Blue Shield of California has two plans that offer maternity coverage: Spectrum PPO 5000 and Spectrum PPO 5500. These PPO plans have negotiated discounted care from the doctors and hospitals in their network, but you may also use out-of-network providers. Your out-of-pocket costs will be greater if you go out-of-network.
Plans with Maternity Coverage at a Glance:
Spectrum PPO 5000 has a $5,000 deductible you must meet before coverage begins. Once the deductible has been met, the plan has a 30% co-payment (the part you pay) on outpatient prenatal and postnatal care as well as for delivery and all necessary inpatient hospital services from in-network providers. The co-payment on these services from out-of-network providers is 50%.
Spectrum PPO 5500 has a $5,500 deductible you must meet before coverage begins. Once the deductible has been met, the plan has a 35% co-payment on outpatient prenatal and postnatal care as well as for delivery and all necessary inpatient hospital services from in-network providers. The co-payment on these services from out-of-network providers is 50% as with the previous plan.
These co-payments do not count toward the co-payment/co-insurance maximum, and will continue to be charged once it is reached. For non-emergency hospital services and supplies received from an out-of-network hospital, Blue Shield’s payment is limited to $250 per day.
Six-month Waiting Period:
For adults age 19 and older, Blue Shield PPO plan benefits will not be provided for pre-existing conditions, including pregnancy,during the first six months of coverage after the plan’s effective date, with the exception of services required to treat involuntary complications of pregnancy.
If you have prior creditable coverage and you apply for coverage within 63 days after termination of the prior coverage, Blue Shield will credit the length of time you were covered on your previous health plan toward the six-month waiting period.
