Introduction to Blue Shield HMO Trio & PPO

We’ve represented Blue Shield for 40 years and have been quite happy.   There is no charge for you to have our expertise as Blue Shield pays us.  It helps them too!

Check out the rest of this page for more information and enrollment.

Jump to section on:

• Rx Prescriptions
• Contact Info
• Employer Plans
• Enroll ONLINE Direct  – Covered CA
• Medi Cal
• Financial Strength
• Medi Gap
• Video Introduction to this page
• Dental 
• Member Portal 
• Medicare Advantage
• Provider Doctor & Hospital Finder

How to go about #Picking a HMO or PPO Primary Care Physician PCP – MD

PPO members for all Covered CA plans and maybe all? plans will now have a central point of contact PCP – Primary Care Physician, in the health system for receiving long-term, comprehensive, coordinated care for most health needs. PPO members are able to switch PCPs at any time. There is no action for members to take. Blue Shield will provide additional details on this new feature in the coming weeks.

Members of non-grandfathered PPO plans will continue to have the freedom to choose specialists and other providers – without referrals inside or outside the network – as they do now.

PPO Primary Care MD – member communication from Covered California

HHS offering $1 million to strengthen link between primary care and health equity  

FAQ’s

• What is a primary care physician?
• Why is it important to have a PCP?
• How did we select your PCP match?
• When will I receive information about the PCP that I was matched with?
• I’ve been matched with a PCP. Now what?
• What should I consider when evaluating my PCP?
• How do I change my PCP?
• I already have a doctor that I like. How do I know if my preferred PCP is part of my plan’s network?
• I can’t find my preferred PCP in the Exclusive PPO Network. What do I do now?
• Will my PCP appear on my ID card?
• What happens if I make a change to my PCP?
• How often can I change my PCP?
• Provider Finder
• Primary Care & PPO VIDEO
• chcf.org/primary-care-matters  * More readable summary * Health care systems with strong levels of primary care investment have better and more equitable health outcomes, lower care costs, and better care quality. We can build a healthier future for all Californians by focusing resources back to patients and their relationship with primary care providers.
• 7 tips for choosing a primary care doctor UHC
• Cedar's Sinai Provider Finder 

COVID

blueshieldca.com/coronavirus-medicare 

Our main webpage on COVID

Blue Shield
Member #Portal Account

• Benefits of creating-registering for a Member Portal Account

• Register for an ONLINE Member Portal  
• Easily search and view benefit information
• Member Website Overview pdf

• Learn how to register for 24/7 access to your health plan VIDEO

  • Change methods of payment for paying premiums
  • See claims by family member
  • Track deductibles and co payment amounts
  • Change PCPs and medical groups
  • Renew your plan  BlueShieldCA.com/Renew
• Print member ID cards – anytime, anywhere!
  • Members can follow three easy steps to print a new ID card:
    1. Go to Member Overview and add New Member ID number (required).
    2. Click View . . . and Print ID.

    The ID card will work at the doctor’s office as soon as your client’s membership becomes effective. The plastic ID card will arrive in seven to 10 business days.

• Explanatory Videos on everything… from Blue Shield
• Treatment Cost Estimator – for PPO Members
  • Cost Helper.com what people are paying
• FAQs / Ask Us a Question

FAQ’s “Member Portal – How to set yours up”

• Thanks for sending me the screen shot of your broker portal showing my coverage. I don’t quite understand it. Would you explain please?
  • Here’s a screen shot with the PHI (Protected Health Information) redacted. Watch this video and I’ll explain.
• We have not received an invoice to our email or physical mailbox and I am not able to login to our Blue Shield CCA account.  When I put in our username, the response is : username not found.  When I click on ‘I don’t know my username’ , the site asks for our email address, I type in our email address.
  BlueShield emails us the username I started with.  Do I need to set up a new blue shield cca account and put in a account number?
  • Here’s the technical support request

• Click here for Blue Shield’s Wellness Website on wellness
• Our Blue Shield Wellness Website
• Our Wellness Website

#Financial Strength

• Blue Shield Mission Report 2016 32 pages pdf
• Financials on Blue Shield Website
• citizenship.blueshieldca.com/
• Blue Shield Story
• Wikipedia
• CA Department of Insurance
• AM Best Guide

FAQ’s “Blue Shield CA Information & New Enrollment”

• My Wife just delivered and we have plan purchased outright blue shield platinum PPO 90, will it cover the baby’s NICU stay as it was required because of pre-term labor?
• Also, I make around 80k a year for a family of 4, is she or new baby boy eligible for temporary medi-cal to cover her for NICU?
• Thanks so much, looking forward to starting conversation and perhaps talking more as it relates to ObamaCare and our family business.
  • The full EOC’s and polices for Blue Shield are on our benefits page. If anything requires a log in, send us an email and we will send to you. Here is the 7 page summary of benefits for the platinum plan. I will email you the full eoc. We have a specimen platinum plan here.
  • On page 2 of the summary, semi private room and board along with medically necessary services and supplies. See also page 84 of the Specimen EOC. Thus I do not see a problem with NICU – Neo Natal Intensive Care being paid, since you state it was required.
  • I’m not qualified nor do I get paid to help you with Medi-Cal. Here’s more information on the Medi-Cal access program for those who are pregnant with up to 322% of Federal Poverty Level, that you can see from our Covered CA Income Chart. Note that Medi-Cal includes the fetus as a dependent. I don’t see why you would need this program. Medi-Cal would deduct payments that Blue Shield makes, under dual coverage rules.
  • We urge you to get a free quote and subsidy calculation here. You might qualify for subsidies and enhanced silver, which in some cases, is better than platinum.
  • Here’s the form to appoint us as your agent, no charge to you, so that we get paid for our time, research and education.
• how much would be monthly payment on a individual plan for a 2 year old
• I’m interested on the silver 70 PPO plan.
  • Please use our FREE quote engine above and get answers from every company and plan. Or use the one above for Blue Shield.
  • We don’t know your zip code or date of birth. Also, since enrollment is online, we need to make sure you can do that, as we don’t get paid to fill out the application for you. The application under ACA is just your name, dob, address and credit card information.
  • What is your special enrollment reason?
• What does it mean when it says, Blue Shield  “exclusive ppo for ifp”?
  • 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.
• 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?
  • Here’s an excerpt of an agent bulletin dated 11.16.2018 9:09 AM:
    • Keep in mind that we will renew your customers automatically if they continue to pay their premium
• What about Blue card 2019 cut backs
  • blue-shield-bluecard-program-benefits-get-trimmed-for-2019/
  • See our webpage on Blue Card & Out of Country coverage
• 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.
• 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?

• • 2 The plans look identical as they are based on the metal level chart. See reply to the prior anonymous visitor. The doctor lists can be accessed through our quote engine, our webpage for each company, whatever it all goes to the same Insurance Company provider finder link
  • 4 Online reviews don’t necessarily mean a lot – see a similar question about Oscar.
  • 5. Yes, I’ve done business with Health Net for years. Get more details about HN on the webpage I have for them. Use this link to enroll in Health Net.