Blue Cross California Basic PPO 1000.

BC Life & Health Basic PPO 1000 (7900) Apply Now Rates by county Some counties have special rates by Zip code
Lifetime Maximum
Participating Provider	$5,000,000/member
Non-participating Provider	$5,000,000/member
Annual Out-of-Pocket Maximum (includes deductible)
Participating Provider	$3,500/single (2-member maximum) Participating and non-participating combined¹
Non-participating Provider	$3,500/single (2-member maximum) Participating and non-participating combined¹
Annual Deductible
Participating Provider	$1,000/member (2-member maximum) All covered benefits
Non-participating Provider	$1,000/member (2-member maximum) All covered benefits
Office Visits
Participating Provider	No office visit benefit until out-of-pocket maximum met, then 100% of negotiated fee
Non-participating Provider	No office visit benefit until out-of-pocket maximum met, then 100% of negotiated fee
Professional Services (other office visits, X-ray, lab, anesthesia, surgeon, etc.)
Participating Provider	20% of negotiated fee, hospital only. No office visit benefits until out-of-pocket maximum met, then covered at 100% of negotiated fee
Non-participating Provider	Covered expenses paid at 50% of the limited-fee schedule plus 100% of excess
Hospital Inpatient/Outpatient
Participating Provider	20% of negotiated fee
Non-participating Provider	All charges except: $650/day inpatient, $380/day outpatient
Hospice
Participating Provider	$10,000 lifetime maximum, participating and non-participating providers combined
Non-participating Provider	$10,000 lifetime maximum, participating and non-participating providers combined
Emergency Services
Participating Provider	20% of negotiated fee³
Non-participating Provider	20% of customary & reasonable for the first 48 hours plus 100% of excess; after 48 hours, you pay all charges except $650/day for covered services³
Maternity (after deductible)
Participating Provider	Not covered
Non-participating Provider	Not covered
Preventive Care
Participating Provider	HealthyCheck Centers: $25 or $75 copay for basic screenings; routine mammogram, PSA and cancer screening, ordered by physician: 20% of negotiated fee (deductible waived)
Non-participating Provider	Outside California, 50% of customary & reasonable to maximum of $250/year; routine mammogram, PSA and cancer screening, ordered by physician: 50% of customary & reasonable plus 100% of excess
Ambulance
Participating Provider	20% of negotiated fee ($750/trip maximum paid by BC Life & Health Insurance Company)
Non-participating Provider	50% of customary & reasonable plus 100% of excess
Physical and Occupational Therapy; Chiropractic Services
Participating Provider	Not covered unless during inpatient admission
Non-participating Provider	Not covered unless during inpatient admission
Acupuncture/Acupressure
Participating Provider	Not covered
Non-participating Provider	Not covered
Drug Benefits (retail or mail order: 30-day supply)
Participating Provider	Not covered
Non-participating Provider	Not covered

Please Note: When locating a provider, PPO plans are also referred to as Prudent Buyer1Non-participating charges in excess of the negotiated fee will not be paid and do not apply to the out-of-pocket maximum.2Additional $500 admission charge at Participating Hospitals (no additional for Preferred Participating Hospitals) is for surgery or infusion therapy. This charge is not required for Ambulatory Surgical Centers or medical emergencies.3Additional $30 copay for PPO Plans applies for each emergency room visit (waived if admitted as inpatient).

TONIK

PPO Basic 1000 rate Areas by County

Basic PPO 1000 Rates

Rates by county

Tonik Rates by City