Blue Shield of California
Essential 1750 Health Insurance Plan
A plan summary of the Blue Shield of California Essential 1750 Plan is detailed out below for both In Network and Out of Network coverage.
| In Network |
Out of Network |
Copay |
No Charge After Deductible |
50% or Not Covered |
Office Visits |
$40 (First 3 Visits, then No Charge after Deductible |
50% |
Annual Deductible |
Individual: $1,750 |
Individual: $1,750 |
Annual Out-Of-Pocket Limit |
Individual: $1,750 |
Individual: $8,000 |
Lifetime Maximum |
Unlimited |
Unlimited |
Prescription Drugs |
Generic: $10
|
Not Covered |
Laboratory & X-Ray |
No Charge after Deductible |
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 |
No Charge after Deductible |
50% |
Emergency Room |
$100 / visit (waived if admitted) |
$100 / visit (waived if admitted) |
Inpatient Hospital |
No Charge after Deductible |
50% |
Ambulance |
No Charge after Deductible |
30% |
Home Health Care |
No Charge after Deductible (60 visits per year) |
Not Covered |
Mental Health - Outpatient |
No Charge after Deductible (20 visits per year) |
Not Covered |
Chiropractic Care |
Not Covered |
Not Covered |
Acupuncture |
Not Covered |
Not Covered |
Mental Health - Inpatient |
|
Not Covered |
Chemical Dependency |
No Charge after Deductible |
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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