Blue Shield of California Essential 4500 PPO

Blue Shield of California
Essential 4500

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California medical insurance Individual Family Blue Shield of California PPO Essential 4500

Blue Shield of California Essential 4500	Other Blue Shield individual family plans Blue Shield of California HMO plans Blue Shield of California PPO plans
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Essential 4500		In-Network	Out-Of-Network
	Annual Deductible	Individual: $4,500	Individual: $4,500
	Annual Out-Of-Pocket Limit	Individual: $4,500	Individual: $6,500
	Lifetime Maximum	$6,000,000	$6,000,000
	Office Visits	$40 (First 3 visits, then No Charge after Deductible)	50%
	Prescription Drugs	$10 Generic	$10 Generic
	Laboratory and Radiology	No Charge after Deductible	50%
	Annual Physical Exam	$40	Not Covered
	Annual OB-GYN Exam	$40	Not Covered
	Prenatal / Postnatal Maternity	Not Applicable	Not Applicable
	Well Baby Care	$40	Not Covered
	Outpatient Surgery	No Charge after Deductible	50% ($250 maximum benefit per day)
	Emergency Room	$100 (waived if admitted)	$100 (waived if admitted)
	Ambulance	No Charge after Deductible	No Charge after Deductible
	Home Health Care	No Charge after Deductible (90 visits per year)	Not Covered
	Mental Health Services	No Charge after Deductible (20 visits per year)	Not Covered
	Chiropractic Care	Not Covered	Not Covered
	Acupuncture / Acupressure	Not Covered	Not Covered
	Inpatient Co-payment	No Charge after Deductible	50% ($250 maximum benefit per day)
	Maternity Care	Not Covered	Not Covered
	Inpatient Mental Health	No Charge after Deductible	50% ($250 maximum benefit per day)
	Chemical Dependency	No Charge after Deductible	50% ($250 maximum benefit per day)

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Blue Shield of California Overview

Fast Facts

Year founded: 1939

Service area: California

Annual revenue: $7.5 billion

Total employees: 4,500

Chairman, President and Chief Executive Officer: Bruce G. Bodaken

Blue Shield is a California not-for-profit mutual benefit corporation.

National affiliation: Independent Member of the BlueCross BlueShield Association

Parent company: California Physicians' Service, Inc.

Accreditation

The National Committee for Quality Assurance (NCQA) recently awarded Blue Shield an "Excellent" rating for service and clinical quality for its HMO and Point of Service (POS) lines of business.

"Excellent" accreditation status is reserved for the best health plans in the nation and is only awarded to those plans that meet or exceed NCQA's rigorous requirements for consumer protection and quality improvement and deliver excellent clinical care. Review Blue Shield's NCQA Health Plan Report Card at www.ncqa.org.

Financial Ratings (as of February 2006)

			A (stable) rating from Standard and Poors
			A (excellent) rating from AM Best
			A (excellent) rating by Weiss Ratings, Inc.

Membership (as of January 2006)

HMO: 1,300,000

PPO: 1,200,000

TRICARE: 500,000

Other: 300,000*

Total: 3,300,000

*= Includes non-underwritten ASO and National Accounts

Provider Network (as of August 2006)

Type of Provider

HMO

PPO

Primary Care Physicians

11,027

18,516

Specialists

16,917

29,372

Total

27,944

47,888

Hospital Network (as of August 2006)

HMO: 304

PPO: 351

Blue Shield also has offices in Chico, Folsom, Fresno, Gold River, Irvine, Hemet, Lodi, Monterey Park, Orange, Petaluma, Redding, Riverside, Sacramento, San Diego, San Jose, Santa Barbara, Walnut Creek and Woodland