Blue Shield Trio HMO ACO   & PPO Plans 2022

California Individual & Family

Blue Shield of California Authorized Agent - Broker 

Blue Shield of California Logo
No extra charge to you 

#Get Quotes & Enroll with Blue Shield 

Introduction to Blue Shield HMO Trio ACO & PPO Plans

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.

Try turning your phone sideways to see the graphs & pdf's?

Blue Shield Individual
#
PPO Plans  2022

blue shield ppo plans

Blue Shield’s #Trio ACO HMO 

Trio ACO’s are a new family of limited network HMO plans: these plans are focused on delivering choice, affordability, and access to high-quality care with lower premiums.

The Trio ACO HMO plans are designed to help break down barriers, enhance care coordination, reduce duplication of services, and improve your  overall experience.

Trio plans are designed to help:

  • Link you to the right services
  • Create cross-organizational focus on patients with complex needs
  • Improve discharge processes and programs to reduce hospital readmissions
  • Learn More==>
    • Blue Shield Website   on TRIO *
      • FAQ’s
      • Just scroll down our page
  • Blue Shield is committed to leveraging their robust and innovative care models to fundamentally change healthcare delivery.
  • An accountable care organization (ACO) is a network of doctors and hospitals that shares responsibility for providing coordinated care to members and limiting unnecessary spending. As with a traditional HMO plan, each member’s care is centered around a primary care physician.
  • Learn More===> Section 3022 ACA

  • Blue Shield’s ACO framework is based on a proven record of delivering integrated care to more than 200,000 Californians.
  • Be sure to enroll on our Blue Shield affliate website.  Blue Shield pays us to help you, at no cost to you, as it saves them time and $$$.
  • Please email us if any of the links require passwords or are not up and running yet. Trio Provider Finder
  • Print a temporary ID card and more – Member Services Center and Registration
  • FAQs / Ask Us a Question

 

FAQ’s “2022 Trio HMO ACO”

  • Do I have to get a referral from my PCP to see my heart specialist?
    • Blue Shield has two options to see a specialist
      • 1. Get a referral from your PCP Primary Care Physician
        2. See a specialist in the same medical group…
        This is a SIMPLISTIC answer, see the actual policy  for exact details.

         

        • Do NOT quote our summary!xxx
      • What hospitals are covered with silver 87 HMO trio… do you have a list you could forward to me please?
      • I’m on SSDI and my agent set me up with Blue shield/Covered California silver 94 HMO trio… I notified her that my income had increased…and without notifying me signed me up for silver 87 HMO trio starting 9/1/2018!!  My question is…can I possibly have this new insurance [silver 87 vs 94] changed or postponed?
        • When you get subsidies from Covered CA you are mandated to report changes of income within 30 days. When you changed your income to show an increase, Covered CA automatically changes the subsidy and the Silver Level. If your income decreases, you can report that change.
        • The main change is that your specialist visits go from $8 to $25.
        • You can also use our quote engine to double check income, silver level, premium, benefits, etc.

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.


FAQ’s

Blue Shield of California

Blue Shield of California Logo
Provider #Finder -
Dentists, Doctors & Hospitals

All Plans - Medicare Advantage, Employer Group, Under 65 - Covered CA
Find a doctor near you
Blue Shield Provider Finder - Dentists

VIDEOS

Blue Shield Individual & Family #Dental Plans

Medicare Supplemental Dental Plans

 

Blue Shield offers affordable and comprehensive dental plans available to clients with and without a Blue Shield health plan.1

They also offer a dental and vision plan package, Specialty DuoSM,which includes comprehensive dental and vision coverage.

Blue Shield’s dental provider networks are among the largest in the state. The dental PPO plans include nearly 47,000 providers in California and nearly 400,000 nationwide. The dental HMO network includes more than 22,000+ providers in California. Check out the dental network map for an overview of county coverage.

