Medical plans

Medical plans

Account-based health plans
Account-based health plans (ABHP) are specially designed health plans that can be wrapped with a tax-advantaged account. 

2024 Summary of Benefits for Account-Based Health Plans

Employer groups who select our integrated model for their ABHPs will have access to online resources and 24/7 customer service – plus a powerful set of additional tools.

When considering our online services for employers and employees, a dedicated ABHP service team, and the variety of plans to choose from, it's easy to see how Blue Shield's programs come together to deliver a comprehensive ABHP platform.

Benefits of account-based health plans accounts

• Health Savings Account (HSA) – HSAs work with lower-premium, higher-deductible medical plans; unused funds accumulate in the HSA account year to year. Because it's employee-owned, the account stays with the employee even if they change jobs, retire, or leave employment.
• Health Reimbursement Account (HRA) – Unlike HSAs and FSAs, HRAs are owned and funded by the employer.
• Health Incentive Account (HIA) – HIAs are new account-based options designed for the employee to solely earn funding for healthcare expenses by participating and completing a health rewards program. They can be sponsored by Blue Shield or the employer.
• Flexible Savings Account (FSA) – FSAs can be paired with any Blue Shield medical plan and offer a tax-free way for employees to save for qualified expenses during a single year. FSAs can be paired with any health plan or used alone. Funds expire if not used by the plan year-end.
• Limited Purpose Flexible Savings Account (LPFSA) – LPFSAs are used for dental and vision expenses and can be offered alongside HSAs administered by HealthEquity.

HealthEquity: An integrated model

We are pleased to power our programs with HealthEquity's premier technologies which provide superior customer support, tools and account administration. This relationship delivers simplified account management and online resources to help employers and employees better manage their money for healthcare expenses.

Blue Shield's vendor, HealthEquity*, delivers a 24/7 platform to manage members' tax advantaged accounts, offering a dedicated website for account management so clients can:

• Make timely payments
• Update employee information quickly
• Print contribution and key reports
• Help employees take advantage of their benefits

Plus, health equity provides:

• A single sign-on website to manage their healthcare needs
• A debit card for pharmacy and other qualified purchases
• A smart pay portal for providers

Learn more about HSAs

Download our flyer (PDF, 2.3 MB) to learn about the advantages of pairing a high-deductible health plan from Blue Shield of California with an integrated health savings account from HealthEquity.

To learn more about Blue Shield ABHP compatible health plans and how they can benefit your clients, contact your Blue Shield representative. For additional information and ABHP materials, please visit the Blue Shield/Health Equity resource site at http://www.healthequity.com/bscsales.

Added Advantage POS plans
Added Advantage POS plans are ideal for employers who want to offer the flexibility of choosing PPO or HMO benefits in a single plan. 

2024 Summary of Benefits for these plans

EPO plans
Exclusive provider organization (EPO) plans give members access to network providers in our Full PPO or Tandem PPO network.  Members have the flexibility to see any network doctors and specialists without a referral.  Except for emergencies, EPO plans have no out-of-network benefits.

2024 Summary of Benefits for EPO plans

HMO plans
HMO plans offer your clients affordable coverage and comprehensive benefits with predictable copayments for office visits. All HMO plans offer clients the freedom to see a specialist without a referral*, and out-of-area coverage for urgent and emergency care through the BlueCard® program.

2024 Summary of Benefits for HMO plans

• Access+ HMO plans
  Access+ HMO® plans include our broadest HMO network that includes more than 44,000 physicians and over 325 hospitals and 350 medical groups/IPAs throughout the state.
• Local access+ HMO plans
  Local Access+ HMO® plans have the same comprehensive coverage as the comparable full-network Access+ HMO plans, but with a narrow network and lower monthly rates.
• Trio HMO plans
  We've put our powerful connection to work for your clients to create a family of precision network HMO plans. These plans focus on delivering choice, affordability and coordinated care for your clients and their employees. With this interactive video, find reasons why Trio could be the right choice for your client. 

PPO plans
The PPO plan family features a progression of plans with different medical deductibles and coinsurance amounts, offering clients a choice of different price points to choose from, within the same plan family.

2024 Summary of Benefits for PPO plans

• Full PPO plans
  Preferred Provider Organization (PPO) plans give your clients and their employees the flexibility and simplicity of having direct access to the physicians and specialists in our preferred provider network.
  
• Full PPO savings plans
  PPO Savings plans are ideal for employees who want to be actively in control of their healthcare expenses by saving tax-advantaged dollars for future medical expenses. These high-deductible health plans (HDHPs)† can be paired with an HSA, HRA, HIA, FSA, LPFSA, or other financial accounts. PPO Savings plans are offered with full network coverage. Each plan includes prescription drug coverage.
• Tandem PPO plans
  These plans offer a select network of providers that deliver the same benefits as our Full PPO plans but at a lower cost. Tandem members are matched with a primary care physician to help them navigate their healthcare needs. Like other PPO plans, Tandem offers members the flexibility to see any doctor or specialist without a referral. Learn more and find out why Tandem may be a great choice for your clients with our interactive video.
• Tandem PPO savings plans
  Tandem PPO Savings plans offer a select network of providers that deliver the same benefits as our Full PPO Savings plans but at a lower cost. Tandem PPO Savings plans are ideal for employees who want to be actively in control of their healthcare expenses by saving tax-advantaged dollars for future medical expenses. Tandem offers members the flexibility to see any doctor or specialist without a referral. Learn more by visiting blueshieldca.com/tandem or find out why Tandem may be a great choice for your clients with our interactive video.
• Active choice PPO plans
  Active Choice plans give flexibility and greater management over spending while providing reliable protection against the impact of high-cost services.

Virtual Blue plans
Today, employees expect more. Virtual Blue delivers with anytime, anywhere virtual care, $0 virtual visits, and in-person care when they want it—driving value for businesses of all sizes.

A proven collaborative care model
Virtual Blue integrates quality primary, behavioral, and specialty care in one collaborative care model. Members can get virtual care 24/7 from their virtual care team; for in-person care, they can select providers in California and nationwide PPO networks.

2024 Summary of Benefits for Virtual Blue Plans