2019 PPO Blue Shield Benefit Summaries

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Individual and Family Plan medical Summaries of Benefits (SOB) are effective January 1, 2019, and must be accompanied by the Important Legal Information booklet (PDF, 2.5MB)Spanish  (PDF, 2.1MB) In addition to the Summary of Benefits, the Evidence of Coverage/Policy (EOC) and Summary of Benefits and Coverage (SBC) forms provide your clients with an easy-to-understand overview of what our IFP plans cover.

PPO Plans
Summary of Benefits Evidence of Coverage/Policy (EOC)
Blue Shield Platinum 90 PPO English (PDF, 2MB) Spanish (PDF, 2MB) Evidence of Coverage/Policy (EOC)
Blue Shield Gold 80 PPO English (PDF, 2MB) Spanish (PDF, 2MB)
Blue Shield Silver 70 PPO English (PDF, 2MB) Spanish (PDF, 2MB)
Silver 70 Off Exchange PPO English (PDF, 2MB) Spanish (PDF, 2MB)
Silver 1850 PPO English (PDF, 2MB) Spanish (PDF, 2MB)
Blue Shield Bronze 60 PPO English (PDF, 2MB) Spanish (PDF, 2MB)
Blue Shield Bronze 60 HDHP PPO English (PDF, 2MB) Spanish (PDF, 2MB)
Blue Shield Minimum Coverage PPO English (PDF, 2MB) Spanish (PDF, 2MB)

We offer six Silver cost-sharing reduction plans through Covered California for clients whose income is between 138% to 250% of the federal poverty level (FPL). These plans are available only through Covered California.  We are authorized Covered CA agents!  No extra charge.

Cost Sharing Reduction Plans Summary of Benefits
Blue Shield Silver 73 PPO English
Blue Shield Silver 73 Trio HMO English
Blue Shield Silver 87 PPO


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13 comments on “2019 PPO Benefit Summaries

    • IFP = Individual Family Plans

      Get started with the basics of your Preferred Provider Organization (PPO) plan
      As a PPO plan member, you have a lot of flexibility. The benefits of being a PPO plan member are:

      You can see any doctor or specialist that you want without a referral. Plus, there are many other ways you can access care.
      You are not required to see a primary care physician (PCP).
      You will get the benefit of a discounted rate and pay less out of pocket when you see a doctor in your plan’s network.
      You have access to our Exclusive PPO Network, which includes more than 46,000 doctors and 350 hospitals across California.
      You don’t need to visit a PCP first to receive care.
      You are covered for routine, urgent and emergency care when traveling throughout the country and abroad. [Citation to follow-Cached Version of Blue Shield Page, as the site is down for maintenance]

      It’s the network you select to find your participating providers.

      select network

  1. I want to continue with my current plan.

    Based on our last conversation all I need to do is continue making payments.

    Is that true?

  2. How come completed my boyfriends Covered CA application for Blue Shield yet you simply gave me the direct affiliate link above asked me to do everything on my own with the application process for Blue Shield direct. This process has been anything but convenient.

    • One reason we get so involved in Covered CA applications, is that Covered CA wants you to wait on hold and call them directly. Their process for one to select an agent is not what they promised us at their mandatory training. Your boyfriend had already partially completed an application with us a few years back. We can also be of more help during the year… The last day of open enrollment is not a good day to expect a lot of personal attention.

      When you use OUR affiliate link, we get notified of the progress of your application. If you just go to Blue Shield’s website, we are not your agent, nor do we know anything about your application. If you want us as your agent… got confused as to which link to use… Not Covered CA etc. we can send you a Broker of Record letter to send to us, then we will send to Blue Shield.

      The Blue Shield ONLINE application above, is rather simple, no income or medical questions. We already discussed the plans with you. You didn’t want Medi-Cal, nor did you qualify for subsidies at your income level. IMHO the complex part is the time and effort selecting a plan, going over coverages and definitions. The hardest part of the application is reading the disclosures and putting in your credit card information. Our website is full of intricate policy details. We feel we can help our clients with that, better than filling out your name and address and going over 16 digit credit card numbers.

      The next thing is that as a Blue Shield member, you can get a member portal to give you instant 24/7 information on your policy, claims and premiums.

  3. It looks like health Net Silver 70 Enhanced Care PPO and Blue Shield Silver 70 PPO offer the exact same benefits.

    However, Health Net is $593.48 and Blue Shield is $740.13.

    Is that correct?

    • When one wants to get into very detailed comparisons, it’s quite helpful to check the actual summary of benefits for each plan. This is the page to find Blue Shield’s. Here’s the summary for the Blue Shield Silver 70 PPO with 73% Enhanced Silver – Cost Sharing Reduction.

      Health Net summaries are here. Here’s the 73 Enhanced Care PPO.

      Here’s the standard metal level chart that all ACA – Obamacare compliant plans must use.

      IMHO the difference you will find, is that Blue Shield’s network is bigger. Here’s what I have on Blue Shield’s network, including their provider finder. Here’s Health Net’s.

    • 1. I am now debating between the Blue Shield Bronze PPO Mirrored plan and Health Net’s Bronze 60 Enhanced Care PPO.

      2. Their benefits look identical and they have similar doctors on their preferred provider network (I was able to locate drs directly on their website not through the quote website).

      3. The big difference is the premium, about $350 more per month for Blue Shield.

      4. Online reviews aren’t bad for this company (Blue Shield’s are higher) but do you know anything about this company?

      5. Would you recommend them?

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