age and region.
1 Brand name benefit shown applies to formulary drugs. Member’s costs may increase for non-formulary brand name drugs if covered by the benefit plan.
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