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Home   >  Health Insurance Companies   >   Blue Shield of CA Plans   >   Shield Spectrum PPO Savings 1800 (HSA)

Blue Shield of California

Shield Spectrum PPO Savings 1800 Health Insurance Plan (HSA Compatible)

A plan summary of the Blue Shield of California Shield Spectrum PPO Savings Plan 1800 is detailed out below for both In Network and Out of Network coverage.

                                                In Network Out of Network



50% or Not Covered

  Office Visits

$35 after Deductible 50%

  Annual Deductible

Individual: $1,800  Family: $3,600

Individual: $1,800  Family: $3,600

  Annual Out-Of-Pocket  Limit

Individual: $5,950  Family: $11,900

Individual: $10,000  Family: $20,000

  Lifetime Maximum

Unlimited Unlimited

  Prescription Drugs


Generic: $10

Brand Formulary: $35

Brand Non-Formulary $50 or 50%, whichever is greater (Maximum of $150 per perscription)

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% 50%

  Emergency Room

$75 / visit after deductible (waived if admitted), then 30% $75 / visit after deductible (waived if admitted), then 30%

  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, 12 visit per year) Not Covered


See Benefit Contract See Benefit Contract

  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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