California Health Insurance: Blue Shield Silver 70 HMO

Blue Shield Silver 70 HMO

In-Network

Cost Share Information 
Individual Deductible  $2,500
Family Deductible  $5,000
Out of Pocket Limit-Individual  $6,800 (including deductible)
Out of Pocket Limit-Family  $13,600 (including deductible)
Co-Insurance  20%
Lifetime Maximum  None
Office Visits 
Primary Care  $35 deductible waived
Specialist  $70 deductible waived
Adult Preventive Care  No Charge
Child Preventive Care  No Charge
Maternity Prenatal/Postnatal Care  No Charge
Rehabilitation Services  $35 deductible waived
Chiropractic Care  Not Covered 
Inpatient Services 
Inpatient Hospital 20% after deductible 
Maternity Delivery/Inpatient  20% after deductible 
Outpatient Services 
Outpatient Facility  20% after deductible 
Mental Health Outpatient  $35 deductible waived
Lab/X-Ray  $35/$75 deductible waived 
Emergency Care 

Emergency Room 

$350 (waived if admitted)

deductible waived

Urgent Care  $35 deductible waived  
Ambulance  $250 after deductible 
Prescription Drugs 
Rx Deductible  $250 individual/ $500 family 
Rx Generic  $15 deductible waived
Rx Preferred  $55 after deductible 
Rx Non-Preferred  $80 after deductible 
Recovery/ Special Needs 

Home Health Care 

$45 deductible waived;

100 visits per year 

Durable Medical Equipment  20% after deductible 
 
Optional Benefits  None 

Complete Benefit Summary


If you you have questions about the Blue Shield Silver 70 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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