Essential Plan FAQ

What is Essential Plan?
Essential Plan is an all-in-one insurance plan for individuals featuring coverage for doctor and hospital services, generic prescription drugs, dental care, and vision care.

Who offers Essential Plan?
Essential Plan is offered by Blue Shield Of California. Blue Shield is Californiaıs third-largest health plan provider, with over 3.3 million members. Blue Shield is a not-for-profit organization with over 20 offices throughout California.

Whatıs covered by Essential Plan?
Essential Plan covers doctor and hospital services, dental exams and care, vision exams, and many generic prescription drugs.

Whatıs the difference between Essential Plan 3000 and Essential Plan 4500?
Both plans offer convenient, all-in-one individual coverage of doctor, hospital, dental, and vision services, plus generic prescription drugs. Essential Plan 3000 has a lower deductible than Essential Plan 4500. Essential Plan 4500 has a higher deductible, but has lower monthly premiums.

Whatıs the difference between a PPO and an HMO?
A PPO, or Preferred Provider Organization, features lower monthly rates and flexibility for choosing your healthcare provider. A HMO, or Health Maintenance Organization, has stricter rules about which healthcare providers will be covered. HMOs usually have higher monthly rates, but lower out-of-pocket expenses.

What is a Preferred Provider?
A Preferred Provider is a healthcare professional or organization that is a member of the Blue Shield network. To maximize your benefits under Essential Plan, you should turn to Preferred Providers for your healthcare needs. Charges for services from healthcare professionals outside the Blue Shield network may not be covered.

How large is Blue Shieldıs Preferred Provider network?
Blue Shield of California has a Preferred Provider network of over 45,000 doctors and 350 hospitals.

Will my family be covered under Essential Plan?
The plan provides individual-only health insurance coverage. That means that only the policy-holder is covered under Essential Plan.

What if I become pregnant while covered by Essential Plan?
The plan does not cover maternity benefits. Instead, Blue Cross Blue Shield of California has made it easy for its Essential Plan clients to switch to their one of their Shield Spectrum plans, which do cover maternity care.

Can members of my family have different plans?
Yes, members of your family can have different plans. In fact, many families can save money by getting individual plans tailored to their own needs instead of getting a single plan to cover all members of a family.

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