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Shield Wise 4500Blue Shield Logo

The Shield Wise 4500 plan from Blue Shield of California features the following:

Plan Type: PPO
Deductible: $4,500
In-Patient Hospital Co-Payment/Coinsurance: 45%
Prescription Drug Coverage (Out Patient): Yes
Maternity Coverage Included: 45%
Obtain a free quote now for the Shield Wise 4500 Member plan and compare to other Blue Shield plans.

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Shield Wise 4500 Summary:

In Network Out of Network
Annual Deductible Individual: $4,500 Family: $9,000 Individual: $13,500 Family: $21,000
Annual Out-Of-Pocket Limit Individual: $9,500 Family: $19,000 Individual: $23,500 Family: $47,000
Lifetime Maximum None None
Office Visits $45 (Deductible waived for first two visits per year) 50%
Prescription Drugs Generic: $10 Brand Formulary: $35 Brand Non-Formulary: Greater of $60 or 50%, $150 max per prescription ($3,000 Brand Deductible/person) Not Covered
Laboratory and Radiology 45% 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 45% 50%
Emergency Room $100 per visit (waived if admitted) then 45% $100 per visit (waived if admitted) then 45%
Ambulance 45% 45%
Home Health Care 45% (90 visits per year) Not Covered
Mental Health Services - Outpatient 45% (20 visits per year) Not Covered
Chiropractic Care 50% (12 visits per year, pays a maximum of $25 per visit, see brochure) Not Covered
Acupuncture / Acupressure 50% (12 visits per year, pays a maximum of $25 per visit, see brochure) 50% (12 visits per year, pays a maximum of $25 per visit, see brochure)
Inpatient Hospital 45% 50%
Maternity Care 45% 50%
Mental Health - Inpatient 45% 50%
Chemical Dependency 45% 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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