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Below explanation is for California plan only

left corner Blue Shield VITAL SHIELD
(Individual only)
(877)566-5454 Toll Free
The coverage you need. The price you want.
Annual Deductible Choices
(choose from 2 low-cost plans)		 $900 per member $2,900 per member
Annual Out-of-Pocket Max.
(includes deductible)		 $4,900 per member $5,900 per member
Coinsurance 40% with preferred providers
50% with non-preferred providers
Office Visits $40¹ copay (each for first 2 office visits)
Preventive Care Exam $40¹ copay
Mammogram & GYN screenings 40% + preventive care exam copay
Hospitalization 40% after deductible
Lab and X-ray $0 after out-of-pocket maximum
Emergency Room Services $100 (waived if admitted) & 40% after deductible
Maternity Not covered
Prescription Drugs Generic formulary drugs: $10 copay
(Brand-name² drugs are not covered)

¹ After 2 visits per member per year for any combination of preventive exam and office visits, subsequent visits are $0 after out-of-pocket maximum.
² Vital Shield and Vital Shield Plus Generic Rx plans do not cover brand-name drugs with the exception of covered drugs and supplies for diabetes. Brand and generic diabetes medications/supplies are covered, and may be subject to Prior Authorization for medical necessity.
  Download Your Blue Shield Vital Shield PPO Brochure  

Apply for Blue Shield of CA Health Online
OR
Download Your Blue Shield Vital Shield Application

health insurance EKG

Or you can fill in this form to have your Blue Shield of CA Health Insurance brochure with pricing & application mailed to you. Further information on our plans is shown below. Or just call us Toll-free at 1-877-Look4Life (1-877-566-5454).
Customer Information
Name
E-mail
Street address
City
County
State
Zip Code
Home Phone
Work Phone
FAX
Insured Age  
Smoker? Yes No
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Barricks Insurance Services
13900 NW Passage #302, Marina Del Rey, CA 90292
Phone:   (310) 827-7286    |   Fax:   (310) 827-0256
Toll-Free 1-877-Look4Life  (1-877-566-5454)

©1995  Barricks Insurance Services. CA License #0383850
Licensed in AL, AR, AZ, CA, CO, CT, FL, GA, IA, IL, IN, KS, KY,
                   LA, MD, MI, MO, MS, NC, NE, NH, NM, NV, NY, OH,
                   OK, OR, PA, SC, SD, TN, TX, UT, VA, WI, WV