Blue shield silver 94 hmo trio providers

California Health Insurance
Covered California
Plans
Silver 94

Table of Contents Show

2021 Silver 94: Enhanced Plan
How to Qualify for a Silver 94 Plan
Is the Silver 94 Right for Me?
A Little More to Think About
Important notices and disclaimers
What is Blue Shield trio HMO?
What is Local Access Plus HMO?

2021 Silver 94: Enhanced Plan

If you already know you qualify for the Silver 94 plan, then congratulations! This plan is hands down the best, but comes with a catch. You have to qualify for it.

Of all the Covered California metal plans, the Silver 94 offers the lowest out-of-pocket costs for medical services. For example, office visits are a flat fee of $5 or $8 for a specialist. Generic drugs are $3. Most x-rays are $8, lab tests are $8. The most you would pay in a year if the worst happened with the Silver 94 plan is $1,000 for an individual or $2,000 for a family, compared to $4,500/$9000 under the Platinum “top-of-the-line” Plan. To see if you are eligible for an Enhanced Silver 94 Plan, click Affordable Health Insurance for California for a free quote.

See All Silver Plans

How to Qualify for a Silver 94 Plan

Not everyone qualifies for a Silver 94 Plan. To qualify, you must sign up through Covered California. Also, you must meet Covered California income requirements. Eligibility is determined using your family income, household size, age, and where you live. Generally, you may qualify if your income is just above 138% to 150% of the Federal Poverty Level. Children up to age 18 do not qualify for the enhanced Silver 94 Plan but may qualify for Medi-Cal or can enroll on a full priced plan.

Is the Silver 94 Right for Me?

If you qualify for the Silver 94, look no further, this is going to be the best for your money.

A Little More to Think About

Keep in mind that the Silver 94 Plan is based on your income. So, if you anticipate earning more in the near future, chances are, you may no longer qualify for the Silver 94 Plan when your income goes up. Be prepared, and know what some of the other metal plans are like so you can plan. But take advantage of the great benefits the Silver 94 offers you while you do qualify.

If you are considering a PPO plan, and you have a favorite doctor who is not part of your insurance company’s network, be aware that your cost for the doctor’s services may be a lot higher than if the doctor were in-network. This is true even on the Silver 94 “lowest-cost” Plan. For example, if you were admitted to the hospital and your physician was out-of-network, you may need to pay a deductible, plus an additional 50%, if applicable. Again, this is only if the doctor was out-of-network. In contrast, if your doctor were in-network, your cost under the Silver 94 Plan would be 10% of the bill up to a $2,350 maximum. As you can see, a whole lot different.

Obama Care

Not sure how Obamacare affects your health care plans in California? Learn how the ACA works in California, including benefits, costs and enrollment.

CA Health Exchange

Covered California is the Golden State’s official health exchange marketplace where individuals, families and small businesses can find high-quality, low-cost California government health insurance.

Income Guidelines

Learn about Obamacare income guidelines in California using our income limits chart, and see if you’re eligible for government assistance.

Online Services

Learn about the Covered California website. Find easy online enrollment. Set up your account, log in, buy insurance and more on the California health marketplace website.

