It\’s hard to get excited about health insurance in California. We\’re constantly bombarded with bad news in the form of an ever-increasing cost structure which is the last thing any client or shopper wants to hear. Every now and then, there\’s actually something we can get excited about and the Blue Shield Vital Shield PPO plans fall into this fleeting and sorely infrequent category. Let\’s a look at the Vital Shield PPO plans, how they work and who they are best fitted for.

First, a quick point about who they might not be geared towards and we have to make a point that this may all change July 1st if the California health insurance maternity changes go into effect. That should have been a cue. Prior to 7/1/2012, the Vital Shield plans do not cover maternity so if that possibility is even out there in the ether, we recommend other options and really there\’s only one plan that makes any sense on the market now (Shield Spectrum 5000 or 5500…whichever is cheaper). So no maternity on the Vital Shield plans. Once we\’ve cleared that hurdle, the plans and rates are very attractive. Let\’s take a quick look at the core benefits.

First of all, you have a choice of deductible; 400, 900, or 2900. The $400 deductible is currently the lowest on the market (aside from no-deductible plans) and the $2900 gives you a good high deductible option. Each deductible also have a generic RX only or brand RX option so in total, we have 6 PPO plan options. With each plan, you will get 4 office copays of $30 before the deductible is met and preventative benefits (including annual routine physical, annual pap/mammogram, wel-child checkup) will be covered at 100%. After the first 4 copays (per calendar year) are used up, additional office visits will then go towards the deductible.

For RX coverage, you will get $10 copays for generic on all the plans right away (no deductible). If you choose a brand RX plan, you will get $45 brand copays after a brand deductible of $500 is met. When you run your California health insurance quote, take a look at the deductible first to find the right price/benefit mix for you and then look at the medication difference (over a year\’s time) to evaluate if the brand RX benefit make sense cost-wise.

Once the deductible of choice is met, you will then pay 40% of the negotiated PPO rate till the OOP (Out of Pocket) maximum is met. The OOP is $2900 for the $400 deductible options; $3900 for the $900 deductible option; and $4900 for the $2900 deductible option. The OOP is in addition to the deductible so it\’s best to add those two numbers to really understand what your true out of pocket exposure is for a really big bill. This number is also what you want to compare against the annual premium difference to see who it stacks up. For example, if you save $1000 in premium and the deductible/OOP difference is close to that, it\’s probably best to go with the higher deductible. One note. Diagnostic lab and x-ray will go towards the OOP and not the deductible. This trend is pretty common with the new plans on the California health insurance market these days and will only continue. So what\’s great about the Vital Shield PPO plans in California?

They\’re priced really well versus the other carriers and even the other plans within Blue Shield of California. The 4 office visit copays will address most people\’s concerns in a given year which is ideal. You have flexibility of generic or brand options and pricing. The deductible spread is ideal with a very low option ($400) and a higher deductible ($2900) although the $900 deductible tends to be best value proposition. The plan is comprehensive (aside from maternity for now) and PPO which gives you 10\’s of thousands of doctors up and down the State and access to the nationwide BCBS provider network. They are tough plans to beat on the current market. Of course, we\’re happy to run a California health insurance quote for your particular situation to see if the Vital Shield PPO plans fit your needs.

Dennis Jarvis is a licensed California health insurance broker with extensive knowledge of the Individual and Small Group health market in California. Individual California health insurance

Dennis Jarvis is a licensed California health insurance broker with extensive knowledge of the Individual and Small Group health market in California. More information can be found at http://www.calhealth.net

Author Bio: Dennis Jarvis is a licensed California health insurance broker with extensive knowledge of the Individual and Small Group health market in California. Individual California health insurance

Category: Finances
Keywords: california health insurance, california health quote,individual california health insurance quote