California Health Insurance Quotes

The following are Exclusions and Limitations that will help you understand what a health care plan does not include before you enroll. These listings are an overview only. For a comprehensive list of the plans’ exclusions and limitations, you can should request a copy of a Policy/Combined Evidence of Coverage and Disclosure Form (EOC) booklet.

Exclusions and Limitations

• Conditions covered by workers’ compensation or similar law.
• Experimental or investigative services.
• Services provided by a local, state, federal or foreign government, unless you have to pay for them.
• Services or supplies not specifically listed as covered under the Policy/EOC.
• Services received before your effective date or after coverage ends.
• Any services received by Medicare benefits without payment of additional premium.
• Services or supplies that are not medically necessary.
• Routine physical exams, except for preventive care services (e.g., physical exams for insurance, employment, licenses or school are not covered), except as specifically stated in the Policy/EOC.
• Any amounts in excess of the maximum amounts listed in the Policy/EOC.
• Sex changes.
• Cosmetic surgery.
• Services primarily for weight reduction except medically necessary treatment of morbid obesity.
• Dental care, dental implants or treatment to the teeth, except as specifically stated in the Policy/EOC.
• Hearing aids.
• Contraceptive drugs and/or certain contraceptive devices, except as specifically stated in the Policy/EOC.
• Infertility services.
• Private duty nursing.
• Eyeglasses or contact lenses, except as specifically stated in the Policy/EOC.
• Vision care including certain eye surgeries to replace glasses, except as specifically stated in the Policy/EOC.
• Mental and nervous disorders and substance abuse, except as specifically stated in the Policy/EOC.
• Certain orthopedic shoes or shoe inserts, except as specifically stated in the Policy/EOC.
• Services or supplies related to a preexisting condition.
• Telephone or facsimile machine consultations.
• Outdoor treatment programs.
• Educational services except as specifically provided or arranged by Anthem Blue Cross.
• Nutritional counseling or food or dietary supplements, except for formulas and special food products to prevent complications of phenylketonuria (PKU).
• Care or treatment furnished in a non-contracting hospital, except as specifically stated in the Policy/EOC.
• Personal comfort items.
• Custodial care.
• Certain genetic testing.
• Outpatient speech therapy, except as specifically stated in the Policy/EOC.
• Any amounts in excess of maximums stated in the Policy/EOC.
• Outpatient drugs, medications or other substances dispensed or administered in any outpatient setting.
• Services or supplies provided to any person not covered under the Agreement in connection with a surrogate pregnancy.

Vital Shield^SM Plus* offers valuable California health insurance coverage for individuals and families, as a low-cost option for those who rarely go to the doctor, but want to know they’re covered when they do. Built on the success of the Vital Shield* plans, the Vital Shield Plus plans offer all the same great benefits plus a whole lot more.

Get a quote and apply online now!
Get Prices for Vital Shield Plans

Ideal for individuals and families

Individuals who only expect to go to the doctor a few times a year Individuals who are not planning to have children or additional children in the near future Younger adults may want to consider lower deductibles ($400 for “young invincibles”, $900 for couples) Older adults may want to consider higher deductibles ($2,900 for established families and empty nesters) Tips for families Families can save money with Vital Shield Plus by enrolling as a family instead of enrolling individually If there are three or more family members, total family deductibles and out-of-pocket maximums would be lower per person on a family plan than with individual plans Benefits are per member, so each family member gets the same number of office visits Get a quote and apply online now! Get Prices for Vital Shield Plans Vital Shield Plus Plan Benefits2  Available for individuals and families  Office visits and preventive exams First 5: $30 (deductible n/a), then $0 after out-of-pocket maximum  Brand Rx $45 after $500 brand Rx deductible (optional)  Generic Rx $10 (deductible n/a)  Gynecological  40% (deductible n/a) + preventive exam copayment  Lab and X-ray  $0 after out-of-pocket maximum  Emergency room  $100 + 40% after deductible  Ambulance  40% after deductible  Hospitalization  40% after deductible  Maternity  Not covered   Deductible and out-of-pocket maximum options  Plan  400 900  2900  Deductible  $400 / $800 (family) $900 / $1,800 (family)  $2,900 / $5,800 (family)  Out-of-pocket maximum  $2,900 / $5,800 (family) $3,900 / $7,800 (family)  $4,900 / $9,800 (family)   1  Please note that Vital Shield Plus plans do not include maternity benefits. 2  Amounts shown represent the member’s financial responsibility when using Blue Shield network provides. * Vital Shield and Vital Shield Plus plans are underwritten by Blue Shield of California Life and Health Insurance Company and are pending regulatory approval.