Blue Shield of CA HSA Plans

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

Blue Shield of California HSA

Blue Shield of California offers four high-deductible health plans -- called Shield Spectrum PPO Savings Plans -- that are eligible for use with a Health Savings Account (HSA).  These plans offer affordable coverage for a high-cost medical event while helping you meet your essential healthcare needs.  They are often selected by people who go to the doctor occasionally.

Blue Shield of CA HSA

Supplemental Accident Coverage
The perfect complement to any HSA

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Shield Spectrum PPO HSA Plans at a Glance

Plan Features Overview:

  • High-deductible health plans designed to be compatible with an HSA for tax-savings opportunities on qualified medical expenses
  • Financial protection against major healthcare expenses
  • Catastrophic coverage
  • Choice of providers every time you seek covered services.  There are lower out-of-pocket costs when you choose from over 45,000 preferred providers.
  • Get prescription drugs at Blue Shield's contracted rate at participating pharmacies
  • Access to a mail-service pharmacy benefit
  • Preventive care benefits before you meet your deductible when you use preferred providers

Use the Expand button to the right to view the Shield Spectrum PPO HSA plans chart details...

Benefit
Participating Provider
Non-Participating Provider
 Annual Deductible
Please run an instant quotes
for deductibles in your area
Please run an instant quotes
for deductibles in your area
 Coinsurance
(% Paid by Insurance Company)
70% with Preferred Choice Providers, and 60% with Preferred Affiliate Providers
You pay 50%
 Out-of-Pocket Maximum
Individuals: $3,200
Families: $5,800 aggregate
Individuals: $3,200
Families: $5,800 aggregate
 Lifetime Maximum
$6,000,000 per member
$6,000,000 per member
 Office Visits
You pay 30% with Preferred Choice Providers, and 40% with Preferred Affiliate Providers
You pay 50%
 Prescription Drugs
-Coverage can be obtained at any retail pharmacy.  Member pays full price and submits claims to Blue Shield of California.  After medical deductible is met, 30% copayment applies
-Oral contraceptives and diaphragms covered
<= Same as Preferred Providers
 Emergency Room
-Emergency room services: you pay $75, then 30%($75 copayment waived if the member is admitted directly to the hospital)
-Inpatient physician and hospital services and supplies: You pay 30%
<= Same as Preferred Providers
 Adult Preventive Care
-Annual routine physical exam, gynecological exam, Well-baby care office visits: You pay $35 for Choice Providers, and $35 for Affiliate Providers
-Annual Pap test or other approved cervical cancer screening tests and routine mammography,immunizations, routine screenings (with annual physical or in a separate office visit): You pay 30%
Not Covered
 Child Preventive Care
See Adult Preventive Care
See Adult Preventive Care
 Lab / X-ray
You pay 30%
You pay 50%
 Maternity
-Outpatient prenatal and postnatal care
-Delivery and all necessary inpatient hospital services
-You pay 30% with Choice Providers, and 40% with Affiliate Providers
-Outpatient prenatal and postnatal care: You pay 50% with Non-Preferred Providers
-Delivery and all necessary inpatient hospital services: You pay 50% (to $300 per day) with Non-Preferred Providers
 Physical Therapy
-Received in the office of a physician, physical therapist or occupational therapist; or hospital outpatient department
-You pay 25% with Choice Providers, and 35% with Affiliate Providers
-Received in the office of a physician, physical therapist or occupational therapist; or hospital outpatient department
-You pay 50% with Non-Preferred Providers
 Skilled Nursing
-Semiprivate accommodations following transfer from hospital unless Blue Shield gives written authorization
-up to 100 days per calendar year
-You pay 30% in hospital or freestanding SNF
-Semiprivate accommodations following transfer from hospital unless Blue Shield gives written authorization
-up to 100 days per calendar year
-Semiprivate accommodations in a hospital SNF unit: You pay 50%
-Semiprivate accommodations in a freestanding SNF: You pay 50%
 Home Health Care
-Up to 90 preauthorized visits per calendar year, including services received at home for physical medicine and speech therapy
-You pay 30%
<= Same as Preferred Providers
 Mental Health
-Inpatient Hospital Facility Services: You pay 30%
-Inpatient Physician Services: You pay 30%
-Outpatient visits for severe mental health conditions: You pay 30%
-Outpatient visits for non-severe mental health conditions (up to 20 visits per calendar year combined with chemical dependency visits): You pay 30%
-Inpatient Hospital Facility Services: You pay 50% (to $300 per day)
-Inpatient Physician Services: You pay 50%
-Outpatient visits for severe mental health conditions: You pay 50%.
-Outpatient visits for non-severe mental health conditions (up to 20 visits per calendar year combined with chemical dependency visits): Not Covered
 Hospital Care
-Inpatient physician visits and consultations, surgeons and assistants, anesthesiologists, pathologists, radiologists
-Inpatient semiprivate room and board, services and supplies, and subacute care services received in a hospital or ambulatory surgery center
-You pay 30% for Choice Providers, and you pay 40% for Affiliate Providers
-Inpatient physician visits and consultations, surgeons and assistants, anesthesiologists, pathologists, radiologists: You pay 50% for Non-Preferred Providers
-Inpatient semiprivate room and board, services and supplies, and subacute care services received in a hospital or ambulatory surgery center: You pay 50%(to $300 per day) for Non-Preferred Providers

 

