Blue Shield of California
Balance Plan 1000 Health Insurance Plan
A plan summary of the Blue Shield of California Balance Plan 1000 is detailed out below for both In Network and Out of Network coverage.
| In Network |
Out of Network |
Copay |
30% |
50% or Not Covered |
Office Visits |
$35 |
50% |
Annual Deductible |
Individual: $1,000 Family: $2,000 |
Individual: $1,000 Family: $2,000 |
Annual Out-Of-Pocket Limit |
Individual: $5,500 Family: $11,000 |
Individual: $8,500 Family: $17,000 |
Lifetime Maximum |
Unlimited |
Unlimited |
Prescription Drugs |
Generic: $10
Brand Formulary: $35
Brand Non-Formulary $50 or 50%, whichever is greater ($500 Brand Deductible) |
Not Covered |
Laboratory & X-Ray |
30% |
50% |
Annual Physical Exam |
No Charge |
Not Covered |
Annual OB-GYN Exam |
No Charge |
Not Covered |
Well Baby Care |
No Charge |
Not Covered |
Outpatient Surgery |
30% plust $250 per visit |
50% |
Emergency Room |
$100 / visit (waived if admitted), then 30% (deductible waived) |
$100 / visit (waived if admitted), then 30% (deductible waived) |
Inpatient Hospital |
40% plus $500 per admission |
50% |
Ambulance |
30% |
30% |
Home Health Care |
30% (90 visits per year) |
Not Covered |
Mental Health - Outpatient |
30% (20 visits per year) |
Not Covered |
Chiropractic Care |
50% (12 visits per year) |
Not Covered |
Acupuncture |
50% (maximum benefit $25 per visit, 15 visit per year) |
50% (maximum benefit $25 per visit, 12 visit per year) |
Mental Health - Inpatient |
30% (20 visits per year) |
Not Covered |
Chemical Dependency |
30% |
50% |
Maternity Care |
Not Covered |
Not Covered |
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.
NOTICE! Final rates and benefits are based on actual plan selection (including plan riders you may request) and the assignment of any rate adjustment factors due to the health plan's underwriting guidelines.
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