follow us

Need definitions?

Common healthcare billing terms

More

Vea esta página en español

Frequently Asked Questions

  • Hide

    Bill payments

    How do I pay my bill?
    You have three options:

    1. Pay online

    • Covered California first-time payments: Register with your application ID on blueshieldca.com/payBSC.

    • For all other payments: Log in to blueshieldca.com and select Payment Center under My Plan & Claims.

    2. Pay by mail
    Use the payment stub that is attached to your monthly billing statement and send it along with your payment. If you do not have your payment stub, write your subscriber ID on your check or money order and send your payment to one of the following addresses:

    If you have a grandfathered plan (a plan you purchased before March 23, 2010, and have not changed since), mail your payment to:
    Blue Shield of California
    P.O. Box 54530
    Los Angeles, CA 90054-0530

    If you bought your plan through Covered California or directly through Blue Shield, mail your payment to:
    Blue Shield of California
    P.O. Box 60514
    City of Industry, CA 91716-0514

    3. Pay by phone
    Call the Customer Service phone number on the back of your Blue Shield member ID card.

    What is Easy$Pay℠ and how can I sign up for it?

    Easy$Pay is the easiest way to pay your bill. You can set up automatic payments through your checking or savings account.

    There are two options:

    1. If your bill looks like this image, follow these steps to set up your automatic payments. 67587_HPSG2E_BillThumb_294w.jpg

    a) Go to blueshieldca.com and Log In or Register for your online account using your member ID number.
    b) Once logged in, hover over the My Plan & Claims tab, and click Payment Center.
    c) This will bring you to the Billing dashboard.
    d) Click Enroll in Automated Billing.
    e) This will bring you to the Billing Account Vault screen.
    f) From here, select one of the three options
    • eBill: Choose this option to receive monthly statements via electronic delivery instead of paper, or to cancel Easy$Pay and receive a monthly statement via electronic delivery.
    • Automated Billing (Easy$Pay): Choose this option to set up Easy$Pay.
    • Paper: Choose this option to either cancel electronic delivery of your statements, or to cancel Easy$Pay and begin receiving monthly bills in the mail.

    g) After selecting Automated Billing, click on Create a New Account. Enter all checking or savings account information and click Create.
    h) You are now enrolled in Easy$Pay, and it will be effective within one to two billing cycles.

    2. If your bill looks like this image, follow these steps to set up your automatic payments.67587_SSEPFacets_BillThumb_330w
    a) Go to blueshieldca.com and Log In or Register for your online account using your member ID number.
    b) Once logged in, locate and hover over the My Plan & Claims tab and click Payment Center.
    c) This will bring you to the Pay My Premium screen.
    d) Click Set Up Auto-Pay located in the Quick Links section on the right-hand side.
    e) Enter your checking or savings account information and click Activate Auto-Pay.
    f) You are now enrolled in Easy$Pay, and it will be effective within one to two billing cycles.

    How do I cancel my Easy$Pay automatic payments?

    There are two options:
    1. If your bill looks like this image, follow these steps to cancel automatic payments.

    67587_HPSG2E_BillThumb_294w.jpg

    a) Go to blueshieldca.com and Log In or Register for your online account.
    b) Once logged in, hover over the My Plan & Claims tab and click Payment Center.
    c) This will bring you to the Billing dashboard.
    d) Click on Enroll in Automated Billing.
    e) This will bring you to the Billing Account Vault screen.
    f) Select eBill or Paper. This will cancel automatic billing, and you will receive monthly statements in the mail within one to two billing cycles.

    2. If your bill looks like this image, follow these steps to cancel automatic payments.

    67587_SSEPFacets_BillThumb_330w
    a) Go to blueshieldca.com and Log In or Register for your online account.
    b) Once logged in, locate and hover over the My Plan & Claims tab and click Payment Center.
    c) This will bring you to the Pay My Premium screen.
    d) Click Setup Auto-Pay located in the Quick Links section on the right-hand side.
    e) Select Stop Auto-Pay.
    f) Click Submit. Easy$Pay is now cancelled!

    The automatic payment for my plan has not been withdrawn from my account. Has my plan been cancelled?
    If you signed up for automatic payment and your payment has not been withdrawn from your account., please call the Customer Service number on the back of your member ID card.

    What do I do if my payment has cleared my bank but is not showing up in Blue Shield's payment history?
    If your payment has cleared your bank, but is not seen in your payment history with Blue Shield, please get a copy of your cashed check or bank statement showing proof of the processed payment and then call the Customer Service number on the back of your member ID card.

    return to top

  • Hide

    Renewing your plan

    When is open enrollment?
    Open enrollment will run from November 1, 2016, through January 31, 2017. With Blue Shield, you can renew your plan or explore other options using our online renewal tool starting in October.

