Health insurance coverage helps you pay for medical care and gives you access to a network of doctors and hospitals.
First, you buy a health plan. A health plan determines the types of medical services (benefits) you are covered for, the doctors and hospitals you can visit, and how much you will pay when you get care.
When you need medical care, you visit a doctor or hospital in your plan’s provider network. A network is a group of doctors and hospitals that has agreed with the health insurance company to charge certain amounts for each service. Your costs for care are usually lower when you use network providers compared to non-network providers.
Healthcare coverage isn’t just for when you’re sick. Preventive care services can help keep you and your family healthy with annual health exams and immunizations like flu shots.
You’ll pay a fixed monthly rate for your health insurance plan. The amount depends on the plan you buy. The lower your plan’s monthly rate, the more you typically pay when you see the doctor, and vice versa. Identifying how often you see a doctor can help you choose the right plan for you.
It depends on the service. Some services have a copayment, which is a fixed dollar amount. Other services have a coinsurance, which is a fixed percentage amount. When you get care from a network* doctor, you pay the copayment or coinsurance, and the health plan pays the rest up to the allowable amount.
To protect you and your family from unexpected costs, most plans have an annual out‑of‑pocket maximum. Once you reach the out‑of‑pocket maximum, your health plan covers 100% up to the allowable amount for most covered medical services.
Now that you understand the basics of health insurance coverage, take a look at our plans, get a quote, and apply for coverage today.
*Although some plans let you get care from hospitals and doctors who aren’t in the plan’s network, you’ll pay more to see those non-network providers. The plan may also have other costs, such as a separate, higher deductible, for seeing these providers. These extra costs can be very high, so it’s best to get care from network providers.
The total dollar amount Blue Shield allows for covered services.
The medically necessary services and supplies covered by the member’s health plan.
The percentage amount a member pays for benefits after meeting any calendar-year deductible.
The fixed dollar amount a member pays for benefits after meeting any calendar-year deductible.
The amount a member pays each calendar year for most benefits before Blue Shield begins to pay. Some benefits, such as preventive care, are covered before the member meets the calendar-year deductible.
A health plan in which members choose a primary doctor to administer their care, including referrals to specialist doctors. Covered benefits need to be received from providers in the primary doctor’s medical group. There is no coverage for services received from providers outside of the medical group or the larger HMO provider network.
A group of providers, including hospitals, doctors, specialists and other healthcare providers that has agreed with the health plan to provide benefits to plan members.
A health plan in which members can choose to see any provider in the PPO provider network without a referral. Members also have the freedom to use non-network providers if they are willing to pay a higher share of the cost.
The combined maximum of the deductible, copayment, and coinsurance amounts for all covered services an individual or family is required to pay each year.
Open enrollment ended January 31, but you can still qualify for health coverage if you’ve experienced one of the life events below. If you don’t have a qualifying life event, you can apply for coverage during the next open enrollment period starting October 15th, 2018.
If you are not eligible for Special Enrollment, please come back on October 15th, when Open Enrollment begins.
To get a quote or apply for coverage, fill in the fields below to find out if you are eligible for financial assistance to lower your monthly rate.
You may be eligible for financial assistance from the government to help you pay for a plan. Browse the site to learn about our plans, then call (888) 273‑0010 to get a quote. This number will stay at the top of your screen while you browse the site.
Browse the site to learn about our plans, then call (888) 273‑0010 to get a quote. This number will stay at the top of your screen while you browse the site.
Based on the information you provided, it appears you are eligible for Medi-Cal. Visit www.medi-cal.ca.gov and find out how to apply for coverage.
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