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Lisence #0726064

(818) 701-0020

or write to us at:

mail@
cainsurancenetwork.com


Types of Health Plans Available
Individual Plans

Group Coverage Plans

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Blue Shield Spectrum PPO Plan 1000
Physicians Directory

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

Company
Blue Shield of California
Plan Name Shield Spectrum PPO Plan 1000
Plan Type PPO
Deductible Preferred and Non-Preferred: $1000 per individual/$2,000 per family
Coinsurance Preferred Providers: 20%
Non-preferred Providers: 50%
Out of Pocket Limit Preferred Providers: $4,000 per individual
$8,000 per family

Non-Preferred Providers: $10,000 per individual
$20,000 per family
Lifetime Maximum $6,000,000
 Professional Services
Office Visits Preferred Providers: $45/visit (deductible waived)

Non-Preferred Providers: 50%
Lab & X-rays Preferred Providers: $45/visit

Non-Preferred Providers: 50%
Allergy & Diagnostic Testing Preferred Providers: 20%

Non-Preferred Providers: 50%
Routine Physical

Includes eye/ear screenings, immunizations; laboratory, including mammogram and pap test screening. (one per calendar year)

Preferred Providers: $45/visit (deductible waived)

Non-Preferred Providers: not covered

Well Baby Care

Office visits (deductible waived) including eye-ear screenings, immunizations, vaccinations; laboratory.

Preferred Providers: $45/visit

Non-Preferred Providers: Not covered

Outpatient Services
Surgery Preferred Providers: $500/surgery + 20%

Non-Preferred Providers: 50%
Treatment and supplies Preferred Providers: 20%

Non-Preferred Providers: 50%
Hospitalization Services
Inpatient Physician Services Preferred Providers: 20%

Non-Preferred Providers: 50%
Semi-private Room and Board

Includes medically necessary services and supplies

Preferred Providers: $1,000/admit + 20%

Non-Preferred Providers: 50%

Skilled Nursing Freestanding

Combined maximum of up to 100 preauthorized freestanding and hopstial unit days per calendar year; semi-private accomodations

Preferred Providers: 20%

Non-Preferred Providers: 20%

Skilled Nursing Hospital

Combined maximum of up to 100 preauthorized freestanding and hopstial unit days per calendar year; semi-private accomodations

Preferred Providers: 20%

Non-Preferred Providers: 50%

Emergency Health Coverage
Facility Services

Not resulting in a direct admission, deductible waived

Preferred Providers: $100 + 20%

Non-Preferred Providers: $100 + 20%

Facility Services

Resulting in a direct admission

Preferred Providers: $1,000/year + 20%

Non-Preferred Providers: $1,000/year + 20%

ER Physician Services Preferred Providers: 20%

Non-Preferred Providers: 20%
Ambulance Services Preferred Providers: 20%

Non-Preferred Providers: 20%
Prescription Coverage ($250 per member brand name deductible)
Retail Prescriptions

For up to a 30-day supply

Preferred Providers:

Generic Drugs: $10/prescription
Formulary brand-name drugs: $25/prescription
Non-formulary brand-name drugs $40/prescription
Home self-adminstered injectable drugs: 30%/prescription

Non-Preferred Providers:
Member pays 20% of allowed charge plus a copayment of:

Generic Drugs: $10/prescription
Formulary brand-name drugs: $25/prescription
Non-formulary brand-name drugs $40/prescription
Home self-adminstered injectable drugs: Not covered

Mail Service prescription

For up to a 90-day supply

Preferred Providers:

Generic Drugs: $20/prescription
Formulary brand-name drugs: $50/prescription
Non-formulary brand-name drugs $80/prescription
Home self-adminstered injectable drugs: Not covered

Non-Preferred Providers:
Member pays 30% of allowed charge plus a copayment of:

Generic Drugs: Not covered
Formulary brand-name drugs: Not covered
Non-formulary brand-name drugs Not covered
Home self-adminstered injectable drugs: Not covered



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Authorized Agent For:

Blue Cross of California
Blue Shield of California
Kaiser Permanente
Aetna
PacifiCare
Health Net
California Farm Bureau Federation
West Coast Life
American General

 

 

 

 

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