Blue Cross of California BCL&H PPO Share 5000 Plan Information
Physician Choice: You choose specialist(s)
Annual Out-of-Pocket Maximum (includes deductible): $7500/member, 2 member maximum participating and non-participating combined
Annual Deductible: $5000/member, 2 member maximum
Office Visits: $40 copay, deductible waived
Professional Services: 30% of negotiated fee
Hospital Inpatient/Outpatient: 30% of negotiated fee
Emergency Services: 30% of negotiated fee; $100 copay, waived if admitted
Maternity: 30% of negotiated fee
Preventive Care - General: $25 or $75 copay for basic HealthyCheck screenings. Routine mammogram, PSA and Pap tests @ 20% of negotiated fee (deductible waived). Well-Child (up to age 6) at 50% of negotiated fee (deductible waived).
Drug Benefits: $10 generic; $35 brand-name copay after $750 brand-name deductible; 30% of negotiated fee for self-administered injectables, except insulin
Financial/Tax Incentive: No
Optometrist Benefit: Optometrists network has been created for BC Life so insureds will have a participating provider network to choose from for medical services.
Preservice Review: Preservice review will be required for all inpatient hospital stays and certain diagnostic and radiological procedures.
pecialty Pharmacy Drug Benefit: Certain drugs will be obtainable only through Precision Rx Specialty Solutions.
Annual Physical Exam: Annual Physical Exam: 30% negotiated fee (deductible waived). Up to $200 Blue Cross payment per calendar year*; *Members covered less than six months, up to $100 Blue Cross payment.
Other Blue Cross of California health insurance plans:
- BCL&H CORE 5000
- BCL&H Basic PPO 2500 with Life
- BCL&H Basic PPO 1000 with Life
- Individual PPO $3500 with HSA Compatibility
- Lumenos HSA 5000/10000/100
- Lumenos HIA 5000/10000/100
- BCL&H 3500 Deductible
- BCL&H RightPlan PPO 40 w/No Rx
- BCL&H RightPlan PPO 40 w/Generic Rx
- Lumenos HIA Plus 5000/10000/100
- BCL&H RightPlan PPO 40 w/Rx
- BCL&H PPO Saver with Life
- Individual Select HMO
- Lumenos HSA 3000/6000/100
- Lumenos HIA 3000/6000/100
- Blue Cross PPO Share 2500
- Lumenos HSA 2500/5000/100
- Lumenos HIA 2500/5000/100
- Lumenos HIA Plus 3000/6000/100
- Blue Cross HMO Saver
- Lumenos HIA Plus 2500/5000/100
- Blue Cross PPO Share 1500
- Lumenos HSA 1500/3000/100
- Lumenos HIA 1500/3000/100
- BCL&H PPO Share 1000
- BCL&H PPO Share 500
- Blue Cross Individual HMO
