Or, please fill out the below information and we'll contact you shortly.
Our Ultimate plan offers you the lowest out-of-pocket costs for medical services. There are no deductibles, so we start paying for covered benefits right from the start. By paying a higher monthly premium, you’ll pay less for medical services such as doctor visits, prescription drugs, and hospitalization.
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||$202||50%2|
|Office visit - specialist doctor||$402||50%2|
|Urgent care visit||$402||50%2|
|Preventive health benefits||$02||Not covered|
|Emergency room services not resulting in admission||$150||$150|
|Generic drugs||$52||Not covered|
|Preferred brand drugs||$15||Not covered|
|Non-preferred brand drugs||$25||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 deductible||$0||$0|
Calendar-year out-of-pocket maximum
|$4,000 per individual / $8,000 per family||$7,000 per individual / $14,000 per family|
|Calendar-year brand drug deductible||$0||Not covered|
For complete plan details on our Ultimate PPO and Ultimate EPO 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.