Blue Shield of California  OLEG SKURSKIY (818) 654-4548  

Authorized Agent for Blue Shield of California


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Blue Shield Active Start Plan 25
Low Premium, No Medical Deductible PPO Plan

 

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Active Start Plan 25

Active StartSM Plan 25* is a new PPO for individual subscribers that currently comes with a six-month rate guarantee.

Target market:
Individuals between 19 and 29 years of age
Those of all ages seeking affordable healthcare coverage


Plan highlights include:
No medical deductible
$25 office visit copayment
$25 plus 40 percent coinsurance emergency room copayment
Limited alternative care and therapy benefits
Copayment for prescription coverage after meeting prescription deductible
24-hour, toll-free access to Nurseline phone consultation
Maternity coverage is NOT included. Should an Active Start member become pregnant, she may transfer to the Shield Spectrum PPO Plan 5000 without having to submit a new application.



Sales begin December 1, 2005.

* Blue Shield Active Start Plan 25 is underwritten by Blue Shield of California Life & Health Insurance Company

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   Blue Shield Active Start 25 In-Network Out-Of-Network
 
  • Annual Deductible  
 None None
 
  • Annual Out-Of-Pocket Limit   
 Individual: $6,000 Individual: $8,000 (with all providers)
 
  • Lifetime Maximum  
 $6,000,000 $6,000,000
 
  • Office Visits  
 $25 50%
 
  • Prescription Drugs  
 $10 Generic ($35 Brand Formulary + $500 Ded.) $50 or 50% whichever is greater Brand Non-Formulary $10 Generic ($35 Brand Formulary + $500 Ded.) $50 or 50% whichever is greater Brand Non-Formulary
 
  • Laboratory and Radiology  
 40% 50%
 
  • Annual Physical Exam  
 $25 Not Covered
 
  • Annual OB-GYN Exam  
 $25 Not Covered
 
  • Well Baby Care  
 $25 Not Covered
 
  • Outpatient Surgery  
 $500 per /admission + 40% 50% ($250 maximum benefit per day)
 
  • Emergency Room  
 $25 (waived if admitted), then 40% $25 (waived if admitted), then 40%
 
  • Ambulance  
 40% 40%
 
  • Home Health Care  
 40% (90 visits per year) Not Covered
 
  • Mental Health Services  
 40% (20 visits per year) Not Covered
 
  • Chiropractic Care  
 40% (12 visits per year) 50% (maximum benefit $25 per visit, 12 visits per year)
 
  • Acupuncture / Acupressure  
 50% (maximum benefit $25 per visit, 12 visits per year) 50% (maximum benefit $25 per visit, 12 visits per year)
 
  • Inpatient Co-payment:  
 40% plus $500 per admission 50% ($250 maximum benefit per day)
 
  • Maternity Care
 Not Covered Not Covered
 
  • Mental Health  
 40% plus $500 per admission 50% ($250 maximum benefit per day)
 
  • Chemical Dependency  
 40% plus $500 per admission 50% ($250 maximum benefit per day)
 
NEW Vital Shield 2900 Monthly rates as low as $42       Access®+ Value HMO
Active Start Plan 35 PPO - No Medical Deductible Shield Spectrum PPO 5000
Active Start Plan 25 PPO - No Medical Deductible   Shield Spectrum PPO 2000   Access®+ HMO
Balance Plan PPO 1000 - no Maternity   Shield Spectrum PPO 1500    
Balance Plan PPO 1700 - no Maternity   Shield Spectrum PPO 750   Blue Shield Senior
Balance Plan PPO 2500 - no Maternity   Shield Spectrum PPO 500    
Essential Plan PPO 1750 Dental & Vision Included   Blue Shield Short Term
Essential Plan PPO 3000 Dental & Vision Included HSA Savings Plan 2400 / 4800  
Essential Plan PPO 4500 Dental & Vision Included HSA Savings Plan 4000 / 8000  

 
 
 
Coinsurance amounts represented with a "%" are payable after the plan deductibles are reached; Co-pay amounts represented with a "$" are not subject to plan deductibles (except where noted). Refer to contract for a detailed explanation of plan benefits, features, exclusions and limitations. Benefits subject to change without notice. Co-pays, Deductibles, and Coinsurance amounts listed above are your share of the costs for covered benefits.

Do Not Cancel your current coverage until a new policy is approved and you have received written confirmation of the policy's rates and benefits from the insurance company. Rate and Benefit Disclaimer Notification! The rate and benefit information provided herein was generated by the Quotit Corporation's individual health insurance quoting system. The Quotit Corporation or It's Licensee's do not guarantee or warrant the correctness or completeness of the rate and benefit information contained herein and shall not be liable for any loss or damage arising out of use of the quoted rate and benefit information.

Additionally, information contained in this website is limited in scope, subject to change without notice, and does not contain all the terms, conditions, limitations, or exclusions of the referenced benefit plans. Only the insurance company Plan Documents and Policy's contain the exact terms and conditions of coverage. Your grant of access to the rate and benefit summaries contained herein may not be relied upon as a guarantee of your eligibility or coverage under these benefit plans.

 
   
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