Individual Health Insurance - BC Life and Health Resources

Plans Offered:

3500 Deductible PPO Plan:

Basic PPO 1000:

Basic PPO 2500:

PPO 3500 HSA Compatible Plan:

PPO Saver:

PPO Share 5000:

Tonik 1500 - Calculated Risk Taker:

Plan Name	3500 Deductible PPO Plan
Details Brochure	Click to view brochure
Plan Description Benefit	This PPO plan offers a higher deductible with most benefits covered at 100% once the deductible is met.
Plan Deductible Benefit	3500
Plan Out of Network Deductible Benefit	$3,500 per member
Plan Coinsurance Benefit	None
Plan Out of Network Coinsurance Benefit	Varies by benefit
Plan Out of Pocket Maximum Benefit	$0 after deductible
Plan Out of Network Pocket Maximum Benefit	$6,500 per member, after deductible
Plan Family Out of Pocket Maximum Benefit	Once two members each reach the maximum, the maximum is satisfied for the entire family.
Maternity Benefit	Not covered
Plan Lifetime Maximum Benefit	$5,000,000 per member
Plan Preventive Care Benefit	$0 after deductible
Plan Child Preventive Care Benefit	$0 after deductible
Plan Lab & X-Ray Benefit	$0 after deductible
Plan Inpatient Hospital Benefit	$0 after deductible
Plan Outpatient Surgery Benefit	$0 after deductible
Plan Office Visits Benefit	$0 after deductible
Plan Urgent Care Benefit	$0 after deductible, plus additional $100 copay applies for each visit (waived if admitted to the hospital)
Plan Emergency Care Benefit	$0 after deductible, plus additional $100 copay applies for each visit (waived if admitted to the hospital)
Plan Ambulance Service Benefit	$0 after deductible
Plan Prescription Drug Benefit	$10 copay generic; $30 copay brand name after annual $500 brand name prescription drug deductible
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	See Exclusions Limitations

Plan Name	Basic PPO 1000
Details Brochure	Click to view brochure
Plan Description Benefit	This PPO plan offers reduced premiums, basic coverage and a large network of providers.
Plan Deductible Benefit	1000
Plan Out of Network Deductible Benefit	$1,000 per member for inpatient and surgical procedures only
Plan Coinsurance Benefit	You pay 20% of negotiated fee
Plan Out of Network Coinsurance Benefit	Varies by benefit
Plan Out of Pocket Maximum Benefit	$2,500 per member, after deductible
Plan Out of Network Pocket Maximum Benefit	$2,500 per member, after deductible
Plan Family Out of Pocket Maximum Benefit	Once two members each reach the maximum, the maximum is satisfied for the entire family.
Maternity Benefit	Not included
Plan Lifetime Maximum Benefit	$5,000,000
Plan Preventive Care Benefit	Mammogram, Pap and PSA - 20% coinsurance applies, deductible waived. Healthy Check Centers - $25 copay for basic and $75 copay for premium screenings.
Plan Child Preventive Care Benefit	Not included
Plan Lab & X-Ray Benefit	20% coinsurance for inpatient or surgical procedures. Other services - you pay 100% until out of pocket maximum is met, then the plan pays 100%.
Plan Inpatient Hospital Benefit	Subject to coinsurance
Plan Outpatient Surgery Benefit	$2,500 per member, after deductible
Plan Office Visits Benefit	No office visits covered until out of pocket maximum is met, then plan pays 100%
Plan Urgent Care Benefit	Subject to deductible and coinsurance plus additional $100 copay (waived if admitted to the hospital)
Plan Emergency Care Benefit	Subject to deductible and coinsurance plus additional $100 copay (waived if admitted to the hospital)
Plan Ambulance Service Benefit	20%
Plan Prescription Drug Benefit	Not included
Plan Supplemental Accident Benefit	Not included
Plan Pre-Existing Conditions Benefit	See Exclusions Limitations

