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Get Covered plan (Catastrophic)

Get Covered plan (Catastrophic)

Blue Shield pays, on average, 60% of covered medical expenses

Get Covered is designed specifically for people under age 30, or those age 30 and over who can provide a certification that they are without affordable coverage or are experiencing financial hardship, and need to purchase a low-cost plan option. The plan carries a high deductible. Most services are subject to the medical deductible, but you’ll still receive important benefits like preventive care and three doctor visits for no additional cost before meeting the deductible.

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

Get Covered plan (Catastrophic) – Benefit Overview

Benefit Participating providers1 (PPO and EPO): Non-participating providers1 (PPO only):
Office visit - primary care doctor $0 for first 3 visits per calendar year prior to deductible2, then $0 after deductible 50%
Office visit - specialist doctor 0% 50%
Urgent care visit $0 for first 3 visits per calendar year prior to deductible2, then $0 after deductible 50%
Preventive health benefits $02 Not covered
Inpatient hospitalization 0% 50%
Outpatient surgery 0% 50%
Lab 0% 50%
X-ray 0% 50%
Emergency room services not resulting in admission 0% 0%
Maternity 0% 50%
Generic drugs 0%4 Not covered
Preferred brand drugs 0%4 Not covered
Non-preferred brand drugs 0%4 Not covered
Chiropractic Not covered Not covered
(from a licensed acupuncturist)
0% 0%
Pediatric eye exam $02 Up to $302
Pediatric eyeglasses $02 $55 single vision2
Calendar-year medical deductible3 $6,350 per individual / $12,700 per family $6,350 per individual / $12,700 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 $04 Not covered

Get complete health plan details

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

Benefit Summary for Get Covered PPO (PDF, 492KB)
Benefit Summary for Get Covered EPO (PDF, 490KB)

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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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.