2022 open enrollment (OE) period has ended.
Here are some useful resources:
The next open enrollment period is November 1, 2022 through January 31, 2023.
Need to know more than what the topics below cover? Find your question in our Frequently Asked Questions.
Californians are required to be enrolled in and maintain minimum essential coverage throughout the year. This law is known as the individual mandate.
In other words, if you do not have health coverage, you may have to pay more in taxes. Staying covered can help you to avoid this tax penalty.
* Blue Shield does not offer tax advice. For information or questions, consult a financial or tax advisor.
On March 11, 2021, President Biden signed the American Rescue Plan Act of 2021. The new law increases premium assistance available and removes the “cliff” that makes people ineligible for subsidies if their income exceeds 400% of the Federal Poverty Level (FPL) for 2021 and 2022. The member premium cost share (required contribution) toward healthcare premiums has decreased across the board. Individuals will not have to pay more than 8.5% of their household income toward the cost of the second lowest cost silver plan.
The amount of federal premium assistance (federal tax credits, also referred to as subsidies) that Californians can qualify for depends on age, household income and size, and the cost of affordable healthcare coverage in their region. Federal premium assistance is available only for medical plans purchased through Covered California.
Use our subsidy eligibility calculator to find out if you might qualify for premium assistance and get an estimate of your potential premium assistance amount. If you find out you may be eligible, contact your broker to learn about your options.
If you qualify for a subsidy and you need a 2021 effective date, you can begin your enrollment process into your new plan today. For a plan effective in 2022, Open enrollment will begin November 1, 2021.
*The new American Rescue Plan Act implementation plan is fluid and pending ongoing updates from Covered California. Blue Shield of California is committed to helping you.
Learn all you can about getting tested and what your plan covers. You should also be aware of how you can get medical care remotely while staying safe and reducing exposure, especially if you fall within a high-risk group. To learn more about virtual care options – and for the most up-to-date information on what your plan offers – visit blueshieldca.com/coronavirus.
If you purchased your plan through Covered California, there are certain situations when you should contact Covered California and other situations when you should contact Blue Shield of California directly. Please review the list below to help you understand whom to call when you need help:
Contact Covered California at (800) 300-1506 or visit CoveredCA.com if you need to:
Contact Blue Shield at the number listed on your ID card, or log in to your online account at blueshieldca.com if you need to:
Family Dental Plans that are now available exclusively through Covered California. With Blue Shield Family Dental PPO and HMO plans, you get a first line of defense for your family's overall health and well-being. From additional pediatric dental benefits for children, to in-network dentist savings to easy, online access to benefits, our Family Dental Plans have something for everyone. Contact your broker to learn more.
A health insurance policy determines the types of medical services or benefits you are covered for, which doctors you can see, and what hospitals you can visit. Your plan also determines what you pay for care and services.
After purchasing a health plan, you can then visit a doctor or hospital in the Blue Shield of California network. A network is a group of doctors, hospitals, and healthcare providers that work with a health plan like Blue Shield. That means you only have to pay a certain amount for healthcare services instead of the full cost. By using in-network doctors and hospitals, you can keep your costs lower.
Health insurance is for preventive and event-based care – meaning you don’t have to wait until you’re sick to see a doctor. Preventive services like annual exams and flu shots are available to you at no additional cost.
You’ll pay a fixed monthly rate for your health insurance policy. The amount depends on the plan you choose, where you live, and the age of each person on the policy. The lower your plan’s monthly rate, the more you typically pay when you see the doctor, and vice versa. Identifying how often you see a doctor can help you choose the right plan for you.
Depending on your household size and income, you may be eligible for financial assistance through Covered California to lower your plan’s monthly rate or even your costs for medical care.
Your bill for visiting the doctor will depend on the reason for your appointment and your plan’s benefits. Some services have a copay (a fixed dollar amount) and other services have coinsurance (a fixed percentage amount). When you pay a copay or coinsurance, Blue Shield of California will pay the rest of the charges for your visit. You should check to see if your health plan has an annual deductible, which is the amount of money you pay for services before the coinsurance and health plan begins paying for them. A high deductible could affect what you pay at each doctor’s visit.
To protect you and your family from unexpected costs, most plans have an annual out‑of‑pocket maximum. Once you reach the out-of-pocket maximum, your health plan covers 100% up to the allowed charges for most covered medical services.
The approved amount Blue Shield will pay for a service or benefit. If your doctor charges more than what’s allowed by your health insurance policy, you may be responsible for the difference.
The medically necessary services and supplies covered by Blue Shield.
A fixed percentage of the cost of your services that you’re responsible for. This is usually after you’ve met your deductible.
A fixed amount you pay for benefits such as doctor’s visits or any wellness services. This is usually after you’ve met your deductible if your plan has one.
The amount you pay each calendar year for most benefits before Blue Shield begins to pay. Some benefits, such as preventive care, are covered before you meet your deductible.
A health plan where you choose a primary care physician (PCP) who treats you regularly. This includes preventive visits and referrals to specialists. You’ll need to see only other doctors or specialists in your PCP’s medical group. There is no coverage for services received from doctors who are outside your PCP’s network.
A group of providers – including hospitals, doctors, specialists and other healthcare providers – that have agreed with Blue Shield to provide benefits for a specified amount.
The most you are required to pay in combined deductible, copayment, and coinsurance amounts for all of the covered services each year.
A health plan in which members can choose to see any provider in the PPO provider network without a referral. Members also have the freedom to use non-network providers for most services if they are willing to pay a higher share of the cost.
Looking for dental, vision, and life insurance coverage?
Protect your smile with one of our PPO or HMO dental plans.
Vision plans starting at only $6.90 per month.
Protect your loved ones’ financial security.
It’s important to know which doctors and hospitals are included in your plan’s provider network before you choose a plan. Use our Find a Doctor tool to determine if your preferred doctors and hospitals are included in our PPO and/or Trio HMO networks.
* Underwritten by Blue Shield of California Life & Health Insurance Company (Blue Shield Life).
* This is for informational purposes only. * Underwritten by Blue Shield Life & Health Company
