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Oleg
Skurskiy (818) 654-4548 |
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Authorized Agent for Blue Shield
of California |
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Blue
Shield of California
Blue
Shield Spectrum PPO Plan 2000,Blue
Shield Spectrum PPO Plan 1500,Blue
Shield Spectrum PPO Plan 750,
Shield
Spectrum PPO Plan 500
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| Oleg
Skurskiy An Authorized Agent
of Blue Shield of California
Call : (818)
654-4548 |
| Get
a Quote |
Apply
now |
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| Summary
of Benefits |
Shield
Spectrum SM
PPO Plan 2000 |
| See
details (PDF) |
| Plan
Type |
PPO
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PPO
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PPO
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PPO
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| Annual
Deductible |
$2,000
per individual/$4,000
per family |
$1,500
per individual/$3,000
per family |
$750
per individual/$1,500
per family |
$500
per individual/$1,000
per family |
| Annual
Copayment Maximum |
$5,000
per individual/$10,000
per family? |
$4,500
per individual/$9,000
per familyΠ
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$4,000
per individual/$8,000
per familyΠ
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$3,500
per individual/$7,000
per familyΠ
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| Out-of-Pocket
Maximum with Preferred
Providers (includes plan
deductible) |
N/A |
N/A |
N/A |
N/A |
Annual
Physical Exam,
Well-Baby Care, Gynecological
Exam |
$45
(Not subject to deductible) |
$40
(Not subject to deductible)
|
$35
(Not subject to deductible)
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$30
(Not subject to deductible)
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Laboratory,
X-Ray, Major
Diagnostic Services |
30%
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30%
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30%
|
25%
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| Physician
Office Visits |
$45
(Not subject to deductible) |
$40
(Not subject to deductible)
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$35
(Not subject to deductible)
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$30
(Not subject to deductible)
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Hospital
Inpatient
(Non-Emergency) |
$250
per admit + 30% |
$250
per admit + 30% |
$250
per admit + 30% |
$250
per admit + 25% |
Maternity
Services
(Resulting in Delivery) |
30%
|
30%
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30%
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25%
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| Surgery |
$250
per visit + 30% |
$250
per visit + 30% |
$250
per visit + 30% |
$250
per visit + 25% |
| Treatment/Procedure |
|
30%
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30%
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25%
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| Emergency
Room Visits |
$100
per visit + 30% |
$100
per visit + 30% |
$100
per visit + 30% |
$100
per visit + 25% |
| Ambulance |
30%
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30%
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30%
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25%
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| Physician
Visits/Consultations |
30%
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30%
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30%
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25%
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| Prescription
Benefits |
$10
generic (Not subject to
deductible)/$35 formulary
brand name, after a $500
brand name deductible
per member/$50 or 50%,
whichever is greater ($150
max per prescription)
for non-formulary brand
name drugs, after $500
brand name deductible |
$10
generic (Not subject to
deductible)/$35 formulary
brand name, after a $500
brand name deductible
per member/$50 or 50%,
whichever is greater ($150
max per prescription)
for non-formulary brand
name drugs, after $500
brand name deductible
|
$10
generic (Not subject to
deductible)/$35 formulary
brand name, after a $250
brand name deductible
per member/$50 or 50%,
whichever is greater ($150
max per prescription)
for non-formulary brand
name drugs, after $250
brand name deductible
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$10
generic (Not subject to
deductible)/$35 formulary
brand name, after a $250
brand name deductible
per member/$50 or 50%,
whichever is greater ($150
max per prescription)
for non-formulary brand
name drugs, after $250
brand name deductible
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| Dental
Services |
N/A
(optional benefit) |
|
Shield
Spectrum SM PPO Plan 2000 |
| Request
paper application |
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a Quote |
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a Quote |
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a Quote |
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a Quote |
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| Apply
online |
Apply
online |
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online |
Apply
online |
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Download
application |
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application |
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application |
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application |
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Blue
Shield plans :
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| † Underwritten
by Blue Shield of California Life
& Health Insurance Company (Blue
Shield Life).
ƒ The out-of-pocket/copayment
maximums include the plan deductible.
p The initial flat dollar emergency
room copayment is waived if you
are admitted directly to the hospital
as an inpatient.
a Dental services provided through
Dental Benefit Providers (DBP).
Benefits limited to $500 per calendar
year. Three month waiting period
following the effective date of
coverage for minor restorative services.
? Vision exam provided through MESVision
network.
ß The plan is subject to regulatory
approval.
With an HMO plan, members must live
or work within the Blue Shield HMO
service area and have a designated
Personal Physician to enroll and
maintain enrollment. The Blue Shield
HMO service area is identified in
the HMO Physician and Hospital Directory.
Each eligible family member may
select a different Personal Physician,
as long as each provider is located
adequately close to the member's
home or work address to ensure access
to care (as determined by Blue Shield).
This information is intended as
a brief comparison of some of the
benefits of the various Blue Shield
plans and shows copay/coinsurance
amounts you will pay for services
received from preferred providers
only. You should review the Combined
Summary of Benefits or the Evidence
of Coverage/Certificate of Insurance
and Plan Contract/Policy for a more
complete description of the benefits,
terms and conditions and limitations
of the health plans.
Note: The federal Health Insurance
Portability and Accountability Act
(HIPAA) makes it easier for people
with pre-existing conditions who
are covered under existing group
health plans to maintain coverage
of pre-existing conditions when
they change jobs or are unemployed
for brief periods of time. If you
meet all the specified conditions,
you may be eligible for a guaranteed
issue plan in accordance with HIPAA.
For more information, contact your
agent
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Coinsurance amounts represented with
a "%" are payable after the
plan deductibles are reached; Co-pay amounts
represented with a "$" 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.
Blue
Shield of California Life & Health
Insurance Company Life was formed in 1954
as a wholly owned subsidiary of Blue Shield
of California to provide a full range
of insurance products for their customers.
With 3.3 million members and $7.5 billion
in annual revenue, Blue Shield of California
is the state's third largest health plan.
Founded in 1939 and headquartered in San
Francisco, Blue Shield is a not-for-profit
corporation with approximately 4,300 employees
and more than 20 offices throughout California.
Blue
Shield of California Life & Health
Insurance Company Life has grown by offering
competitive insurance products including
Group Term Life, Accidental Death &
Dismemberment, Blue Shield of California
Life & Health Insurance Company Life
Vision Plan, Stop Loss and Exec-U-Med
medical reimbursement plans in tandem
with Blue Shield of California health
plans or on a stand-alone basis . In the
early 1980s, introduced their Short-Term
Health products. The Option One and Option
Twelve plans remain one of the leading
products of their kind in California |
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Copyright © 2005 Oleg Skurskiy Authorized
Independent Agent, CA License 0E50389 |
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