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Our Basic plan for health savings accounts is perfect for those who want low monthly rates and to better manage their healthcare spending through a health savings account (HSA). With this HSA-compatible*, high-deductible health plan, you can prepare for future medical costs by contributing pre-tax money to your own savings account for healthcare expenses. You’ll even enjoy preventive care before meeting the deductible.
This plan is available for purchase directly through Blue Shield or through Covered California.
|Benefit||Participating providers1 (PPO and EPO):||Non-participating providers1 (PPO only):|
|Office visit - primary care doctor||40%||50%|
|Office visit - specialist doctor||40%||50%|
|Urgent care visit||40%||50%|
|Preventive health benefits||$02||Not covered|
|Emergency room services not resulting in admission||40%||40%|
|Generic drugs||40%4||Not covered|
|Preferred brand drugs||40%4||Not covered|
|Non-preferred brand drugs||40%4||Not covered|
|Chiropractic||Not covered||Not covered|
(from a licensed acupuncturist)
|Pediatric eye exam||$02||Up to $302|
|Pediatric eyeglasses||$02||$55 single vision2|
|Calendar-year medical deductible3||$4,500 per individual / $9,000 per family||$4,500 per individual / $9,000 per family|
Calendar-year out-of-pocket maximum
|$6,350 per individual / $12,700 per family||$9,350 per individual / $18,700 per family|
|Calendar-year brand drug deductible||$04||Not covered|
For complete plan details on our Basic PPO for HSA and Basic EPO for HSA plans, see the Benefit Summaries and Legal Disclosures below:
Legal Disclosure (PDF, 916KB)
We also have Summary of Benefits and Coverage Forms that can help you make a decision by providing you with an easy to understand overview of what these plans cover. Visit blueshieldca.com/sbc to obtain the forms.
Pediatric dental is an essential health benefit for children under age 19, and must be purchased when applying for a medical plan directly through Blue Shield. We offer four pediatric dental plans to choose from. Download our pediatric dental plans flier for more information.
Individual / Family Plans
We'll respond within 30 minutes Monday to Friday, 8 a.m. to 5:30 p.m. PST, or the next business day for requests made at all other times.