Blue Cross of CA Non-HSA PPO Plans

Anthem Blue Cross of California is one of the most known and trusted names in the health insurance industry.

Anthem Blue Cross of California HSA

Anthem Blue Cross is the largest insurer in the state of California, offering traditional plans that can include co-payments for doctor visits and prescriptions, economical major medical plans, and coverage that qualifies to work with a Health Savings Account (HSA).

The plans below are all Non-HSA qualified plans.  If you are interested in an HSA qualified plan from Anthem Blue Cross of California, please visit our 3500 PPO HSA plan page, or our Lumenos HSA plan page. 

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Non-HSA Plans at a Glance

Use the Expand button to the right to view the Anthem Blue Cross of California Non-HSA plans details...

Plans
RIght Plan 40 PPO
PPO Share
3500 PPO
Lifetime Max
$5 Million per Member
$5 Million per Member
$5 Million per Member
Dr. Co-Pay
$40
$25
100% after Deductible

Rx
 
Three Options:
 1)
2)
3) 		No Rx Coverage
$10 co-pay for generics only
$10 co-pay for generics, $30 for brand name, after $500 per year deductible
 Co-payment is $10 for Generic Drug, $35 for Brand Name Drugs, after $750 Brand Name deductible.
  Co-payment is $10 for Generic Drug, $30 for Preferred Brand Name Drug, 50% off Non-Preferred Brand Name Drug.

Wellness
Services
  Routine mammograms and well baby and child visits - $40 plus 40% of negotiated fee.

$25 or $75 co-pay for basic one basic screening per year (deductible waived) for adults and children over age 7.
 

Healthy Check Centers: $25 or $75 copay for basic screenings.

Routine mammogram, PAP and PSA tests ordered by physician: 30% of negotiated fee; well-baby and well-child through age 6, 40% of negotiated fee (deductible waived).

  100% after Deductible.

$25 or $75 co-pay for basic one basic screening per year (deductible waived) for adults and children over age 7.


Deductibles
 
$0
 $500, $1,000, $1,500, $2,500, $5,000 per individual.

The family deductible is three times the individual deductible.
  $3,500 for single; individual; 2 family max
Network
Co-insurance
60% + $0 deductible per hospital stay or outpatient surgery
70% after deductible
100% after deductible
Non-Network
Co-insurance
50% of negotiated fee,
member pays 100% of excess.
50% of negotiated fee,
member pays 100% of excess.
After deductible 50% of negotiated fee, plus 100% of charges in excess of negotiated fee.

Out-of-Pocket Maximum
(in addition to the deductible)

$7,500
 $5,000 ($500 and $1,000 deductible),
$6,000 ($1,500 deductible), or $7,500 ($2,500 and $5,000 deductibles) /single (2-member maximum) Participating and non-participating combined.

Note: Non-participating charges in excess of the negotiated fee will not be paid and do not apply to the out-of-pocket maximum.


$5,000 single; individual;

$10,000 aggregate family

Emergency
Services
60%
70%, plus $100 co-pay per visit
After deductible, $100 co-pay
Acupuncture/
Acupressure
After deductible, $25 co-pay -
24 visits per year max
$25 co-pay - 24 visits per year max, deductible waived.
After deductible, $25 co-pay -
24 visits per year max
Other Covered
Services
60%
70% after deductible
100% after deductible

Plans
3500 PPO HSA Compatible
HMO
Lifetime Max
$5 Million per Member
Unlimited
Dr. Co-Pay
100% after Deductible
$10

Rx
  Co-payment is $10 for Generic Drug, $30 for Preferred Brand Name Drug, 50% off Non-Preferred Brand Name Drug.
 Co-payment is $10 for Generic Drug, $30 for Brand Name Drugs, after $250 Brand Name deductible.

Wellness
Services
  100% after Deductible.

$25 or $75 co-pay for basic one basic screening per year (deductible waived) for adults and children over age 7.

$10 co-pay

Deductibles
  $3,500 for single; individual; $7,000 aggregate family
 $1,500 per member Inpatient Hospital, Outpatient Ambulatory Surgical Center Visit.
Network
Co-insurance
100% after deductible
80%
Non-Network
Co-insurance
After deductible 50% of negotiated fee, plus 100% of charges in excess of negotiated fee.
Not Covered.

