Blue Shield of California Vital Shield
PPO Plans
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.
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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