We're going to look at the Vital Shield plus plans from Blue Shield of California but keep in mind that these very popular plans are no longer available to new enrollees but many Californians are on the plans so let's go through how they stack up against other options on the market. Turns out, they stack up pretty well.
We'll provide you with the current equivalent of
the Vital Shield plans below.
The Vital Shield plus plans by Blue Shield of California were the answer to Anthem's Smart Sense plans.
They composed a suite of plans that all worked the same but with different deductibles ($400, $900, or $2900) and an option between generic RX only or comprehensive RX (includes brand name) within each deductible.
The most popular two deductibles were the $900 and $2900 and most people chose the generic RX only option due to the price difference versus the Brand RX option.
The plans came on the scene roughly around 2010 (if memory serves us) and they were discontinued to new applications effective 7/1/2012. Existing members were allowed to remain on the plan but it essentially became a closed plan as new applicants could not choose these plans. When you run your quote, you will not see these options.
The plans were PPO (not HSA qualified) but they quickly became one of the most popular plans on the market as the pricing was extremely competitive especially against the intended (or so we're guessing) target of Anthem's Smart Sense plans which also had a range of deductibles and the generic/brand option. As to why the plans were discontinued especially considering their tremendous success in the market, we can only guess that the benefits were to rich for the premium charged with new Health Reform mandates coming online such as Maternity on all plans effective July 1st, 2012 and preventative benefits at 100% to name just two. The max out of pocket (amount paid at a percentage beyond the deductible) was also pretty low at $2900.
This means that if you had very serious bills (let's say $50K) on the $900 Vital Shield deductible plan, you might be looking at $3800 out of pocket ($2900 + $900) which was one of the lowest OOP maxes on the California individual health insurance market.
The plans were originally designed with no maternity benefit but as we mentioned above, all California individual plans (old and new) cover maternity as of July 1st, 2012. The Vital Shield plus plans gave you 4 office visit copays per member at $30 without needing to meet the deductible.
Beyond those four, further office visits in a calendar year would be subject to the deductible. The generic RX option was pretty straight forward with a $10copay.
For the Brand RX option, you had $10 copays
right away for generic and $45 copays for brand
RX after a $500 brand deductible.
Again, it's a shame we lost this option since the pricing was great and it was a real relief to have something to offer cash-strapped Californians on the individual health market.
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