California Health Insurance: Blue Shield Platinum 90 HMO

Blue Shield Platinum 90 HMO

In-Network

Cost Share Information 
Individual Deductible  $0
Family Deductible  $0
Out of Pocket Limit-Individual  $4,000
Out of Pocket Limit-Family  $8,000
Co-Insurance  10%
Lifetime Maximum  None
Office Visits 
Primary Care  $15
Specialist  $40
Adult Preventive Care  No Charge
Child Preventive Care  No Charge
Maternity Prenatal/Postnatal Care  No Charge
Rehabilitation Services  $15
Chiropractic Care  Not Covered 
Inpatient Services 
Inpatient Hospital $250 per day; 5 days/admit 
Maternity Delivery/Inpatient  $250 per day; 5 days/admit
Outpatient Services 
Outpatient Facility  $250
Mental Health Outpatient  $15
Lab/X-Ray  $20/$40
Emergency Care 
Emergency Room  $150 (waived if admitted)
Urgent Care  $15 
Ambulance  $150 
Prescription Drugs 
Rx Deductible  N/A
Rx Generic  $5
Rx Preferred  $15
Rx Non-Preferred  $25
Recovery/ Special Needs 

Home Health Care

$20; 100 visits per year

Durable Medical Equipment  10%
 
Optional Benefits  None 

Complete Benefit Summary


If you you have questions about the Blue Shield Platinum 90 HMO 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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Please note that we cannot bind insurance via email, fax, or voicemail. Any quotes given are subject to underwriting guidelines by the respective insurance carriers. Any reference of coverage used are not intended to express legal opinion as to the nature of coverage, but rather just a brief generalization of coverages. Please read your policy for coverage details.
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