Annual Out-of-Pocket Maximum
(includes deductible)
$3,000/single (2-member maximum)
Annual Deductible
No deductible
Office Visits
You pay $25
Professional Services
(X-ray, lab, anesthesia, surgeon, etc.)
$25 office visit Copayment, No charge for office visit related services
Hospital Inpatient/Outpatient
Inpatient — $250 per day Copayment, four (4) day Copayment maximum per admission
Outpatient — you pay 20% of negotiated fee (for non-emergency services)
Emergency Services
Professional services — no charge when authorized by a medical group within 48 hours of emergency care
Outpatient — you pay $100 emergency room copayment plus 20% of the negotiated fee rate (waived if admitted into the hospital)
Inpatient - $250 per day Copayment, four (4) day Copayment maximum per admission.
Maternity
Professional Services: $25 office visitsInpatient Services: $250 per day Copayment, four (4) day Copayment maximum per admission
Preventive Care
You pay a $25 copayment for specific health maintenance services
Ambulance
You pay a $50 Copayment unless admitted to the hospital
Physical and Occupational Therapy; Chiropractic Services
You pay $25 per visit; limited to 60 consecutive days following illness or injury; no charge for inpatient services Chiropractic benefits with
medical group referral
Drug Benefits
(retail or mail order: 30-day supply)
Participating Provider
You pay $10 for generic and $30 for Brand drugs, after a $250 deductible for Brand drugs
Non-Formulary:Participating Provider: Generic 50%; Brand 100% of negotiated Fee Rate for Brand Name Drugs until the Brand Name Prescription Drug Deductible is satisfied. After
the Brand Name $250 Drug Deductible is satisfied, 50% of the Negotiated Fee Rate for Brand Name Drugs if no Generic Equivalent is available.
If you select a Brand Name Drug when a generic equivalent is available even if a physician writes a “dispense as written” or “do no substitute” prescription you pay the generic
drug Copayment plus the cost between the Brand Name drug and the generic drug. None of the amount paid applies toward your Brand Name Drug Deductible.
Non-participating Provider
50% of drug Limited Fee Schedule within California less the Copayment/Coinsurance stated for participating pharmacies
Here at Santa Barbara Health Insurance Services we know that no web site
can substitute for courteous service from an experienced professional. Our staff
is always happy to help with your California health insurance, California dental
insurance, or term life insurance needs. Feel free to call us any time at (800)
765-1540.
FREE Health Quote
Testimonials...
"Santa Barbara Health Insurance helped us improve our health benefits and has saved us a significant amount of money. We highly recommend them."
- Renee Grubb, Co-Owner of Village Properties Realtors
"Rob and Steve at Santa Barbara Health Insurance have been thorough, professional, and very easy to work with. They helped us transition to
a Health Savings Account strategy which benefits our employees and our company."
- Dave Larson, Managing Partner at McGowan Gunterman CPA's
“The guys at Santa Barbara Health Insurance are always available to answer our questions and have given us great service. It is almost like
they are right next door.” - Scott Branch, Partner, Burnell, Branch, and Pester Architects.
“When I broke my wrist skateboarding, the Anthem Blue Cross Tonik plan that Rob set me up with really came through big and saved me from racking
up huge debts.”
- Peter Schick, Individual.
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