PPO
Dental

  • No waiting period for diagnostic or preventive services
  • Covered diagnostic and preventive services, such as X-rays and routine cleanings, do not count toward the annual coverage limit for dental PPO and Specialty Duo dental plans, providing more coverage for other services before reaching the annual limit
  • A wide range of dental benefits, including most diagnostic and preventive services and oral cancer screening, at no additional cost when using a dental network provider
  • Implants coverage available in our dental PPO plans with a $1,250 calendar-year benefit maximum
  • Orthodontic benefits are available for both children and adults
  • Choice of $25 or $50 deductible per member, per calendar year
  • Choice of a $500, $1,000 or $1,250 calendar-year benefit maximum per member
  • Coverage even when your clients use a non-network dentist. Our plan reimburses your clients up to an allowed amount for covered services, and your clients pay the remaining balance of the total billed charges.

 

HMO

Dental Benefit Summaries

Dental HMO English (PDF, 250KB)
Dental Standard HMO English (PDF, 155KB)
Plan name Benefit summaries
Dental PPO English (PDF, 2MB)
Specialty DuoSM Dental English (PDF, 2MB)
Enhanced Dental PPO 25/500 English (PDF, 145KB)
Enhanced Dental PPO 50/1250 English (PDF, 145KB)
Enhanced Dental PPO 50/2000 English (PDF, 2MB)
Spanish (PDF, 1.7MB)
Enhanced Dental PPO 50/2000/Lifetime Ortho 1500 English (PDF, 2MB)
Spanish (PDF, 1.7MB)
Plan name Benefit summaries
DMHC Disclosure English (PDF, 2MB)
CDI DisclosureImportant Legal Information Booklet ( English (PDF, KB)

Broker Page for Dental on Blue Shield Site 

#Importance of Dental Coverage 
Dental & General Health

Insurance 101?

We suggest that you check out Life Insurance, Disability, Long Term Care and Retirement as these risks may cause much more financial devastating to your budget than dental bills.

Picture of Oral Health 

Why you need Group Dental Coverage

 

Steve on buying, shopping and best use of premium dollars
Dental Insurance VIDEO

steve's video on dental coverage

MORE VIDEOS

Resources, More Info & Links

Blue Shield
Member #
Portal Account

Blue Shield of California Logo

  • Benefits of creating-registering for a Member Portal Account

  • Register for an ONLINE Member Portal  
  • Easily search and view benefit information
  • Member Website Overview 
  • Learn how to register for 24/7 access to your health plan VIDEO

    • Change methods of payment for paying premiums
        • eChecks use the Automated Clearing House (ACH) to direct debit from a member’s checking account directly to BSC in this case  If a member’s premium is not paid by the 1st of the month – it will show the account as late
      • Use member portal or call 888-256-3650
    • 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
  • 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?
  • 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?

Sample inquiry that you can make through the member portal

Inquiries you can make through the member portal

Inquiries you can make through the member portal

Blue Shield #Contact Info

Blue Shield of California Logo

  • Many of your issues can be resolved for our clients by emailing us [email protected] and we can help immediately or in a few days via  email  rather than calling and waiting on hold with  Blue Shield.  Here’s the form to appoint us as your broker with Blue Shield, no extra charge!
  • Customer Service (800) 393-6130
  • Technical Support
  • Claims Department
    • phone:   888-256-3650
    • fax:   209-371-3049
    • mail:   P.O. Box 272540 Chico, CA    95927-2540
    • BROKER ONLY 877 806-7688
  • Provider – Pre Authorizations Website
    • Pre-admission (800) 541-6652
  • More Contact Info
    • Tech Support (800) 393-6130
    • Website Technical Support 877 932-3375
  • Contact Info on Blue Shield’s website
  • Get a Member Portal

Blue Shield Medi Cal 
#Promise Health Plan

Blue Shield Promise Medi Cal Health Plan

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
  • 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?
  • 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.

27 comments on “Blue Shield 2022 PPO & Trio

  1. I have Silver 70 Trio HMO.

    I don’t like the prior authorization hassle.

    If I get a PPO would there be less problems?

  2. 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?

  3. 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?

  4. 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?

    • 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.

    • 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

  5. what is the difference between blueshieldca and subsidy

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

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.