Medical Plans

With a wide range of medical plans, along with dental coverage, vision coverage and life insurance¹ – you can be assured that you're offering your clients solid support from Blue Shield. You'll find a selection of quality health plans for all your clients, from cost-conscious groups to others looking for richer plans. Large employers (101 and above) can choose from a range of plans and have the flexibility to tailor benefits and financial arrangements to meet specific needs.

Learn about our new Summary of Benefits (SOB) documents for all 2024 medical plans.

Broker Resources

Medical Plans

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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

Download our flier 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.

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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.

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2024 Summary of Benefits for 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.

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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.

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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.