Blue Shield of California
Access+ HMO Health Insurance Plan
A plan summary of the Blue Shield of California Access+ HMO Plan is detailed out below for both In Network and Out of Network coverage.
| In Network |
Out of Network |
Copay |
$20 |
Not Applicable |
Office Visits |
$20 |
Not Applicable |
Annual Deductible |
Individual: $2,000 Family: $4,000 |
Not Applicable |
Annual Out-Of-Pocket Limit |
Individual: $3,000 Family: $6,000 |
Not Applicable |
Lifetime Maximum |
Unlimited |
Not Applicable |
Prescription Drugs |
Generic: $10
Brand Formulary: $35
($200 Brand Deductible) |
Not Applicable |
Laboratory & X-Ray |
$20 |
Not Applicable |
Annual Physical Exam |
No Charge |
Not Applicable |
Annual OB-GYN Exam |
No Charge |
Not Applicable |
Well Baby Care |
No Charge |
Not Applicable |
Outpatient Surgery |
$250 per visit after deductible |
Not Applicable |
Emergency Room |
$75 / visit (waived if admitted), No Charge After Deductible |
Not Applicable |
Inpatient Hospital |
$250 per admission after deductible |
Not Applicable |
Ambulance |
$50 |
Not Applicable |
Home Health Care |
$20 (100 visits per year) |
Not Applicable |
Mental Health - Outpatient |
$20, $35 MHSA Specialist per visit (20 visits per year) |
Not Applicable |
Chiropractic Care |
Not Covered |
Not Applicable |
Acupuncture |
See Benefit Contract |
Not Applicable |
Mental Health - Inpatient |
$20, $35 MHSA Specialist per visit (20 visits per year) |
Not Applicable |
Chemical Dependency |
$250 per admission after deductible |
Not Applicable |
Maternity Care |
$250 per admission after deductible |
Not Applicable |
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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