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2021 open enrollment period has ended. If are uninsured, you still have an opportunity to enroll in coverage during a Special Enrollment Period (SEP).
NEW for 2021: The American Rescue Plan EXPANDS eligibility for financial assistance! You may be newly eligible for financial assistance even if you didn’t qualify before and can apply for coverage through Covered California starting April 12 to get it.
Starting April 12, you check again to see if you qualify for help to cover part or all your premium. The American Rescue Plan Act increases the available subsidies and expands who is eligible for them.
Check to see if I qualifyLook at our plan options, including dental, vision and life insurance plans, for you to stay fully covered.
Explore moreIf you now qualify for a subsidy, learn more about what to do next.
Learn moreNeed to know more than what the topics below cover? Find your question in our Frequently Asked Questions
You have a small window every year – the open enrollment period – when you can enroll in a medical plan. You can renew your current plan, choose a new one, or make changes, such as adding dependents. When early renewals start on October 1, you can get an early start to shop and compare Blue Shield plan options and decide to keep your plan. The open enrollment period officially begins November 1.
So, when we say “renew your health coverage,” we mean make the decisions to maintain coverage with a plan that is best for you and your family.
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 for 2021, you may have to pay more in taxes in 2022. 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.
*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 if you need to:
You can also log in to your online account at blueshieldca.com to:
New for 2021, we are pleased to announce our 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.
Preferred provider organization
Enjoy the flexibility to see doctors in a larger network and ability to customize your care.
*HMO not available in all areas *Los planes HMO no están disponibles en todas las áreas.
Health maintenance organization
Partner with a doctor in your local area to coordinate your care at lower costs.
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.
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.
The most you are required to pay in combined deductible, copayment, and coinsurance amounts for all of the covered services each year.
The terms and acronyms for health coverage can be confusing. Below are some common ones to know.
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 $6.50 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.
Use Teladoc to connect with a national network of U.S. board-certified physicians, nurses, and mental health professionals by phone or video-chat, from the convenience of your home.
WellvolutionSM offers online and in-person health and wellness programs designed to support well-being and disease reversal, all for no extra charge.
You can access our high-quality network of doctors and hospitals and enjoy the freedom to choose from a variety of care options.
* Underwritten by Blue Shield of California Life & Health Insurance Company (Blue Shield Life).
† Covered California will contact you if you bought your plan through them and there is anything you need to do to confirm your government premium assistance (federal tax credits/state subsidy), or if there are certain changes to your eligibility.
* This is for informational purposes only. * Underwritten by Blue Shield Life & Health Company
