HMO benefit guidelines
These guidelines describe benefit details including coverage criteria, benefit exclusions, limitations and exceptions for HMO IPAs and medical groups that contract with Blue Shield of California. Examples of covered services and non-covered services pertaining to that topic may also be included. You'll need Adobe Reader to view the guidelines.
Change notifications
January 2026 HMO Benefit Guidelines change notification letter (PDF, 140 KB)
Optional benefits (group plan riders)
Acupuncture/chiropractic services (PDF, 158 KB)
Chiropractic services (PDF, 140 KB)
Dental HMO (PDF, 202 KB)
Infertility – additional benefits (PDF, 154 KB)
Vision care – VPA (PDF, 146 KB)
Complete manual
January 2026 HMO benefit guidelines (PDF, 1.4 MB)
Benefit summaries
Forms
Download and print commonly requested patient care, prior authorization and network forms.
Guidelines and procedures
Find operating guidelines for clinical practices, preventive health and procedures for continuing network participation.
Policies and standards
Find medication policies information and standards for HIPAA transactions, medical records and more.