Anthem Blue Cross of California
Premier 1500 Plus Health Insurance Plan
A plan summary of the Anthem Blue Cross of California Premier 1500 Plus Plan is detailed out below for both In Network and Out of Network coverage.
| In Network |
Out of Network |
Copay |
50% |
70% |
Office Visits |
50% |
70% |
| Annual Deductible |
Individual: $1,500 Family: $3,000 |
Individual: $1,500 Family: $3,000 |
| Annual Out-Of-Pocket Limit |
Individual: $3,500 Family: $7,000 (Deductible not Included) |
Individual: $7,500 Family: $15,000 (Deductible not Included) |
| Lifetime Maximum |
Unlimited |
Unlimited |
| Prescription Drugs |
Tier 1: $15
Tier 2: $40
Tier 3: $60
($7,500 Deductible / member / Tier 2 & 3) |
Not Covered |
| Laboratory & X-Ray |
50% |
70% |
| Annual Physical Exam |
No Charge |
70% |
| Annual OB-GYN Exam |
No Charge |
70% |
Well Baby Care |
No Charge |
70% |
| Outpatient Surgery |
50% plus $200 facility copay / admission |
70% plus $200 facility copay / admission
|
| Emergency Room |
50% |
50% |
| Inpatient Hospital |
50% plus $500 facility copay /day (3 day maximum/admission) |
70% plus $500 facility copay / day (3 day maximum / admission) |
| Ambulance |
See Brochure |
See Brochure |
| Home Health Care |
See Brochure |
See Brochure |
| Mental Health - Outpatient |
See Brochure |
See Brochure |
| Chiropractic Care |
See Brochure |
See Brochure |
Acupuncture |
See Brochure |
See Brochure |
| Mental Health - Inpatient |
See Brochure |
See Brochure |
| Chemical Dependency |
50% (30 days / member / calendar year; In and Out-of-Network combined)
|
70% (30 days / member / calendar year; In and Out-of-Network combined)
|
| 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.
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