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Anthem Blue Cross : PPO Share Plans

PPO Share Plans

PW_A116587
These plans offer a broad range of benefits and are ideal for families with young children or planning to have children. 
Features: 
A choice of three deductibles: $3500, $5000, or $7500
Immediate benefits (deductible waived) for doctors’ office visits, annual physical exam and preventive care
Comprehensive brand-name (Tier 2) and generic (Tier 1) prescription drug coverage
Maternity benefits
Lower rates on services when you use our PPO network of more than 50,000 doctors and 400 hospitals. This means your share of medical costs will be lower, too.
Health and wellness programs. Learn how to improve your health with online access to health-related information, tools and product discounts.
Out-of-state coverage. Protection from the high cost of unexpected emergencies when you travel.
 
For extra security, we offer dental and life insurance plans that you can add to your medical coverage.  
If you have questions:  
Call 1-800-777-6000, Monday – Friday, 8:30 a.m. – 6:30 p.m. (PST) to speak to a licensed agent
Complete an Information Request Form
Or contact your local Anthem Blue Cross agent
Click here for our PPO Share Plans brochure
 
Get a Quote and Apply Now 
 
Benefits-at-a-glance for PPO Share Plans  

Plan Benefits  
 PPO Share Plans 3500/5000/7500
In-Network Out-of-Network
Annual Deductible Choices 
Individual  
$3,500/$5,000/$7,500 per member  
Family  
Each family member has an individual deductible. Once 2 members each reach the deductible, the deductible is satisfied for the entire family. 
Annual Out-of-Pocket Limit1  
(in addition to deductible, if any) 
Individual  
$4,000/$2,500/$0 per member  
Family  
Each family member has an individual deductible. 
Lifetime Maximum  
Plan pays up to $5 Million per member  
 
Covered Services  
The amounts shown are your share of costs after any deductible  
 In-Network Out-of-Network
Doctors’ Office Visits  
$40 copay (deductible waived) 
50% of negotiated fee plus all excess charges (deductible waived) 
Professional Services  
(x-ray, lab, anesthesia, surgeon, etc.) 
30% of negotiated fee (with $3500 and $5000 deductible plans) or $0 (with $7500 deductible plan) 
50% of negotiated fee plus all excess charges (with $3500 and $5000 deductible plans) OR $0 (with $7500 deductible plan) 
Hospital Inpatient 
(overnight hospital stays) 
30% of negotiated fee2 (with $3500 and $5000 deductible plans) or $0 (with $7500 deductible plan) 
All charges except $650 per day 
Hospital Outpatient 
(if you don’t stay overnight) 
30% of negotiated fee2 (with $3500 and $5000 deductible plans) or $0 (with $7500 deductible plan) 
All charges except $380 per day 
Emergency Room Services 
($100 copay applies for each visit; waived if admitted as inpatient) 
30% of negotiated fee2 (with $3500 and $5000 deductible plans) or $0 (with $7500 deductible plan) 
30% of customary and reasonable fees plus all excess charges (with $3500 and $5000 deductible plans) OR $0 (with $7500 deductible plan) 
Maternity 
30% of negotiated fee (with $3500 and $5000 deductible plans) or $0 (with $7500 deductible plan) 
50% of negotiated fee plus all excess charges (with $3500 and $5000 deductible plans) OR $0 (with $7500 deductible plan) 
Preventive Care 
(tests ordered by physician are covered, including appropriate screening for breast, cervical, ovarian, and prostate cancer) 
Adult Services 
Annual Physical exam(s)3: 30% of negotiated fee (deductible waived)  
OR HealthyCheckSM Centers: $25 / $75 copay for basic/premium screening (deductible waived)  
Routine mammogram, Pap and PSA tests: 30% of negotiated fee (deductible waived)  
50% of negotiated fee plus all excess charges (deductible waived) 
Children's Services 
Well-Child (through age 6): 40% of negotiated fee (deductible waived) 
Acupuncture / Acupressure 
All charges except $30 per visit, up to 24 visits per year (deductible waived) 
Chiropractic Services 
30% of negotiated fee (with $3500 and $5000 deductible plans) or $0 (with $7500 deductible plan) 
All charges except $25 per visit 
Plan covers up to 12 visits per year 
 
Prescription Drug Coverage Options 
In-Network 
Out-of-Network 
Comprehensive Prescription Drug Coverage 
For $5000 deductible plan:  
Generic (Tier 1): $15 copay  
Brand-name (Tier 2): $35 copay after $750 annual brand-name deducible (2 member max) 
For $3500 and $7500 deductible plans: 
Generic (Tier 1): $15 copay or 40%, whichever is greater. 
Brand-name (Tier 2): $15 copay or 40%, whichever is greater after $750 annual brand-name deducible (2 member max) 
50% of drug limited fee schedule and all excess charges plus the copay/coinsurance as stated for in-network benefits; subject to the $750 annual brand-name prescription drug deductible 
Generic Prescription Drug Coverage 
Included above 
No Prescription Drug Coverage 
Not applicable 

1. Excludes non-participating charges in excess of the Anthem Blue Cross negotiated fee and non-participating charges in excess of customary and reasonable fees for emergency care. Copays/coinsurance to participating and non-participating providers apply to annual calendar year out-of-pocket limit except where specifically noted in the policy.
2. Additional $500 admission charge at participating hospitals (no additional charge for preferred participating) is for inpatient stays or outpatient surgery or infusion therapy. The charge is not required for ambulatory surgical centers or medical emergencies.
3. Maximum annual physical exam benefit is $200 for members covered more than 6 months; $100 for members covered less than 6 months.

 

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Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association.