California Health Insurance: Blue Shield Bronze 5550 PPO

*Update September 13, 2017: The Blue Shield Bronze 5550 will no longer be available for the 2018 plan year. Effective January 1, 2018 Blue Shield of California will automatically re-enroll everyone enrolled in the Bronze 5550 plan over to the Blue Shield Bronze 60 PPO.

Blue Shield Bronze 5550 PPO

In-Network Out-Network
Cost Share Information 
Individual Deductible  $5,550 $9,500 
Family Deductible  $11,000 $19,000 
Out of Pocket Limit-Individual  $6,800 (including deductible) $9,800 (including deductible) 
Out of Pocket Limit-Family  $13,600 (including deductible) $19,600 (including deductible) 
Co-Insurance  30% 50% 
Lifetime Maximum  None None 
Office Visits 
Primary Care  $70 deductible waived 1st visit 50% after deductible
Specialist  30% after deductible 50% after deductible
Adult Preventive Care  No Charge Not Covered 
Child Preventive Care  No Charge Not Covered 
Maternity Prenatal/Postnatal Care  No Charge 50% after deductible 
Rehabilitation Services  30% after deductible 50% after deductible  
Chiropractic Care  Not Covered  Not Covered 
Inpatient Services 
Inpatient Hospital 30% after deductible  50% after deductible; $2,000 max benefit per day 
Maternity Delivery/Inpatient  30% after deductible  50% after deductible; $2,000 max benefit per day 
Outpatient Services 
Outpatient Facility  30% after deductible  50% after deductible; $300 max benefit per day 
Mental Health Outpatient  30% after deductible  50% after deductible 
Lab/X-Ray  30% after deductible  50% after deductible 
Emergency Care 
Emergency Room  30% after deductible  30% after deductible 
Urgent Care  $120 deductible waived after first visit  50% after deductible 
Ambulance  30% after deductible  30% after deductible 
Prescription Drugs 
Rx Deductible  Integrated Medical/Rx  N/A 
Rx Generic  30% after deductible; $500 max/script  Not covered 
Rx Preferred  30% after deductible; $500 max/script  Not covered 
Rx Non-Preferred  30% after deductible; $500 max/script  Not covered 
Recovery/ Special Needs 
Home Health Care  30% after deductible; 100 visits per year  Not covered 
Durable Medical Equipment  30% after deductible  50% after deductible 
 
Optional Benefits  None  None 

Complete Benefit Summary


If you you have questions about the Blue Shield Bronze 5550 PPO plan or any other plans from Blue Shield of California please call The Lynn Company at (800)-326-5966 for more information on California Health Insurance Plans
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