Whether you decide to renew your current plan or choose a new plan for 2019, ensure that the plan you choose is the best fit for your needs. Review the following information as it may impact your healthcare coverage decision.
Changes to the BlueCard Program for PPO plans purchased 1/1/2014 and after
The BlueCard® Program enables Blue Shield of California members to access limited care while outside of California, such as when traveling or on vacation.
Starting January 1, 2019, for our non-grandfathered PPO plans*, Blue Shield will only cover out-of-area healthcare services received for emergency care, urgent care, and any follow-up care resulting from an initial emergency or urgent care visit. Any other services received outside California will no longer be covered.
If needed, you have other ways to access non-emergency health care when you are out of state. Your non-grandfathered PPO plan gives you access to Teladoc to call or video chat with a doctor 24/7. Additionally, you have anytime access to healthcare advice through NurseHelp 24/7SM.
If you have questions about this change, please view our frequently asked questions about changes to the BlueCard Program or contact member services at the number on the back of your Blue Shield member ID card.
* Plans purchased on or after January 1, 2014, are non-grandfathered plans. If you have a grandfathered PPO plan, purchased on or before March 23, 2010, or a Trio HMO plan, your BlueCard benefit has not been changed as noted above. Please review your Evidence of Coverage for full details.
Changes in age that can affect your coverage
The pediatric dental and vision benefits included in your medical plan are available only to children up to age 19. When children turn 19 they will no longer be eligible for these pediatric benefits. Make sure your whole family is covered by purchasing one of our dental and vision plans, which you can do at any time throughout the year.
Dependents turning 26
When your dependents turn 26, they will no longer be eligible for coverage on your medical plan unless they qualify for an extension of coverage past age 26 due to disability. Losing eligibility for coverage qualifies them for a special enrollment period. They can get their own individual coverage from Blue Shield or Covered California up to 60 days after coverage on your plan ends.
To learn how to keep your dependents covered, call (800) 660-3007 or visit blueshieldca.com/keepcovered.
Turning 30 or older and on a Minimum Coverage plan
If you are enrolled in the Minimum Coverage PPO plan and are age 30 or older as of January 2019 (the renewal date), you will be automatically renewed into the Bronze 60 PPO plan for 2019. To remain on the Minimum Coverage plan, you must qualify for and receive an approval from the Healthcare Marketplace for an exemption. To apply, get the appropriate Hardship or Affordability (SBM) exemption form, follow the instructions, and mail your application to the address listed on the form. Fax your approved certificate of exemption to (209) 367-6490 and please include your Blue Shield subscriber ID number.
If you originally purchased your Minimum Coverage plan through Covered California, are age 30 or older in 2019, and want to continue enrollment in that plan, you must re-enroll directly with Blue Shield beginning October 15 and include a copy of your certificate of exemption. Call Blue Shield at (800) 660-3007, press #, and tell us that you would like to re-enroll in a Minimum Coverage plan. Our agents are available to help.
If you or a member of your household are turning 65 in 2019, or are eligible for Medicare, you could save money by switching to a Blue Shield Medicare Advantage Prescription Drug Plan or Medicare Supplement Plan. To learn more about your Medicare options, call (888) 434-4179 or visit blueshieldcamedicare.com.
Our PPO gets 4-star rating
Blue Shield of California is pleased to receive a 4-star Summary Quality Rating* for our Individual and Family plan PPO products. Each year, quality ratings for health plans are published on the Covered California website to help Californians shop and compare coverage options. This rating reflects Blue Shield’s focus on improving clinical quality outcomes and member experience.
Our 4-star PPO plans give members the flexibility to choose their own providers from more than 50,000 doctors and 350 hospitals in our Exclusive PPO Network.
*CMS rates qualified health plans (QHPs) using the Quality Rating System (QRS), which is based on third-party validated clinical measure data and QHP Enrollee Survey response data. CMS calculates QRS ratings annually using a 5-star scale. QHP issuers contract with HHS-approved survey vendors that independently conduct the QHP Enrollee Survey each year. QRS ratings and QHP Enrollee Survey results may change from one year to the next. For more information, please see CMS’ Health Insurance Marketplaces Quality Initiatives website.