2021 Blue Shield Trio & PPO
CA Individual & Family
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!
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Blue Shield - Get a quote & enroll.
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Paper Application - BUT ONLINE is better.
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Blue Shield Individual PPO Plans
- Understanding Health Care Coverage Rev 1/21
- HSA Health Savings Accounts – HDHP Plans – High Deductible Health Plans Usually Bronze
- 56,212 doctors 329 hospitals BS Website *
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
- 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
Blue Shield Authorized Broker Website
INSTANT QUOTES & Enroll
Steve @ Blue Shield HQ
Appoint us as your broker – Covered CA ********* Direct
Blue Shield Provider #Finder -
Dentists, Doctors & Hospitals
VIDEOS
- Finding or changing MD with Trio Plan VIDEO
- Blue Shield Exclusive PPO Your new ppo * PPO Primary MD FAQ’s * has 50k+ doctors and 320 hospitals statewide, plus Blue Card benefits out of state & country. 2020 Agent Guide * Member Outreach Bulletin *
- How to use the Finding a provider tool above VIDEO
- Understanding Your Plan pdf
- Nurse Help 24/7, Heal and Teladoc save on prescriptions ER vs. urgent care.
- Get the most from your health care plan VIDEO
- Use your online account to review claims, copays or deductibles and take advantage of other member benefits.
- Explanatory VIDEOS on everything... from Blue Shield
- Our webpage for PRINT Directory’s MAPD Plans
- Late Bloomers – Medicare – VIDEO
- Enroll and get full details on our
Formulary
https://www.blueshieldca.com/bsca/pharmacy/formulary/home.sp
I have Silver 70 Trio HMO.
I don’t like the prior authorization hassle.
If I get a PPO would there be less problems?
Looks like HMO’s have less problems with getting Prior Authorization.
See our video and links below
Medical Necessity
Blue Shield Member Portal
Our Trio HMO Page
Trio EOC Evidence of Coverage Prior Authorization Section
TRIO PPO EOC
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?
Video Explanation
Use Ctrl F to search through EOC & Formulary
EOC for Silver 73 PPO Covered CA
Formulary
Medicare Durable Medical Equipment
Medicare coverage for diabetes
comments on “Blue Shield CA Information & New Enrollment”
https://www.blueshieldca.com/bsca/bsc/public/broker/PortalComponents/StreamDocumentServlet?fileName=A44674-FF.pdf
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
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.
comments on “FAQ’s from retired pages”
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, “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:
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.
Or your member portal.
You can get quotes from all companies & plans here.
Blue card 2019 cut backs
https://insuremekevin.com/blue-shield-bluecard-program-benefits-get-trimmed-for-2019/
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.
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?
Did you get a confirmation that looks like this?
Did you check with your ONLINE Banking?
I can check with Blue Shield – Broker Services, but that may take a few days.
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
Here’s where we did some research a while back on Rx reimbursement in the Bronze Plan https://individuals.healthreformquotes.com/aca/essential-benefits/prescriptions-rx/bronze-plan-how-are-drugs-reimbursed/
Here’s where we used the Medicare.Gov tool to find the retail cost of Rx https://medicare.healthreformquotes.com/part-d-rx/donut-hole/shop-compare-tools/
Video of how we used the Medicare Tool
See our module on Blue Shield Rx Above https://individuals.healthreformquotes.com/companies/blue-shield/#pharmacy
See our metal level page on comparisons of the plans, how they relate to Medical Loss Ratio, etc. https://individuals.healthreformquotes.com/aca/metal-levels/
My video on what plan to buy if you are going to have a big surgery next year https://youtu.be/9B_zcZHIHCo
I just got my renewal notice for 2021 from Blue Shield.
How & when do I shop & compare?
Blue Shield is ahead of the ball. Their own broker manual says that the notices wouldn’t go out till October 1st.
Note that in the notice that you got, nothing happens till November 1st.
The averages for 2021 look good. Those are averages, I’m sorry you show a 5% increase.
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.
I tested the link above to renew and it takes you to your member portal. So, if you don’t have a member portal, here’s how to set one up.
