1) Losing other health coverage due to job loss or expiration of COBRA coverage
2) Employer coverage changed
3) Turning 26 years old
4) New child
5) Moved into or out of service area
6) Marriage, separation or divorce
7) Loss of Medi-Cal or Medicaid
8) Death of the person through whom you receive health coverage as a dependent
9) End of military service
10) Medical child support orders issued by state or federal court
11) Other exceptional circumstances (validated by Covered California)
If you are unsure of your eligibility, please call us at (855) 656-0466, Monday through Friday, 8 a.m. to 5:30 p.m.
If you haven’t experienced a qualifying life event, you can apply for coverage during the next open enrollment period starting November 1, 2021.
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.
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.
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.
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.
Watch this video to learn more!
* This is for informational purposes only. * Underwritten by Blue Shield Life & Health Company