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Shield Spectrum 5500Blue Shield Logo

The Shield Spectrum 5500 plan from Blue Shield of California features the following:

Plan Type: PPO
Deductible: $5,500
In-Patient Hospital Co-Payment/Coinsurance: 35%
Prescription Drug Coverage (Out Patient): Yes
Maternity Coverage Included: Yes

Obtain a free quote now for the Shield Spectrum 5500 plan and compare to other Blue Shield plans.


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Shield Spectrum 5500 Summary:

In Network Out of Network
Annual Deductible Individual: $5,500 Family: $11,000 Individual: $5,500 Family: $11,000
Annual Out-Of-Pocket Limit Individual: $7,500 Family: $15,000 Individual: $10,000 Family: $20,000
Lifetime Maximum $6,000,000 $6,000,000
Office Visits
35% 50%
Prescription Drugs Generic: $10 Brand Formulary: $45 Brand Non-Formulary $60 or 50%, whichever is greater ($750 Brand Deductible) Not Covered
Laboratory and Radiology 35% 50%
Annual Physical Exam $35 Not Covered
Annual OB-GYN Exam $35 Not Covered
Well Baby Care See Brochure Not Covered
Outpatient Surgery 35% 50% ($250 maximum benefit per day)
Emergency Room $100 (Waived if admitted) then 35% $100 (Waived if admitted) then 35%
Ambulance 35% 35%
Home Health Care 35% (90 visits per year) Not Covered
Mental Health Services - Outpatient 35% (20 visits per year) Not Covered
Chiropractic Care See Brochure See Brochure
Acupuncture / Acupressure See Brochure See Brochure
Inpatient Hospital 35% 50% ($250 maximum benefit per day)
Maternity Care 35% 50% ($250 maximum benefit per day)
Mental Health - Inpatient 35% 50% ($250 maximum benefit per day)
Chemical Dependency 35% 50% ($250 maximum benefit per day)

 

IMPORTANT NOTICE: Coinsurance amounts represented with a "%" are payable after the plan deductibles are reached; Co-pay amounts represented with a "$" are not subject to plan deductibles (except where noted). Refer to contract for a detailed explanation of plan benefits, features, exclusions and limitations. Benefits subject to change without notice. Out of pocket maximum shown includes the plan deductible unless otherwise noted. Co-pays, Deductibles, and Coinsurance amounts listed above are your share of the costs for covered benefits.

Do Not Cancel your current coverage until a new policy is approved and you have received written confirmation of the policy's rates and benefits from the insurance company. Rate and Benefit Disclaimer Notification!

Information contained in this website is limited in scope, subject to change without notice, and does not contain all the terms, conditions, limitations, or exclusions of the referenced benefit plans. Only the insurance company Plan Documents and Policy's contain the exact terms and conditions of coverage.

 

 
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California Health Plans, a division of Dave Terpening Insurance Agency, Inc.  |   22850 Crenshaw Blvd. #206  |   Torrance, CA 90505
Copyright © 2017 Dave Terpening Insurance Agency, Inc. |  CA Lic# 0G47857
Blue Cross of California is an independent licensee of the Blue Cross Association. The Blue Cross name and symbol are registered service marks of the Blue Cross Association.

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