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Shield Select Providers
We contract with physicians and hospitals across California in the Shield Select Provider Network who have agreed to accept allowable amounts* as payment in full, for their services.
- When you use Shield Select Providers, your out-of-pocket expenses will usually be lower.
- Shield Select Providers file claims directly, saving you time and paperwork.
Out-Of-Network Providers
Using out-of-network providers may result in higher out-of-pocket expenses. Your portion will be 20% of the allowable amount, plus any charges over and above the allowable amount covered by CPIC Life.
Copayments and Deductibles
After each covered person meets the Plan deductible...
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Allowable Amount for Covered Services
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What Each Covered Person Pays
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In Network
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Out of Network
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First $5,000
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20%
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20% (+charges over allowable amount)
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$5,000+*
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0%
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Any charges over allowable amount
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| *CPIC Life pays 100% of the allowable amount for covered services in excess of 5,000 (unless otherwise noted in the policy). |
CPIC Life has five deductibles for you to choose from:
Deductible
(towards the allowable amount)
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Maximum Out-of-Pocket Expenses**
of Allowable Amount
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$250
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$1,250
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$500
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$1,500
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$1,000
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$2,000
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$1,500
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$2,500
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$2,000
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$3,000
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| ** Plus any charges over and above the allowable amount |
Deductible Waived for Accidents
If you have an accident while your policy is in force, we will waive your plan deductible and emergency room deductible for covered services.
Maximum Coverage Period
The Option One Short-Term Health Insurance policy is non-renewable and is designed to meet your temporary health insurance needs. If your need for temporary health coverage continues after your termination date, you may re-apply for an additional Option One Plan only. However if the total days of coverage for all plans combined (Option One and/or Option Twelve), has reached 365 days, there is a mandatory 6-month waiting period before you may re-apply for any Short-Term Health Insurance plan offered by CPIC Life.
Please Note: You must meet all eligibility guidelines in order to purchase an additional policy. Purchasing an additional policy does not constitute a continuation of your previous policy.
Maximum Benefit
You and each of your enrolled family members are covered for a maximum benefit of $2 million of allowable amounts during the policy term.
*The allowable amount is the amount that the Shield Select Providers have agreed to accept as payment pursuant to the contract with Blue Shield of California, CPIC Life's parent company.
This amount is determined as (a) the amount Blue Shield has determined is an appropriate payment for the service(s) rendered in the provider's geographic area, based on such factors as Blue Shield's evaluation of the value of the service(s) relative to the value of other services, market considerations and provider charge patterns;(b) Such other amount as the Shield Select Provider and Blue Shield have agreed will be accepted payment for the service(s) rendered; or (c) The amount Blue Shield determines is appropriate considering the particular circumstances and services rendered - if an amount is not described in a or b above.
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