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Shield Saver 4000Blue Shield Logo

The Shield Saver 4000 plan from Blue Shield of California features the following:

Plan Type: HSA
Deductible: $4,000
In-Patient Hospital Co-Payment/Coinsurance: 0%
Prescription Drug Coverage (Out Patient): Yes
Maternity Coverage Included: No Charge after Ded.
Obtain a free quote now for the Shield Saver 4000 Member plan and compare to other Blue Shield plans.

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Shield Saver 4000 Summary:

In Network Out of Network
Annual Deductible Individual: $4,000 Family: $8,000 (embedded; See Brochure) Individual: $8,000 Family: $16,000 (embedded; See Brochure)
Annual Out-Of-Pocket Limit Individual: $4,000 Family: $8,000 Individual: $14,000 Family: $28,000
Lifetime Maximum None None
Office Visits No Charge after Deductible 50%
Prescription Drugs No Charge after Medical/Rx Deductible Not Covered
Laboratory and Radiology No Charge after Deductible 50%
Annual Physical Exam No Charge Not Covered
Annual OB-GYN Exam No Charge Not Covered
Well Baby Care No Charge Not Covered
Outpatient Surgery No Charge after Deductible 50%
Emergency Room No Charge after Deductible No Charge after Deductible
Ambulance No Charge after Deductible No Charge after Deductible
Home Health Care No Charge after Deductible (90 visits per year) Not Covered
Mental Health Services - Outpatient No Charge after Deductible (20 visits per year) Not Covered
Chiropractic Care No Charge after Deductible (12 visits per year, pays a maximum of $25 per visit, see brochure) Not Covered
Acupuncture / Acupressure No Charge after Deductible (12 visits / year, pays up tp $25 /visit, see brochure) No Charge after Deductible (12 visits / year, pays up tp $25 /visit, see brochure)
Inpatient Hospital No Charge after Deductible 50%
Maternity Care No Charge after Deductible 50%
Mental Health - Inpatient No Charge after Deductible 50%
Chemical Dependency No Charge after Deductible 50%

 

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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