Welcome Anesthesia Consultants of California Medical Group Employees!
Here's where you can find information about the 
health & life benefits available to you. 

Health

Platinum Access+ HMO $25
Office Visit - $25/$50 copay (Primary Care / Specialist)
Hospital – Inpatient - $250 per day, up to 3 days/admission
$200 copay for Emergency Room (waived if admitted) & $100 for Ambulance
Out-Of-Pocket Max - $2,500 Individual / $5,000 Family
RX copays –$5 Generic / $15 Brand Formulary /$25 Brand Non-Formulary
Silver Full PPO 1250
Office Visit - $30/$60 copay (Primary Care / Specialist)
Deductible - $1250 Individual; $2,500 Family (In/out Combined)
Hospital – Inpatient - 20%
$100 co-pay + 20% (waived if admitted) for Emergency Room and 20% for Ambulance
Out-Of-Pocket Max - $6,250 Individual / $12,500 Family
RX Deductible/copays – $500 RX ded. - $15 Generic / $50 Brand Formulary / $75 Brand Non-Formulary
Silver Full PPO HSA 2000
Office Visit – ​20% (Primary Care / Specialist)
Deductible - $2,000 per Individual / $4,000 Family
Hospital – Inpatient - 20% Cost
$100 co-pay + 20% (co-pay waived if admitted) for Emergency Room & 20% for Ambulance
Out-Of-Pocket Max - $4,400 Individual / $8,800 Family
RX Deductible/copays – None - $15 Generic / $50 Brand Formulary / $75 Brand Non-Formulary

Find a Provider
​with Blue Shield!

    How do I determine my cost?
    Fill out this form and we'll get back to you with age-based rates for you and any dependents.

Medical Enrollment Form

Please return all completed enrollment forms to Bill Graham
Fax: (714) 979-2809
Email: billg@aclevidence.com

Once you've submitted your paperwork, 
your ID cards should arrive within 7-10 business days. 
Need to print a temporary ID card now?


Download Blue Shield's mobile app 
to access plan benefits and claims, search for a doctor, and view ID card information.

Life

$15,000 Basic Life Insurance 

Life Enrollment Form

Subscribe
to our quarterly health and wellness newsletter!

Have questions about the plans available to you?

Please contact Ashbrook Clevidence with any questions regarding your current benefits and the insurance options available to you. 

Call us at (714) 755-2485!