Out-of-Pocket Maximum
(in addition to the deductible)


$5,000 single; individual;

$10,000 aggregate family

$3,000 / single
(2-member maximum)
Emergency
Services

After deductible, $100 co-pay
 

Inpatient and professional services no charge when authorized by a medical group within 48 hours of emergency care.

Outpatient you pay $50 emergency room co-payment plus 20%.

Acupuncture/
Acupressure
After deductible, $25 co-pay -
24 visits per year max
Not Covered
Other Covered
Services

100% after deductible
 Subject to $1,500 deductible.
Inpatient no charge.
Outpatient you pay 20% of negotiated fee (for non-emergency services).

Additional Benefits for the HMO Plan

Lab/X-ray
  Unlimited office visits: you pay $10 copay per visit
Inpatient hospital no charge

Maternity
  Office visits, Inpatient and outpatient paid as above (inpatient and outpatient subject to deductible)

Physical Therapy
  You pay $10 per visit; limited to 60 consecutive days following illness or injury; no charge for inpatient services. Chiropractic benefits with medical group referral.

This information is presented only as a very brief overview of some of the benefits of this plan, and is intended only for general education.  The amount of benefits provided depends on the plan selected. Premium will vary with the type of benefits selected.  These plans contain exclusions from and limitations of coverage.  Please see the product brochure for more complete information, as well as information about terms of renew ability, preexisting conditions, out-of-network penalties, and notification requirements.  Plans are subject to health underwriting.  To be considered for reimbursement, expenses must qualify as covered expenses.  Expenses are also subject to reasonable and customary limits, unless you use a network, and all other policy provisions, including determinations of medical necessity.

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Coverage Synopsis

Anthem Blue Cross generally offers the best value for full coverage in California.  They cover doctor visits, prescription drugs, vision, accident benefit, and of course, hospitalization.  The coverage and rates are excellent, and they have what is probably the widest PPO network in the state of California.

Notes on Anthem Blue Cross HMO plan:

A Health Maintenance Organization (HMO) is a plan that provides health care from specific doctors and hospitals that contract with the plan.  While the plans comes with low co-payments for Doctor Visits ($10) and coverage for maternity benefits, your geographical service area is often limited, and you have no coverage if seen by a doctor or hospital that does not participate with the plan.

With an HMO, you must first chose a Primary Care Physician (PCP), from whom you must obtain a referral prior to seeking care from a specialist.  You will not receive coverage for any (non-emergency) care not authorized by your Primary Care Physician at your Participating Medical Group.

Rate Information

Rates vary based upon zip code, age, and effective date.  Preferred rates without riders are available on our instant quote page. 

Anthem Blue Cross of California PPO Network

Anthem Blue Cross gives you access to one of the largest networks in California, with thousands of health care providers throughout the state.  Having access to the PPO network can mean substantial discounts in what you pay for your health care, even before you meet your deductible.  The large list of doctors and hospitals can be viewed at their online directory.

Underwriting

Anthem Blue Cross has one of the easiest, most efficient underwriting teams in the industry.  The process is very fast if no medical records are needed.  While it is always a good idea to apply at least three weeks prior to the time you need your new coverage to take effect, some applications that are done online are approved by Anthem Blue Cross within 24 hours.  

The company does have the right to accept or decline any individual or family application.  Certain conditions may be waivered with a temporary rider (usually for one to two years), or an indefinite rider.  If you are currently being treated for depression, anxiety, or high cholesterol, please let us know before you apply so we can make sure there are no delays in getting you covered.

Effective Dates

The coverage can go into effect in as quickly as 24 hours, though you risk being declined if claims are submitted before the underwriting process is completed.  You may request an effective date any time the date after you sign the application and 60 days later.  Please note that you will be billed starting on your requested effective date, even if you have not yet been notified that you have been approved.  This is very good for someone who does not have any present coverage and would like for their benefits to begin right away.  For those who are already covered, it is suggested that you maintain your current coverage in force until you have received notice from either HSA for America or directly from Anthem Blue Cross that your coverage has been approved and is in force.

Your earliest possible effective date will be the day after Anthem Blue Cross has received all the necessary documents and information needed to process your application.

About Anthem Blue Cross of California

Anthem Blue Cross has been serving the health care needs of Californians since 1937.  Anthem Blue Cross, together with its branded affiliates, provides health care services to more than 6.8 million members.

Anthem Blue Cross has been assigned a rating of "A" (Excellent) from the A.M. Best Company, an independent insurance rating organization.

HSA for America is an independent authorized Anthem Blue Cross agent.  CA License #: 0E39302

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