Home > Health Insurance Companies > Blue Shield of California > Plan Details

Plan Summary
Plan Type	HMO
Office Visit for Primary Doctor Find Doctors	$5 Copay
Office Visit for Specialist	$8 Copay
Office Visit for Other Practitioner (Nurse, Physician Assistant)	$5 Copay
Annual Deductible	Individual: $75
Separate Prescription Drugs Deductible	$0 per person \| $0 per group
Coinsurance	10%
Retail Prescription Drugs	Generic Drugs: $3 Copay; Preferred Brand Drugs: $10 Copay; Non-Preferred Brand Drugs: $15 Copay; Specialty Drugs: 10% Coinsurance;
Annual Out-of-Pocket Limit	Individual: $800 Includes deductible
Lifetime Maximum	Unlimited
Health Savings Account (HSA) Eligible	No
Out-of-Network Coverage	No
Out-of-Country Coverage	No.
Office Visit
Primary Care Physician Required	Yes
Specialist Referrals Required	Yes
Preventive Care Coverage
Periodic Health Exam	No Charge
Periodic OB-GYN Exam	No Charge
Well Baby Care	No Charge
Emergency and Urgent Care
Emergency Room	$50 Copay
Emergency Ambulance Services	$30 Copay
Urgent Care Facility	$5 Copay
Prescription Drug Coverage
Retail Prescription Drugs	Generic Drugs: $3 Copay; Preferred Brand Drugs: $10 Copay; Non-Preferred Brand Drugs: $15 Copay; Specialty Drugs: 10% Coinsurance;
Separate Prescription Drugs Deductible	$0 per person \| $0 per group
Mail Order Prescription Drugs	N/A
Mail Order Supply	N/A
Outpatient Coverage
Outpatient Surgery	Outpatient Surgery Physician/Surgical Services: 10% Coinsurance Outpatient Facility Fee: 10% Coinsurance
Outpatient Lab/X-Ray	Outpatient Lab: $8 Copay X-rays: $8 Copay
Imaging (CT and PET scans, MRIs)	$50 Copay
Outpatient Mental Health	$5 Copay
Outpatient Substance Abuse	$5 Copay
Outpatient Rehabilitation Services (PT, OT, ST)	$5 Copay
Inpatient Coverage
Hospitalization	Inpatient Hospital Services: 10% Coinsurance after deductible Inpatient Physician and Surgical Services: 10% Coinsurance
Skilled Nursing Facility	10% Coinsurance after deductible, limited to 100 Days per Benefit Period
Inpatient Mental Health	10% Coinsurance after deductible
Inpatient Substance Abuse	10% Coinsurance after deductible
Home Healthcare	$3 Copay, limited to 100 Visit(s) per Year
Maternity Coverage
Pre & Postnatal Office Visit	No Charge
Labor & Delivery Hospital Stay	10% Coinsurance after deductible
Pediatric Services
Dental Checkup for Children	No Charge
Vision Screening for Children	No Charge
Eye Glasses for Children	No Charge
Major Dental Coverage (Pediatric)	50% Coinsurance
Additional Coverage
Chiropractic Coverage	Not Covered
Durable Medical Equipment	10% Coinsurance
Hospice	No Charge
Major Dental Coverage (Adult)	Not Covered
Vision Coverage (Adult)	Not Covered
Out-of-Network Coverage
Out-of-Network Authorization Required	N/A
Out-of-Network Annual Deductible	N/A
Out-of-Network Annual Coinsurance	N/A
Out-of-Network Annual Out-of-Pocket Limit	N/A
Additional Information
A.M. Best Rating	A as of 10/26/2021
Electronic Signature for Application Available	Yes
Details and documents about this plan
View Plan Brochure (Not available) The carrier has not provided a separate document for Exclusions and Limitations.

Important notices and disclaimers

The information shown here is a summary of benefits for informational purposes only. Review the official plan documents (such as evidence of coverage, plan brochure, or insurance policy) for a detailed description of coverage benefits, limitations, and exclusions. Only the terms and conditions of coverage benefits listed in the policy are binding.
The benefits listed may be contingent on your use of physicians, hospitals, and services within the specific insurance company's provider network.
The Copayment, Deductible, and Coinsurance amounts are your share of the costs for covered benefits. These amounts are subject to change.
Each insurance carrier may have unique Notices, Disclaimers, and Fees. Please check below for information regarding the plans and carriers you selected.
The quotes or rates shown above are estimates only. Your premium is subject to change based on the optional benefits you selected, if any, and other relevant factors, such as changes in rates that take effect before your coverage start date. The insurance company always determines your actual premium. Insurance companies reserve the right to change the terms of a policy upon proper notification.
The Summary of Benefits & Coverage can be found at healthcare.gov. A paper copy of this Summary of Benefits & Coverage is available upon request by calling our toll free number. Click here to view the Uniform Glossary of Coverage and Medical Terms.

What is Blue Shield trio HMO?

Our Trio HMO plans are designed to give you access to a quality network of doctors and hospitals – including Dignity Health, Hoag Memorial, John Muir, Providence, St. Joseph, St. Jude and UC San Francisco – at an affordable price.

What is Local Access Plus HMO?

With Local access+ HMO your employees can enjoy these benefits and more: Access to local doctors and hospitals employees trust. Out-of-state urgent and emergency care through the BlueCard^® Program. Access to specialists without a referral.

blue shield silver hmo trio providers