live by your own plan

blueshieldca.com

Welcome to Blue Shield. This guide provides information to help get you started on making the most of your membership. Because knowing more about your health plan gives you the freedom to

PPO

Let’s get started We’ll help you to better understand and use your health plan, which includes a wide range of health and wellness programs and services.

It’s the first important step to making the most of your health plan, and it only takes a few easy steps:

1. Go to blueshieldca.com.

2. Click on Log In or Register.

3. Fill out the form. Follow the instructions by entering the ID number on your Blue Shield member ID card and your date of birth. Then create your own username and password.

4. You’re registered! Now access the Member Center for instant, secure access to your plan information and a wealth of resources, all in one place.

You’ll find information about your benefits along with tools, programs, and services that help you get the most out of your Blue Shield PPO plan.

And be sure to explore all of blueshieldca.com for a virtual world of health and wellness resources.

Need help registering? Please call the Web Help Desk at (877) 932-3375.

Register to access your plan 24/7

Member Overview

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Faster, easier online accessMember Overview is available 24/7 when you want to find the health plan information that’s important to you, right away. It’s now more convenient than ever to go online and:

Find a doctorBe sure to log in using your username and password. Once you do, you can search for doctors, specialists, hospitals, pharmacies, and other healthcare providers who are in your plan’s network.

Print a Blue Shield member ID cardView and print a copy of your member ID card online. Only the name of the subscriber member will appear on the ID card, but the same ID card can be used for your spouse and children.

Look up medicationsFind out which drugs are covered by your plan.

Access health and wellness resources Access Ask the Pharmacist, NurseHelp24/7,SM and Wellvolution.®

View your claimsSee your most recent claims and detailed information for each claim including total billed amount, patient responsibility, and more. You can also sign up for automated claims alerts, and we’ll send you an email whenever your finalized claims are available to view online.

Understand your deductible and copayment amountsSee where your medical dollars are applied and find out how close you are to reaching the benefit maximum.*

Important tip! Always make sure that any provider you intend to visit is in your plan’s Exclusive PPO Network by using the Find a Provider tool. If not, you will end up paying much higher out-of-pocket costs.

* The benefit maximum is the maximum dollar limit for how much your health plan will pay for a particular covered benefit.

Get a detailed description of your plan’s benefits and what’s covered. Download a copy of your Evidence of Coverage and Health Service Agreement or EOC from blueshieldca.com/welcome. Just enter your member ID number to view your plan documents. While there,

you can also access the Summary of Benefits and Coverage (SBC) forms, which provide a summary of benefits as well as examples of coverage for certain services. You can download the SBC form for your Blue Shield PPO plan at blueshieldca.com/welcome.

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Managing your familyIt’s hard to think of anything more important to you than your family members. The Manage Family section of our website lets you easily view and manage the family members on your plan. To access the Manage Family section, click on the Family Members link under “Who’s Covered.”

Request access – Send a request to access a family member’s plan information and claims for anyone over the age of 12.

Grant access – Submit an authorization for release of your personal and health information to a family member, giving this member access to your plan information and claims.

Member information – Once granted access, you can view the member’s physician and medical group, change or add a physician or medical group, and access summary and details of five of the most recently processed claims.

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Making payment convenientWith Easy$Pay, you can authorize your checking or savings account to make automatic payments to Blue Shield for your coverage. Get AutoPay and you’ll never have to worry about having an interruption in your coverage due to a forgotten payment.

Sign up today!

Looking for care?

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Your Blue Shield plan’s Exclusive PPO Network* gives you a choice of doctors, specialists, and facilities. Your plan’s network also includes hospitals recognized as Blue Distinction Centers with a proven track record for delivering better results in specialty care. Visit bcbs.com/why-bcbs/blue-distinction for more information.

If you plan on visiting a doctor, specialist, facility, or other healthcare provider, make sure they’re in your plan’s network. PPO plans offer limited coverage for services received from providers outside of our networks.

How to use the Find a Provider site to find a participating provider in your current plan.

1. Log in using your username and password at blueshieldca.com.

2. Click on Find a Provider.

3. Click on the type of provider you want to search for.

4. Enter the doctor’s name, specialty, or other search terms and then click Find Now.

5. All of the search results will be providers that are participating in your plan’s network.

6. Use the filters on the left side and the map to narrow and personalize your results.

Urgent care centersIf you are experiencing a medical problem that is not an emergency, you may save time and money by going to an urgent care center instead of the emergency room. It’s quick and easy to find the nearest urgent care center by using our Find a Provider site.