What ACA/Obamacare plan – Metal Level has the most diverse coverage For breast cancer care
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
Prescription Rx Formularies All Companies
Medicare comparison & shopping tools
Our Webpage Blue Shield Formulary Finder
https://www.blueshieldca.com/bsca/pharmacy/home.sp
Financial Help for very expensive Rx?
https://medimedi.healthreformquotes.com/low-income-subsidy-lis/more-help-beyond-lis/
https://medimedi.healthreformquotes.com/low-income-subsidy-lis/more-help-beyond-lis/rx-assistance-from-manufacturer/
https://www.breastcancer.org/treatment/chemotherapy/medicines
Chemotherapy medications for breast cancer include:
Abraxane (chemical name: albumin-bound or nab-paclitaxel)
Adriamycin (chemical name: doxorubicin)
carboplatin (brand name: Paraplatin)
Cytoxan (chemical name: cyclophosphamide)
daunorubicin (brand names: Cerubidine, DaunoXome)
Doxil (chemical name: doxorubicin)
Ellence (chemical name: epirubicin)
fluorouracil (also called 5-fluorouracil or 5-FU; brand name: Adrucil)
Gemzar (chemical name: gemcitabine)
Halaven (chemical name: eribulin)
Ixempra (chemical name: ixabepilone)
methotrexate (brand names: Amethopterin, Mexate, Folex)
Mitomycin (chemical name: mutamycin)
mitoxantrone (brand name: Novantrone)
Navelbine (chemical name: vinorelbine)
Taxol (chemical name: paclitaxel)
Taxotere (chemical name: docetaxel)
thiotepa (brand name: Thioplex)
vincristine (brand names: Oncovin, Vincasar PES, Vincrex)
Xeloda (chemical name: capecitabine)
Blue Shield Formulary
Check out the research we did before on a very similar question.
Check out these comparisons of major claims by metal level.
What are the monthly and maximum out of pocket costs that I have to incur on Gold vs the other Metal Levels?
Check out the Metal Level Chart
Check out our webpage on OOP – Out of Pocket Maximums, Deductibles, Co Pays & Co Insurance
The average costs per patient allowed by the insurance company in the year after diagnosis were $60,637, $82,121, $129,387, and $134,682 for disease stage 0, I/II, III, and IV, respectively.
The average costs allowed per patient in the 24 months after the index diagnosis were $71,909, $97,066, $159,442, and $182,655 for disease stage 0, I/II, III, and IV, respectively.
The cost difference based on the stage at diagnosis was largely driven by the cost of chemotherapy and noncancer treatments. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822976/
Resource Guide for People with Cancer
https://www.cancercare.org/publications/365-managing_the_cost_of_cancer
Other pages on our website dealing with cancer and how Insurance and Rx Prescription coverage might pay for it
https://wp.me/P50Eh9-2PK
https://medicare.healthreformquotes.com/sign-medicare/part-hospital-part-b-md-visits/preventative-care/mammograms-breast-cancer/
https://medi-cal.healthreformquotes.com/eligibility/cancer-program/
Does Blue Shield PPO cover Memorial Care?
Dr. John Link?
See the link to the provider finder in the webpage above. See our page with more detail on searching for a provider.
Memorial Care
Covered California Health Benefit Exchange Plans
Blue Shield of California
Health Net
Breast Link
https://www.breastlink.com/doctors/dr-john-link/
https://www.breastlink.com/patient-info/insurance/
Breast Cancer Insurance Coverage **
Aetna
ADOC *
Blue Cross of California
Blue Shield of California
Cigna
Fortified Provider Network
Galaxy Health Network
Greater Newport Physicians
Health Net & Health Net Community Care HMO
Medicare
MultiPlan, Beech Street, PHCS
Prime Healthcare Services
Prospect Medical Group *
Regal Medical Group *
Three Rivers Provider Network
Tricare
United Healthcare
** Please contact a Breastlink facility for information regarding your coverage as these insurance company relationships may change from time to time. Breastlink is not financially responsible for denied insurance claims.
I just emailed Dr. Link to verify what Individual Plans he takes.
If a doctor or facility is not participating, since you are using a PPO, you can go out of network at a higher cost. Please review the Gold PPO Summary of Benefits
Phone call with Becky @ Breast Link
Excerpt of email from Blue Shield Broker services
select the Provider and scroll to the bottom on the screen there is a selection called: “Plans Accepted by Provider” that will show you a list of the current plans they accept.
Trying to verify coverage with a doctor, hospital or medical group can be VERY trying. The Medical Groups listing of Insurance Companies, does not mean that you as an individual, employer group, medi-cal or Medicare can buy it! Learn more
Plans that UCLA and other providers cover
https://medicare.healthreformquotes.com/sign-medicare/coverage-choices-medicare/provider-lists/
https://individuals.healthreformquotes.com/provider-finder/
what is the difference between blueshieldca and subsidy
need to clear this then can renew my plan gold 80 ppo
Please use our quote engine and enter your expected 2020 MAGI income.
Then appoint us as your Covered CA agent, so that we can get compensated for helping you. No extra charge to you. Covered CA pays us.
Depending on your subsidy, Gold 80 might not be good for you as Silver 97 and 87 provide MORE benefits, lower Co Pays, deductible, etc.
Open Enrollment doesn’t start till the 15th of October. Deadline is December 15th for January 1st.