Plan Name	Basic PPO 2500
Details Brochure	Click to view brochure
Plan Description Benefit	This PPO plan offers reduced premiums, basic coverage and a large network of providers.
Plan Deductible Benefit	2500
Plan Out of Network Deductible Benefit	$2,500 per member for inpatient and surgical procedures only
Plan Coinsurance Benefit	You pay 20% of negotiated fee
Plan Out of Network Coinsurance Benefit	Varies by benefit
Plan Out of Pocket Maximum Benefit	$2,500 per member, after deductible
Plan Out of Network Pocket Maximum Benefit	$2,500 per member, after deductible
Plan Family Out of Pocket Maximum Benefit	Once two members each reach the maximum, the maximum is satisfied for the entire family.
Maternity Benefit	Not included
Plan Lifetime Maximum Benefit	$5,000,000
Plan Preventive Care Benefit	Mammogram, Pap and PSA - 20% coinsurance applies, deductible waived. Healthy Check Centers - $25 copay for basic and $75 copay for premium screenings.
Plan Child Preventive Care Benefit	Not included
Plan Lab & X-Ray Benefit	20% coinsurance for inpatient or surgical procedures. Other services - you pay 100% until out of pocket maximum is met, then the plan pays 100%.
Plan Inpatient Hospital Benefit	Subject to coinsurance
Plan Outpatient Surgery Benefit	Subject to coinsurance
Plan Office Visits Benefit	No office visits covered until out of pocket maximum is met, then plan pays 100%
Plan Urgent Care Benefit	Subject to deductible and coinsurance plus additional $100 copay (waived if admitted to the hospital)
Plan Emergency Care Benefit	Subject to deductible and coinsurance plus additional $100 copay (waived if admitted to the hospital)nce
Plan Ambulance Service Benefit	Subject to coinsurance
Plan Prescription Drug Benefit	Not included
Plan Supplemental Accident Benefit	Not included
Plan Pre-Existing Conditions Benefit	See Exclusions Limitations

Plan Name	PPO 3500 HSA Compatible Plan
Details Brochure	Click to view brochure
Plan Description Benefit	This PPO plan offers a higher deductible and the ability to combine a Health Savings Account (HSA) with the plan.
Plan Deductible Benefit	3500
Plan Out of Network Deductible Benefit	$3,500 per member, $7,000 per family aggregate
Plan Coinsurance Benefit	None
Plan Out of Network Coinsurance Benefit	Varies by benefit
Plan Out of Pocket Maximum Benefit	$1,500 per member, after deductible
Plan Out of Network Pocket Maximum Benefit	$1,500 per member, after deductible
Plan Family Out of Pocket Maximum Benefit	$3,000, after deductible
Maternity Benefit	Not covered
Plan Lifetime Maximum Benefit	$5,000,000 per member
Plan Preventive Care Benefit	$0 after deductible
Plan Child Preventive Care Benefit	$0 after deductible
Plan Lab & X-Ray Benefit	$0 after deductible
Plan Inpatient Hospital Benefit	$0 after deductible
Plan Outpatient Surgery Benefit	$0 after deductible
Plan Office Visits Benefit	$0 after deductible
Plan Urgent Care Benefit	$0 after deductible, plus additional $100 copay applies for each visit (waived if admitted to the hospital)
Plan Emergency Care Benefit	$0 after deductible, plus additional $100 copay applies for each visit (waived if admitted to the hospital)
Plan Ambulance Service Benefit	$0 after deductible
Plan Prescription Drug Benefit	$10 copay generic; $30 copay brand name after annual deductible
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	See Exclusions Limitations

Plan Name	PPO Saver
Details Brochure	Click to view brochure
Plan Description Benefit	This PPO plan offers reduced premiums, basic coverage and a large network of providers.
Plan Deductible Benefit	5000
Plan Out of Network Deductible Benefit	$500 for hospital and emergency services, $5,000 other covered services, per member
Plan Coinsurance Benefit	You pay 20% of negotiated fee
Plan Out of Network Coinsurance Benefit	You pay 20% of negotiated fee
Plan Out of Pocket Maximum Benefit	$5,000 per member
Plan Out of Network Pocket Maximum Benefit	$5,000 per member
Plan Family Out of Pocket Maximum Benefit	Once two members each reach the maximum, the maximum is satisfied for the entire family.
Maternity Benefit	Not included
Plan Lifetime Maximum Benefit	$5,000,000
Plan Preventive Care Benefit	Mammogram, Pap and PSA - 20% coinsurance applies, deductible waived. Healthy Check Centers - $25 copay for basic and $75 copay for premium screenings.
Plan Child Preventive Care Benefit	You pay 50% of negotiated fee, deductible waived
Plan Lab & X-Ray Benefit	20% coinsurance for inpatient or surgical procedures. Other services - you pay 100% until out of pocket maximum is met, then the plan pays 100%.
Plan Inpatient Hospital Benefit	Subject to deductible and coinsurance
Plan Outpatient Surgery Benefit	Subject to deductible and coinsurance
Plan Office Visits Benefit	In Network - $30 copay (limited to 4 visits per year per child and 2 visits per year per adult)
Plan Urgent Care Benefit	See Emergency Care
Plan Emergency Care Benefit	Subject to deductible and coinsurance plus additional $100 copay (waived if admitted to the hospital)
Plan Ambulance Service Benefit	Subject to coinsurance
Plan Prescription Drug Benefit	Formulary Drugs - $10 copay for generic; $30 copay for brand name after $500 brand name deductible.
Plan Supplemental Accident Benefit	Not included
Plan Pre-Existing Conditions Benefit	See Exclusions Limitations