Benefit
Participating Provider
Non-Participating Provider
 Annual Deductible
Individuals: $4,000
Families: $8,000 aggregate
Individuals: $4,000
Families: $8,000 aggregate
 Coinsurance
(% Paid by Insurance Company)
100% with Preferred Choice Providers, and 60% with Preferred Affiliate Providers
You pay 50%
 Out-of-Pocket Maximum
$4,000 Individual / $8,000 Family with Preferred Choice Providers, and $5,000 Individual / $10,000 Family with All Providers
$4,000 Individual / $8,000 Family with Preferred Choice Providers, and $5,000 Individual / $10,000 Family with All Providers
 Lifetime Maximum
$6,000,000 per member
$6,000,000 per member
 Office Visits
After Deductible, No Charge
After Deductible, you pay 50%
 Prescription Drugs
After Deductible, No Charge (Up to a 30-day supply)
Mail Service Prescriptions: 100% of Blue Shield negotiated rate (Up to a 30-day supply)
 Emergency Room
After Deductible, No Charge
After Deductible, No Charge
 Adult Preventive Care
-Annual routine physical exam, gynecological exam, Well-baby care office visits: You pay $35 (until deductible is met, then no charge)
-Annual Pap test or other approved cervical cancer screening tests and routine mammography,immunizations, routine screenings (with annual physical or in a separate office visit): No Charge
Not Covered
 Child Preventive Care
See Adult Preventive Care
See Adult Preventive Care
 Lab / X-ray
After Deductible, No Charge
After Deductible, You pay 50%
 Maternity
Not Covered
Not Covered
 Physical Therapy
No Charge
50%
 Skilled Nursing
No Charge in hospital or Freestanding SNF
50% in hospital or Freestanding SNF
 Home Health Care
After Deductible, No Charge
Not Covered
 Mental Health
After Deductible, No Charge
Not Covered
 Hospital Care
After Deductible, No Charge
After Deductible, 50%

 

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.


Expand

Coverage Synopsis

The Shield Spectrum PPO Savings Plans 2400/4800 and 4000/8000 are designed to protect you from major healthcare expenses while giving you the freedom to choose from one of the state’s largest provider networks.  They cover doctor visits, prescription drugs, vision, accident benefit, and of course, hospitalization.  The 2400/4800 plan pays 70% in-network until your out-of-pocket maximum is reached, then 100% to $6 million, and includes maternity coverage.  The 4000/8000 plan pays 100% of covered in-network expenses up to $6 million.  Preventive care is covered at the doctor of your choice, with no annual benefit limit.

Rate Information

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

Blue Shield of California PPO Network

Blue Shield of California 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

Blue Shield 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 Blue Shield 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 Blue Shield that your coverage has been approved and is in force.

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

HSA Administrators

Your health savings account is totally separate from your health insurance, and you may use any approved bank or trustee as your HSA administrator.  We recommend that you choose one from our HSA administrator page, where you can compare rates and features. 

About Blue Shield of California

With 3.3 million members and $7.5 billion in annual revenue, Blue Shield of California is the state's third largest health plan.  Founded in 1939 and headquartered in San Francisco, Blue Shield is a not-for-profit corporation with approximately 4,500 employees and more than 20 offices throughout California.

Blue Shield of California 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 Blue Shield of CA agent.  CA License #: 0E39302

"I've spent some time on my local talk show (which covers most of the northern half of California) talking about your website."

People complain about the high cost of healthcare but are not doing anything about it.  I found out about your website and thought it was beneficial enough to tell my audience.  It is a great resource for people who want to learn more about Health Savings Accounts.  I've spent some time on my local talk show (which covers most of the northern half of California) talking about your website.

Tom Sullivan
News Talk 1530 KFBK in Sacramento CA

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Blue Shield of California in the News


Blue Shield of California agrees to cover autism treatment
Blue Shield of California will provide coverage of an expensive autism treatment after reaching an agreement with the state.

Blue Shield settles autism therapy dispute
Blue Shield will cover behavioral therapy for autism in accordance with the state's mental heal

Blue Shield agrees to cover autism therapy
The health insurance firm settles an action launched by California regulators and will now pay for applied behavior analysis therapy. A major health insurance company has settled an enforcement action with state regulators over providing special therapy for autism patients.

HP and Blue Shield of California Sign Five-Year Infrastructure and Applications Services Agreement
PALO ALTO, CA-- - HP Enterprise Services and Blue Shield of California today announced they have signed an agreement designed to enable Blue Shield to deliver new services that enhance efficiencies and ...

Autism treatment dispute settled with Blue Shield
A state regulator has reached an agreement with Blue Shield of California to provide coverage of a pricey type of autism treatment.

Insurance news: Sen. Feinstein supports state review of rate increases; Anthem plans in Colo. and Conn. to pay extra ...
Sen. Dianne Feinstein announced she is supporting a ballot measure to give California regulators the power to approve health insurance rates. In other news, Blue Shield in California says it will cover an autism behavioral therapy and Anthem Blue Cross and Blue Shield plans in Colorado and Connecticut announce plans to pay doctors for coordinating care.

Blue Shield of California Urged to Withdraw Rate Hike
Rate Hike Expected to Force More Than 30,000 Californians to Drop Blue Shield Coverage

Agendia Signs Contract with Blue Shield of California
IRVINE, Calif. and AMSTERDAM , Jan. 5, 2012 /PRNewswire/ -- Agendia, an innovative molecular cancer diagnostics company, today announced that the company has signed a contract with Blue Shield of California ...

Kantor & Kantor, LLP Announces District Court Victory: Blue Shield Must Provide Residential Care Benefits for ...
LOS ANGELES, Jan. 19, 2012 /PRNewswire/ -- Kantor & Kantor, LLP announced today that the U.S. District Court for the Central District of California ruled in favor of the firm's client Laura Burton, deciding ...

Hewlett-Packard signs contract with Blue Shield of California
Hewlett-Packard signs contract with Blue Shield of California

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