— 33 Comments ↓

2022 Blue Shield Trio & PPO

CA Individual & Family

Blue Shield Authorized Agent
No extra charge to you 

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#Get Quotes & Enroll with Blue Shield 

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 brochure to the right if you have a full size monitor or below if you are on a smart phone.  See the buttons to enroll, set a Zoom meeting or ask us a question.

 

 

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Blue Shield Individual PPO Plans
2022

blue shield ppo plans

Blue Shield
Summary of Benefits & Evidence of Coverage
2022 Summary of Benefits

Individual & Family Documents EOC SBC

2021 Rate Book

Rating Regions

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Picking a 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


FAQ’s

Primary Care & PPO VIDEO

Pick primary care even if on PPO

 

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Blue Shield Coverage for COVID

COVID Coverage 

Our main webpage on COVID 

 

Blue Shield Provider #Finder -
Dentists, Doctors & Hospitals
Blue Shield Provider Finder - Dentists

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Rx Prescription Drugs

Drug formularies       Pharmacy networks           Member resources          Pharmacy FAQs

 

Holistic alternative for erectile dysfunction to Viagra?

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FAQ’s for Covered CA Renewals

Covered CA New Business to Blue Shield FAQ’s 

33 comments on “Blue Shield 2022 PPO & Trio”

  2. I have Silver 70 Trio HMO.

    I don’t like the prior authorization hassle.

    If I get a PPO would there be less problems?

    Reply

  3. How are durable medical goods paid, because I am in insulin.

    I’ll need a glucose monitor and it’s expensive

    How would silver 73 PPO pay for it?

    Reply

  4. comments on “Blue Shield CA Information & New Enrollment”

    2. Stuart K says:
      Edit
      Dear Sir, 

      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.

      Thank you Sir,

      Stuart K

      Reply
    Edit

    comments on “FAQ’s from retired pages”

    1. Anonymous says:
       Edit

      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?

    2. Anonymous says:
       Edit

      What does it mean when it says, “exclusive ppo for ifp”?

      • Steve Shorr says:
         Edit

        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

    3. Anonymous says:
       Edit

      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:

        Important note for IFP renewals with 1/1/2019 effective dates:
        • Keep in mind that we will renew your customers automatically if they continue to pay their premium

        Thank you for your compliance with Rule C 1 in our phone meeting terms of service – only relying on written proof.

        Here’s where we send you a copy of the notification to Blue Shield that you wanted to renew the same plan rather than making any changes.

        renewal proof

        Or your member portal.

        You can get quotes from all companies & plans here.

    5. Anonymous says:
       Edit

      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.

      • Steve Shorr says:
         Edit

        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.

    6. Anonymous says:
       Edit

      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?

      • Steve Shorr says:
         Edit

        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.

      • Anonymous says:
         Edit

        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?

        • Steve Shorr says:
           Edit

          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.

    Reply

  5. I clicked on the pay now [In the Covered CA portal] and it had me put in my card info but I don’t think it processed the payment yet.

    Is there anyway for you to check?

    Reply

  6. I’m considering Bronze HDHP with an HSA vs Gold Plan with no deductible.

    I have hardly any claims.

    I do have Rx though with very little Co Pays.

    Is there a way to know what my Rx cost would be if I had the $7k deductible in Bronze Plan?

    Bronze Evidence of Coverage

    bronze 7k

    Reply

    • Blue Shield is ahead of the ball. Their own broker manual says that the notices wouldn’t go out till October 1st.

      key dates for 2021

      Note that in the notice that you got, nothing happens till November 1st.
      November 1st can change plans

      The averages for 2021 look good. Those are averages, I’m sorry you show a 5% increase.
      average rate changes

      To shop with Blue Shield, use the link above, starting November 1st.

      To get quotes from all other companies and get subsidy calculation, here’s our quoting tool. We’ve been advised the rates for 2021 would be loaded and available on October 15th.

      Here’s our Open Enrollment Webpage for more details on dates and deadlines.

      Please note that many companies have told us that full details would not be available till November 1. So, please how about waiting till say November 5th to give us time to review all the materials. We pride ourselves on accurate information not the SWAG method.

      Reply

    • ACA/Obamacare pretty much made the coverage for all plans and all companies, exactly the same. It’s a function of Metal Levels, Platinum, Gold, Silver & Bronze. Silver 73, 87 & 94 are only available if your income is low. Get a quote to see.

      There are 10 essential benefits under ACA/Obamacare.

      CA has additional benefits

      ACA Obamacare Essential Benefits

      (A) Ambulatory patient services.
      (B) Emergency services.
      (C) Hospitalization.
      (D) Maternity (page 9 & 85) [but not infertility] and newborn care.
      (E) Mental health and substance use disorder services, including behavioral health treatment.
      NAMI Website , AB 88, CFR 156.115 (a) (3), “Federal Mental Health” Mental Health Parity Act 1996 2008 Final Rules

      (F) Prescription drugs.
      CFR 156.122

      (G) Rehabilitative and habilitative [learn or improve skills for daily living] services and devices. (American Academy of Reb 18 page paper)
      (H) Laboratory services.
      (I) Preventive and wellness services and chronic disease management.
      (J) Pediatric services, including oral and vision care. Blue Shield Individual Flyer Essential Health Benefits 5.2013 Group Essential Health Benefits (EBH) 42 USC 18022 SB 951
      Get Adult Dental & Vision Quotes – ONLINE Enrollment
      (H?) Cancer and other life threatening disease – clinical trials

      CA Essential Benefits
      Preventive services for children 16 and younger
      Mental health parity
      Autism care including behavioral health treatment
      Prescription drug coverage for contraceptives
      Maternity hospital stay
      Maternity: Inpatient hospital and ambulatory
      AIDS vaccine
      HIV testing
      Organ transplants for HIV
      Diabetes education, management and treatment
      Alpha feto protein testing
      Prosthetics for laryngectomy
      Reconstructive surgery
      Mastectomies and lymph node dissections
      Mammography
      Cervical cancer treatment
      Cancer screening tests
      Cancer clinical trials
      Prostate cancer treatment
      Osteoporosis treatment
      Surgical procedures for jaw bones
      Anesthesia for dental
      Conditions attributable to diethylstilbestrol
      Hospice (end of life) care
      Pain management medication for terminally ill
      Emergency response ambulance or ambulance transport services
      Medicare Coverage # 11021
      Phenylketonuria treatment
      Sterilization operations and procedures View the Affordable health ca.com page Assembly Bill 1453 (Monning) and Senate Bill 951 (Hernandez). View the California Health and Safety Code, section 1367.005

      Reply

  11. what is the difference between blueshieldca and subsidy

    need to clear this then can renew my plan gold 80 ppo

    Reply

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