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2021 Blue Shield Promise Cal MediConnect Plan

Blue Shield Promise Cal MediConnect Plan (Medicare-Medicaid Plan) combines Medicare and Medi-Cal coverage into one plan to provide you all-in-one coverage. To learn about your 2020 plan benefits, access the 2020 plan page.

Blue Shield is closely monitoring the coronavirus global health situation. Read about coverage for members

If you live in Los Angeles County or San Diego County and are eligible for both Federal Medicare benefits and State Medicaid benefits (known as Medi-Cal in California), our Cal MediConnect Plan can help you maintain your health and independence.

Under Blue Shield Promise Cal MediConnect Plan, a single health plan oversees all of your Medicare and Medi-Cal benefits, plus more, with only one ID card! This makes it simpler for you to get the services you need.

A Blue Shield Promise Cal MediConnect Plan includes:

  • A specially trained Care Navigator to help you complete your Individualized Care Plan and manage all your providers and services
  • Medical care
  • Prescription drugs
  • Eyewear
  • Over-the-counter items like toothpaste, allergy medicine and pain relievers
  • Transportation to medically necessary and covered services
  • Long-term support and social services, such as adult day care, in-home care, housekeeping, and meal delivery
  • Mental and behavioral health care
  • Dental care (through California Denti-Cal)
  • Medical alert device that gives you access to help 24/7 with the push of a button
  • Hearing Aids
  • Wellbeing, preventive care and chronic condition treatment program like SilverSneakers® fitness and wellness program

To find out which benefits your plan covers, review plan details in the Member Handbook.

Get to know your plan to learn how to use your benefits effectively.

If you don't have a Blue Shield Promise Cal MediConnect Plan yet, review our plan overview and learn how to enroll.

Cal MediConnect plan highlights

Coordinated care

A Cal MediConnect plan puts a coordinated organization of doctors, hospitals, pharmacies and providers at your fingertips with the help of an experienced Care Navigator. The Care Navigator coordinates all of your providers and services to make sure you get the care you need, and is available to answer your questions and refer you to any community resources you may need. Your care team will work with you to come up with an Individualized Care Plan (ICP) to help you lead a healthy, independent life in your own home and community.

 

Eyewear

As a Blue Shield Cal MediConnect plan member you will have up to $500 for eyewear every two years.

 

Prescription drugs and preferred pharmacy benefits

Your Blue Shield Promise Cal MediConnect Plan includes Part D prescription drug coverage including a quarterly over-the-counter (OTC) allowance that allows you to purchase OTC products you may need. Learn more about the drugs covered in your plan, what pharmacies you can use to fill your prescriptions, and other pharmacy programs available to you.

View our list of covered drugs

 

Access the care you need, when you need it

Your plan includes $0 unlimited transportation to doctors, pick up medicines, and more.1 If you’re recovering from a stay in the hospital or a skilled facility, we also offer a home meal delivery service.2

 

Health education and well-being programs

Blue Shield Promise Cal MediConnect Plan believes that the more informed you are, the better you can manage your health. We provide information on topics like staying fit, managing diseases, maintaining a healthy weight, eating healthy, and many more. We can also help you find classes, counseling, and support groups.

Find programs and educational materials

 

1Transportation trips are limited to plan-approved locations.  
2Upon discharge from the hospital or Skilled Nursing Facility.

 

Contact Blue Shield Promise Cal MediConnect Plan

If you have any questions about your benefits, the cost for care you received from your doctor or hospital; or if you receive a bill for a service, please contact Blue Shield of California Promise Cal MediConnect Plan Customer Care.

Phone:(855) 905-3825 [TTY: 711], 8 a.m. - 8 p.m., seven days a week.

Fax: (323) 889-5416

Email us

Blue Shield of California Promise Health Plan
Customer Care
601 Potrero Grande Dr.
Monterey Park, CA 91755

Get to know Blue Shield Promise Cal MediConnect Plan

Get to know your health plan: learn more about your rights and responsibilities, see how to file an appeal or a grievance, and read answers to frequently asked questions.

Get to know your health plan

Read FAQs

Learn how to submit an appeal or a grievance

Submit a grievance form online

2021 Cal MediConnect plan documents

Download a comprehensive plan description listed in your Member Handbook. Get a sample member ID card, and learn how to get services in your preferred language.

View 2021 Member Handbook

Get language assistance and translation services

Find other plan documents and notices

Cal MediConnect plan benefits information

Find information about the benefits, services, and programs covered by Blue Shield Promise Cal MediConnect Plan. Learn what to do if a service or a procedure requires prior authorization or exception.

Learn about your medical benefits

Prescription drug benefit information

Access and search your plan formulary - the list of drugs covered by your plan. Get pharmacy directories and learn about specialty pharmacies in our network and our mail service pharmacy. Review medication related policies.

Learn about the prescription drug benefits

Find a pharmacy

Find a provider

Use our tool for the most up-to-date listing of doctors, specialists, pharmacies, hospitals, behavioral health services, and vision care providers in your area. You can also download or request a copy of our provider directory.

Find a Cal MediConnect provider

Get a Provider directory for your area

Member resources

Learn about our quality improvement initiatives, request a member ID card, and change your primary care doctor.

Access member resources

Learn about our quality improvement initiatives

Health and well-being programs and resources

Take charge of your health with our Health and Well-being member programs in Wellvolution. Find information on personalized healthy living programs offering tools, coaches and support to help you improve your health, lose weight, prevent or treat chronic conditions and feel better.

Find programs for your health needs and goals

Access Health and wellness member site

Are you still looking for a plan?

Get more information and learn how to enroll using the following resources:

View 2021 Cal MediConnect potential member information

Learn how to enroll

Blue Shield of California Promise Health Plan is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.

Blue Shield of California Promise Health Plan’s pharmacy network includes very limited lower-cost, preferred pharmacies in Merced County, California. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call (800) 544-0088 [TTY: 711],  8 a.m. to 8 p.m., seven days a week, from October 1 through March 31, and 8 a.m. to 8 p.m., weekdays, from April 1 through September 30 or consult the online pharmacy directory at blueshieldca.com/promise.

The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against your health plan, you should first telephone your health plan at (855) 905-3825 (TTY: 711) and use your health plan’s grievance process before contacting the department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you.

If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health plan, or a grievance that has remained unresolved for more than 30 days, you may call the department for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The department also has a toll-free telephone number ((888) 466-2219) and a TDD line ((877) 688-9891) for the hearing and speech impaired. The department’s internet website www.dmhc.ca.gov has complaint forms, IMR application forms, and instructions online.

H0148_20_215A Accepted 09192020

Page last updated: 10/01/2020

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Medicare has neither reviewed nor endorsed this information. Blue Shield of California Promise Health Plan is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.

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