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Home   >  Health Insurance Companies   >   Blue Shield of CA Plans   >   Balance Plan 2500

Blue Shield of California

Balance Plan 2500 Health Insurance Plan

A plan summary of the Blue Shield of California Balance Plan 2500 is detailed out below for both In Network and Out of Network coverage.

                                                In Network Out of Network



50% or Not Covered

  Office Visits

$30 50%

  Annual Deductible

Individual: $2,500  Family: $5,000

Individual: $2,500  Family: $5,000

  Annual Out-Of-Pocket  Limit

Individual: $7,500  Family: $15,000

Individual: $10,500  Family: $21,000

  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

30% 50%


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% (maximum benefit $25 per visit, 15 visit per year) Not Covered


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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