Anthem Blue Cross of California
PPO Share 5000 Health Insurance Plan
A plan summary of the Anthem Blue Cross of California PPO Share 5000 Plan is detailed out below for both In Network and Out of Network coverage.
| In Network |
Out of Network |
Copay |
$40 |
50% |
Office Visits |
$40 |
50% |
| Annual Deductible |
$5,000 per member / 2 member maximum |
$5,000 per member / 2 member maximum |
| Annual Out-Of-Pocket Limit |
$2,500 per member / 2 member maximum |
$2,500 per member / 2 member maximum |
| Lifetime Maximum |
Unlimited |
Unlimited |
| Prescription Drugs |
Generic: $15 ($35 Copay after $750 Brand Deductible; 2 member max, See Brochure)
|
Generic: $15 ($35 Copay after $750 Brand Deductible; 2 member max, See Brochure) |
| Laboratory & X-Ray |
30% |
50% |
| Annual Physical Exam |
No Charge |
50% |
| Annual OB-GYN Exam |
No Charge |
50% |
Well Baby Care |
No Charge |
50% |
| Outpatient Surgery |
30% |
All Charges except $380 / day after Deductible |
| Emergency Room |
30% plus $100 (waived if admitted) |
30% plus $100 (waived if admitted) |
| Inpatient Hospital |
30% |
All Charges except $650 / day after Deductible |
| Ambulance |
See Brochure |
See Brochure |
| Home Health Care |
See Brochure |
See Brochure |
| Mental Health - Outpatient |
See Brochure |
See Brochure |
| Chiropractic Care |
See Brochure |
See Brochure |
Acupuncture |
See Brochure |
See Brochure |
| Mental Health - Inpatient |
See Brochure |
See Brochure |
| Chemical Dependency |
See Brochure |
See Brochure |
| Maternity Care |
30% |
50% |
To learn more about your
individual and family
California health insurance options, the price of each plan and/or a detailed benefit summary of the plans, visit us here.
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