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Vital Shield Plus 2900 GenericRx SingleBlue Shield Logo

Blue Shield Vital Shield Plus 2900 GenericRx Single Plan Information

The Vital Shield Plus 2900 GenericRx Single plan from Blue Shield of California features the following:

Plan Type: PPO
Deductible: $2,900
In-Patient Hospital Co-Payment/Coinsurance: 40%
Prescription Drug Coverage (Out Patient): Yes
Maternity Coverage Included: No

Demarketed

Vital Shield Plus 2900 GenericRx Single Summary:

In Network Out of Network
Annual Deductible Individual: $2,900 Family: $5,800 Individual: $2,900 Family: $5,800
Annual Out-Of-Pocket Limit Individual: $4,900 Family: $9,800 Individual: $15,000 Family: $30,000
Lifetime Maximum $3,000,000 $3,000,000
Prescription Drugs Generic: $10 Not Covered
Laboratory and Radiology No Charge after Out of Pocket is met No Charge after Out of Pocket is met
Annual Physical Exam $30 (First 5 visits, See Brochure) Not Covered
Annual OB-GYN Exam $30 (First 5 visits, See Brochure) Not Covered
Well Baby Care $30 (First 5 visits, See Brochure) Not Covered
Outpatient Surgery 40% 50% ($250 max. per day)
Emergency Room $100/visit (waived if admitted), then 40% $100/visit (waived if admitted), then 40%
Ambulance 40% 40%
Home Health Care No Charge after Out of Pocket is met (90 visits per year) Not Covered
Mental Health Services - Outpatient 40% 50%
Chiropractic Care Not Covered Not Covered
Acupuncture / Acupressure Not Covered Not Covered
Inpatient Hospital 40% 50% ($250 max. per day)
Maternity Care Not Covered Not Covered
Mental Health - Inpatient 40% (non-severe mental health not covered) 50% (non-severe mental health not covered, see brochure)
Chemical Dependency 40% 50% (see brochure)

 

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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