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Enhanced plan (Silver)

Enhanced plan (Silver)

Blue Shield pays, on average, 70% of covered medical expenses

Our Enhanced plan offers you affordable, comprehensive coverage without surprises. You’ll receive benefits like doctor visits and generic drugs prior to meeting a moderate deductible. Other services, such as hospitalization, are covered after you meet the medical deductible. By paying a little more when you use services, you’ll pay lower monthly rates.

This plan is available for purchase directly through Blue Shield or through Covered California.

Enhanced plan (Silver) – Benefit Overview

Benefit Participating providers1 (PPO and EPO): Non-participating providers1 (PPO only):
Office visit - primary care doctor $452 50%2
Office visit - specialist doctor $652 50%2
Urgent care visit $902 50%2
Preventive health benefits $02 Not covered
Inpatient hospitalization 20% 50%
Outpatient surgery 20%2 50%2
Lab $452 50%2
X-ray $652 50%2
Emergency room services not resulting in admission $250 $250
Maternity 20% 50%
Generic drugs $192 Not covered
Preferred brand drugs $50 Not covered
Non-preferred brand drugs $70 Not covered
Chiropractic Not covered Not covered
Acupuncture
(from a licensed acupuncturist)
$452 $452
Pediatric eye exam $02 Up to $302
Pediatric eyeglasses $02 $55 single vision2
Calendar-year medical deductible3 $2,000 per individual / $4,000 per family $2,000 per individual / $4,000 per family
Calendar-year out-of-pocket maximum
(includes deductible)
$6,350 per individual / $12,700 per family $9,350 per individual / $18,700 per family
Calendar-year brand drug deductible $250 per individual / $500 per family Not covered

We also offer Enhanced cost-sharing reduction plans through Covered California for those who meet federal financial guidelines. These plans provide you with lower cost-sharing to reduce your out-of-pocket costs when accessing medical care. Contact your broker or Blue Shield to help you determine if you qualify for one of these plans.

These plans are only available for purchase through Covered California.

Benefit Enhanced 150 Subsidy Enhanced 200 Subsidy Enhanced 250 Subsidy
Participating providers1 (PPO and EPO): Non-participating providers1 (PPO only): Participating providers1 (PPO and EPO): Non-participating providers1 (PPO only): Participating providers1 (PPO and EPO): Non-participating providers1 (PPO only):
Office visit - primary care doctor $32 50%2 $152 50%2 $402 50%2
Office visit - specialist doctor $52 50%2 $202 50%2 $502 50%2
Urgent care visit $62 50%2 $302 50%2 $802 50%2
Preventive health benefits $02 Not covered $02 Not covered $02 Not covered
Inpatient hospitalization 10% 50% 15% 50% 20% 50%
Outpatient surgery 10%2 50%2 15%2 50%2 20%2 50%2
Lab $32 50%2 $152 50%2 $402 50%2
X-ray $52 50%2 $202 50%2 $502 50%2
Emergency room services not resulting in admission $25 $25 $75 $75 $250 $250
Maternity 10% 50% 15% 50% 20% 50%
Generic drugs $32 Not covered $52 Not covered $192 Not covered
Preferred brand drugs $5 Not covered $15 Not covered $30 Not covered
Non-preferred brand drugs $10 Not covered $25 Not covered $50 Not covered
Chiropractic Not covered Not covered Not covered Not covered Not covered Not covered
Acupuncture
(from a licensed acupuncturist)
$32 $32 $152 $152 $402 $402
Pediatric eye exam $02 Up to $302 $02 Up to $302 $02 Up to $302
Pediatric eyeglasses $02 $55 single vision2 $02 $55 single vision2 $02 $55 single vision2
Calendar-year medical deductible3 $0 $0 $500 per individual / $1,000 per family $500 per individual / $1,000 per family $1,500 per individual / $3,000 per family $1,500 per individual / $3,000 per family
Calendar-year out-of-pocket maximum
(includes deductible)
$2,250 per individual / $4,500 per family $5,250 per individual / $10,500 per family $2,250 per individual / $4,500 per family $5,250 per individual / $10,500 per family $5,200 per individual / $10,400 per family $8,200 per individual / $16,400 per family
Calendar-year brand drug deductible $0 Not covered $50 per individual / $100 per family Not covered $250 per individual / $500 per family Not covered

Get complete health plan details

For complete plan details on our Enhanced PPO and Enhanced EPO plans, see the Benefit Summaries and Legal Disclosures below:

Benefit Summary for Enhanced PPO (PDF, 476KB)
Benefit Summary for Enhanced EPO (PDF, 468KB)
Benefit Summary for Enhanced PPO 150 Subsidy (PDF, 480KB)
Benefit Summary for Enhanced EPO 150 Subsidy (PDF, 467KB)
Benefit Summary for Enhanced PPO 200 Subsidy (PDF, 491KB)
Benefit Summary for Enhanced EPO 200 Subsidy (PDF, 467KB)
Benefit Summary for Enhanced PPO 250 Subsidy (PDF, 490KB)
Benefit Summary for Enhanced EPO 250 Subsidy (PDF, 470KB)

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

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.

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