Blue Shield of California Oleg Skurskiy (818) 654-4548  

Authorized Agent for Blue Shield of California


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Blue Shield of California

Spectrum PPO Plan 5000
 

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Summary of Benefits Blue Shield Spectrum SM PPO Plan 5000†
Please see full benefits details (PDF)
Medical Benefits
Plan Type PPO  
Annual Deductible $5,000 per individual/$10,000 per familyε
Annual Copayment Maximum $7,000 per individual/ $14,000 per family
Out-of-Pocket Maximum with Preferred Providers (includes plan deductible) N/A
Preventive Care
Annual Physical Exam,
Well-Baby Care, Gynecological
Exam		 $35 (Not subject to deductible)  
Laboratory, X-Ray, Major
Diagnostic Services		 30%
Professional Services
Physician Office Visits 100% until you reach deductible, then $35 copay  
Hospital Inpatient
(Non-Emergency)		 30%
Maternity Services
(Resulting in Delivery)		 30%
Outpatient Services (Non-Emergency)
Surgery 30%  
Treatment/Procedure 30%
Emergency Room Services
Emergency Room Visits 30%  
Ambulance 30%
Physician Visits/Consultations 30%
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) for non-formulary brand name drugs, after $500 brand name deductible
Dental Services
Dental Services ( optional benefit )

See benefits

  
   
Blue Shield SpectrumSM PPO Plan 5000†

All Blue Shield of California health plans

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.

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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