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Active Start Plans A36809_1-11

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Active Start Plans A36809_1-11 Powered By Docstoc
					Active Start
                                                                                                             Active Start Plan 25

                                                                                                             Active Start Plan 25 Generic Rx

                                                                                                             Active Start Plan 35
Individual Plans
                                                                                                             Active Start Plan 35 Generic Rx

Get value right away, with no deductible to pay.
Active StartSM PPO plans* offer a blend of lower costs and comprehensive benefits for active individuals who want
coverage in case of a serious medical event, but also want to take care of more routine day-to-day healthcare
needs. Active Start plans have no medical deductibles, so your benefits start right away.

With fixed, low copayments for physician office visits, going to the doctor won’t cost you a fortune. And with the
choice of generic-only, or generic and brand-name prescription drug coverage, you have greater control over
your monthly premiums.

    Four great reasons to choose an Active Start plan today:

   •	 Services	are	available	right	away	–	there’s	no	medical	deductible	to	meet

   •	 	 ow	copayments	for	office	visits	and	prescription	drugs

   •	 100%	coverage	for	most	in-network	services	after	meeting	the	out-of-pocket	maximum

   •	 Chiropractic	and	acupuncture	benefits

Compare for yourself all the great benefits of Active Start plans

                                                   Active Start 25,                                          Active Start 35,
                                              Active Start 25 Generic Rx                                Active Start 35 Generic Rx
Office visits                                                  $25                                                       $35
Preventive care exam                                                                         $0
Mammogram and                                                                                $0
GYN screening
Inpatient hospitalization                                                          $500/admit	+	40%
Outpatient surgery                                                                 $500/admit	+	40%
Lab and X-ray                                                                              40%
Emergency room                                                           $100	(waived	if	admitted)	+	40%	
Maternity                                                                             Not covered
Generic Rx                                                                                  $10
Brand formulary Rx      1
                                                            $35                                                      $35
                                             after	$500	Brand	Rx	deductible                           after	$750	Brand	Rx	deductible
                                                           -OR-	                                                    -OR-	
                                            Not	covered	on	Generic	Rx	plan2                          Not	covered	on	Generic	Rx	plan2
Annual deductible                                             None                                                     None
Annual out-of-pocket                                        $6,000                                                    $7,500
maximum                                                  per member                                                per member
Amounts	shown	represent	the	member’s	financial	responsibility	when	using	Blue	Shield	network	providers,	unless	otherwise	indicated.	This	document	is	a	
summary only. For a detailed description of plan benefits and exclusions, request a copy of the Policy by calling Member Services at (800) 431-2809.

                                          click here to apply onine                                          
Advantages of Blue Shield Individual and Family plans                           Understanding your plan
•	 	 ffordable	–	we’ve	negotiated	with	providers	for	                           To	make	health	coverage	easier	for	you,	here	is	a	simple	
   lower fees, so you’ll pay less for covered medical                           description of how these plans work:
   services. A lot less.
                                                                                •	 	 ith	no	deductible,	you’ll	receive	most	benefits	–	like	
•	 	 ith	more	than	60,000	doctors,	Blue	Shield	has	some	                           office	visits	and	generic	prescription	drugs	–	right	
   of	the	largest	PPO	provider	networks	in	California.	If	                         away for a copayment.
   you already have a doctor, chances are your doctor
                                                                                •	 	 ou’ll	pay	the	reduced	fee	we	negotiated	with	your	
   is in one of our networks.
                                                                                   provider until you’ve reached your annual out-of-
•	 	 ots	of	extras	such	as	around-the-clock	access	to	a	                           pocket	maximum.	After	that,	we’ll	pay	100%	for	most	
   registered nurse, wellness programs and discounts,                              covered medical services.1
   and out-of-state coverage at no additional cost.
•	 	 0%	vision	discounts	for	eye	exams,	frames	and	lenses,	
   and other products.3

          Take	an	active	approach	to	
         your health care. Apply for an

                                                                                                                                                             An	Independent	Licensee	of	the	Blue	Shield	Association				A36809	(1/11)
            Active Start plan today!

*	 	 nderwritten	by	Blue	Shield	of	California	Life	&	Health	Insurance	Company.	Active	Start	Plan	25	Generic	Rx	and	Active	Start	Plan	35	Generic	Rx	are	
   subject to regulatory approval.
1	 	 mounts	you	pay	for	prescriptions	do	not	count	toward	the	out-of-pocket	maximum.	After	you	meet	the	out-of-pocket	maximum,	copayments	for	
   prescriptions will continue.
2	 	 rand-name	prescription	drug	coverage	is	not	offered	under	Active	Start	Plan	25	Generic	Rx	or	Active	Start	Plan	35	Generic	Rx,	with	the	exception	of	
   covered	drugs	and	supplies	for	diabetes.		Brand	and	generic	diabetes	medications/supplies	are	covered,	and	may	be	subject	to	Prior	Authorization	for	
   medical necessity.
3	 	 he	network	of	practitioners	and	facilities	in	the	Discount	Vision	Program	are	managed	by	a	contracted	vision	plan	administrator	(including	any	
   screening	and	credentialing	of	provider).	Blue	Shield	does	not	review	the	services	provided	by	discount	program	providers	for	medical	necessity	or	
   efficacy.	Nor	does	Blue	Shield	make	any	recommendations,	representations,	claims,	or	guarantees	regarding	the	practitioners,	their	availability,	fees,	
   services,	or	products.	Some	services	offered	through	the	discount	program	may	already	be	included	as	part	of	the	Blue	Shield	health	plan	covered	
   benefits. Members should access those covered services prior to using the discount program. Members who are not satisfied with products or services
   received	from	the	discount	program	may	use	the	Blue	Shield	grievance	process	described	in	the	Grievance	Process	section	of	the	Policy.	Blue	Shield	
   reserves the right to terminate this program at any time without notice.

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