* Every member in an IFP PPO plan has access to the Exclusive PPO Network. The Exclusive PPO Network includes fewer providers than Blue Shield’s Full PPO Network.

“ I frequently call the 24-hour nurse help line and am always satisfied. I would recommend the nurse help line for everyone.” – Blue Shield member Lindsay

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24/7 nurse adviceYou can talk to a registered nurse anytime for medical support with NurseHelp 24/7.SM Services are confidential and available online and over the phone, toll-free, at (877) 304-0504.

Preventive care at no additional costYou can do your part to help stay healthy by getting regular checkups and screenings. Go online and check out the Preventive Health Guidelines section to see what tests and screenings are appropriate for your age and gender. Screenings can help identify small problems before they get worse.

Access to dental and vision plansFor more comprehensive coverage, consider Blue Shield dental and vision plans. Adding dental and vision, along with your health plan, is a great way to help promote your overall health.

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Save money with generic drugsA generic drug has the same active ingredient and dosage form (e.g., tablet or capsule) and works in exactly the same way as its brand-name counterpart. The FDA approves generic drugs when manufacturers have proven that the generic version is equally safe and effective as the brand-name counterpart, and they usually cost less than the brand-name equivalent. Therefore, using generic drugs instead of a brand-name drug is one of the easiest ways to reduce your prescription costs. Most generic drugs are covered even if they are not listed in the drug formulary.*

Ask your doctor if a generic drug is right for you.

Getting your medications

Fill your prescription at a retail pharmacyOur large pharmacy network includes retail chains such as Walgreens, CVS, and Rite Aid as well as other local pharmacies. Most prescriptions may be filled at any participating network pharmacy. To find a local retail network pharmacy, check the Pharmacy section from the Member Overview section.

Fill your prescription at a mail service pharmacyBlue Shield offers a secure, easy-to-use mail service prescription drug program through our contracted mail service pharmacy, PrimeMail. Using the mail service drug program can save time and money, and is a convenient way to fill maintenance medications for up to a 90-day supply. For more information on using the mail service prescription benefit, please log in to your account and click on the Pharmacy link under My Plan & Claims and then go to Mail-Service Prescriptions on the Pharmacy page.

* A drug formulary is a list of preferred medications maintained by Blue Shield for its prescription drug benefits. This list includes both generic and brand-name drugs approved by the federal Food and Drug Administration (FDA).

Join the WellvolutionGet the information and support you need to get healthy with Wellvolution ! We can help you quit smoking, lose weight, eat healthier, or decrease stress. You can easily access our wellness programs at mywellvolution.com anytime from your smartphone, tablet, or computer!

8* The Treatment Cost Estimator tool allows PPO members to research treatment and service cost estimates for family members under the same

plan who have been set up under Manage Family.

Total Cost estimates reflect claims data gathered from Blue Shield of California’s provider network. For out-of-state searches, the Treatment Cost Estimator tool uses the nationwide provider network accessible to Blue Shield members.

Note: Information provided by the Treatment Cost Estimator tool is for reference, regarding services and treatment only, and actual out-of-pocket costs may vary.

Automatic health remindersHealth and wellness emails are great reminders offering smart and helpful tips for taking care of yourself and your loved ones. Sign up and we’ll help you stay on top of all the latest health trends and concerns.

Easy, paperless paymentsYou can set up your checking or savings account to make automatic payments to Blue Shield to pay your monthly premiums. Set up your payment preferences by visiting the Your Payments section of Member Overview.

Put your plan in your pocketGet health plan and healthcare services information anytime, anywhere through the Blue Shield mobile website and mobile apps.Access the mobile website by visiting blueshieldca.com on your mobile device. You can also download the Blue Shield of California mobile app from the App Store or Google Play.

Estimate treatment costs*The Treatment Cost Estimator can give you a better idea of how much your treatments might cost and help you decide which facility best suits your needs. It’s one of our most popular tools and a great resource when you’re considering your healthcare budget.

Important numbers

For questions, call the number shown on your Blue Shield member ID card, Monday - Friday, 8 a.m. to 6 p.m.

For questions about blueshieldca.com, call (877) 932-3375, Monday - Friday, 8 a.m. to 5 p.m.

blueshieldca.com

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