Plan Name	PPO Share 5000
Details Brochure	Click to view brochure
Plan Description Benefit	This PPO plan offers competitive premiums, extensive coverage and a large network of providers.
Plan Deductible Benefit	5000
Plan Out of Network Deductible Benefit	$5,000 per member
Plan Coinsurance Benefit	You pay 30% of negotiated fee
Plan Out of Network Coinsurance Benefit	You pay 50% of negotiated fee
Plan Out of Pocket Maximum Benefit	$2,500 per member (in addition to the deductible)
Plan Out of Network Pocket Maximum Benefit	$2,500 per member (in addition to the deductible)
Plan Family Out of Pocket Maximum Benefit	Once two family members each reach the individual maximum, the maximum for the family is satisfied.
Maternity Benefit	Subject to deductible and coinsurance
Plan Lifetime Maximum Benefit	$5,000,000
Plan Preventive Care Benefit	Annual physical, Mammogram, Pap and PSA - you pay 30%, deductible waived. Healthy Check Centers - $25 copay for basic or $75 copay for premium screenings.
Plan Child Preventive Care Benefit	You pay 40% of negotiated fee, deductible waived (through age 6)
Plan Lab & X-Ray Benefit	Subject to deductible and coinsurance
Plan Inpatient Hospital Benefit	Subject to deductible and coinsurance
Plan Outpatient Surgery Benefit	Subject to deductible and coinsurance
Plan Office Visits Benefit	$40 copay (deductible waived)
Plan Urgent Care Benefit	Subject to deductible and coinsurance
Plan Emergency Care Benefit	Subject to deductible and coinsurance plus an additional $100 copay (waived if admitted to the hospital)
Plan Ambulance Service Benefit	Subject to deductible and coinsurance
Plan Prescription Drug Benefit	Formulary Drugs in Network - $10 copay for generic, $35 copay for brand name after $750 brand name deductible.
Plan Supplemental Accident Benefit	Not included
Plan Pre-Existing Conditions Benefit	Six month waiting period for coverage of any condition, disease or ailment for which medical advice or treatment was recommended or received within six months preceding the effective date of coverage.

Plan Name	Tonik 1500 - Calculated Risk Taker
Details Brochure	No brochure available
Plan Description Benefit	This plan offers a simplified benefit structure and affordable premiums.
Plan Deductible Benefit	1500
Plan Out of Network Deductible Benefit	$1,500 per member
Plan Coinsurance Benefit	None
Plan Out of Network Coinsurance Benefit	Varies by benefit
Plan Out of Pocket Maximum Benefit	$1,500 per member
Plan Out of Network Pocket Maximum Benefit	$10,000 per member
Plan Family Out of Pocket Maximum Benefit	N/A
Maternity Benefit	None
Plan Lifetime Maximum Benefit	$5,000,000 per member
Plan Preventive Care Benefit	Subject to deductible; $25 or $75 for HealthCheck centers
Plan Child Preventive Care Benefit	N/A
Plan Lab & X-Ray Benefit	$0 after the deductible is met
Plan Inpatient Hospital Benefit	$0 after the deductible is met
Plan Outpatient Surgery Benefit	$0 after the deductible is met
Plan Office Visits Benefit	$40 copayment per visit. Out-of-Network After meeting the annual deductible, member pays 50% of covered expenses plus all excess charges for each visit. NOTE Professional Services performed during an office visti (e.g. any surgery, infusion therapy, diagnostic x-ray, laboratory, pathology, and radiology) are not covered under the office visit copay. These services will be subject to the deductible.
Plan Urgent Care Benefit	$100 copayment per visit
Plan Emergency Care Benefit	$0 after the deductible is met. Out-of-Network After meeting the annual deductible, member pays 50% of covered expenses plus all excess charges.
Plan Ambulance Service Benefit	$0 after the deductible is met
Plan Prescription Drug Benefit	$10 copay for generic drugs (no coverage for brand name)
Plan Supplemental Accident Benefit	None
Plan Pre-Existing Conditions Benefit	See Exclusions Limitations

Blue Cross of California
Celtic Insurance Company
Health Net Life Insurance Company
PacifiCare Health Systems
Time Insurance Company
UniCare Life and Health Insurance Company
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Name:	BC Life and Health
Description:	BC Life and Health is an affiliate of Blue Cross of California.
Website:	http://www.bluecrossca.com/
Customer Service:	800-333-0912
Address:	2000 Corporate Center Dr Newbury Park, CA 91320
Not Offered by QuickQuote in:	All states except for CA
Year Founded:	1937
AM Best Rating:	A as of 2006
S&P Rating:	A+