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Blue Shield Active Choice Plan 750
Physicians Directory

To view a quote for this plan visit our Free Health Insurance Quotes section.

Company
Blue Shield of California
Plan Name Active Choice Plan 750
Plan Type PPO
Deductible None
Out of Pocket Limit $3,000 Individual/$6,000 Family for Preferred Providers
$10,000 Individual/$20,000 Family for Non-Preferred Providers
Lifetime Maximum $6,000,000
Primary Benefits

 

Category One
Preventive Care
• Routine physical exams, Well-baby care Immunizations, and other services as recommended by the U.S. Preventive Services Task Force

Outpatient Professional & Diagnostic
• Office visits, Diagnostic testing
First Dollar Services Coverage: $750 Individual/$1,500 Family Then the member is responsible for charges up to the calendar- year copayment maximum
Category Two
Outpatient & Inpatient Services
• Surgeries, Emergency room visits, Renal dialysis, Chemotherapy
80/60% coinsurance (some copays apply)
Category Three
Prescription Drugs
• Generic
$10 copayment
• Brand-name drugs
– Calendar-year deductible
$250 per member
– Copayment for formulary
$30 copayment after deductible is met
– Copayment for non-formulary
$45 copayment or 50% of Blue Shield contracted rate, whichever is greater after the deductible is met
– Home self-administered injectable drugs 30% after deductible is met


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