    What do I have to do to renew my coverage with Blue Shield of California?
    For many members, there are two easy steps to renew Blue Shield coverage for 2017:

    1. Use the renewal tool starting in October to renew your 2017 coverage online. Watch our renewal tool video to see how you can easily compare plans and renew your coverage online

    2. Pay your January premium bill when you receive it in December to make sure you have continued coverage.

    For more information about renewing or changing your plan for 2017, visit our Renewal Center.

    return to top

  • Hide

    ID cards

    I paid my premium, but I haven't received my ID card. What should I do?

    If you signed up for your plan through Covered California and paid your premium but have not received your welcome letter and ID card within 10 business days, call (855) 836-9705.

    If you signed up directly through Blue Shield, call (888) 256-3650.

    return to top

  • Hide

    Premium tax credits, cost-sharing reduction and premium assistance

    What are the tax penalties for not having health coverage?
    View the tax penalties for not having health insurance. Read more about tax penalties from Covered California.

    To avoid the tax penalty, an individual must have health coverage for at least nine months of the year. If you're uninsured for just part of the year, 1/12 of the yearly penalty applies to each month you're uninsured.

    We're not tax professionals and cannot provide tax advice, but we can help you find the information you need to file.

    Need more help? Visit the IRS website for tax filing tips or ACA tax provisions.

    What is premium assistance?

    Premium assistance refers to government payments made to your health insurance plan to lower the cost of your monthly premiums. The amount of your premium assistance is based on an estimate of the premium tax credit that you may be allowed for the year. This estimate was made when you enrolled. The premium tax credit is a federal tax credit that helps make health insurance more affordable.

    Who can get a premium tax credit or cost-sharing reduction under health reform?

    If your income is between 138% and 400% of the federal poverty level (FPL), and your job does not offer affordable coverage, you may get tax credits and potentially reduce cost-sharing to help you afford your health coverage. Members who are eligible must file a tax return. If you do not file a tax return, you will lose premium assistance.

    View income and program eligibility requirements to qualify for financial assistance on their Open Enrollment Paper Calculator.

    Tax credits are available only through Covered California. You can learn more about getting help paying for coverage through Covered California, or call (800) 300-1506.

    Will my premium tax credit be the same as it was last year?
    Probably not. The premium tax credit amount you will receive next year will most likely be different than your current-year tax credit based on changes in your household size, income, and the health insurance rates in your area.

    Why is there a difference between my current premium and my premium for next year?
    In addition to the reasons above, the difference in premiums may be due to one or more of the following:

    • You or your dependents had a birthday since your enrollment date: As a member, you are given a rate based on your age at the time of enrollment. Upon renewal (on January 1), we recalculate the rate based on each member's age at the renewal date. For example, if you were 35 when you enrolled and turned 36 before the renewal date (January 1), we will recalculate your rate. Additionally, when members turn 21, they are considered adults, and we recalculate the rate.
    • You moved to a different rating (geographic) region: There are 19 rating regions in California, and the prices of the plans available vary by region. If you move to a different rating region, we recalculate your rate based on your new address. For example, if you move from Sacramento to San Francisco, we will recalculate your rate based on your new address, and the rate for the same plan may change.
    • Changes in family status: All members of the family who are enrolled for coverage are factored into the overall rate: the subscriber, spouse, the first three children under age 21, and every member over the age of 21. Adding or removing dependents from the plan may impact the monthly rate.
    • Rising medical costs: These include general costs associated with the administration and delivery of health benefits, hospital, physician, and drug costs, as well as the cost of ever-advancing medical technology. Your premium payments are used to pay these costs.
    • Changes to benefits offered in your plan: Changes to coverage will affect rates. Some benefit changes include changes in the law, coverage for certain services, authorization requirements, or changes that affect which providers participate in our networks. See your renewal notice for more details on changes specific to your plan.
    • If you haven't updated your information with Covered California for next year: Your premium and premium tax credit may not reflect the most accurate information. You should always report income and family size changes to Covered California when they happen throughout the year. This will help make sure you get the proper type and amount of premium assistance and will help you avoid getting too much or too little in advance, which can affect your premium.

    How can I make sure I get the right premium tax credit?

    To make sure you get the right premium tax credit, update your household size, income and other eligibility information with Covered California. Visit Covered California to make these updates, or call (800) 300-1506. Your final tax credit is determined when you file your federal income tax return for the year.

    How does my premium tax credit affect my taxes? Do I need to claim my premium tax credit at tax time?

    Learn more about how to claim the premium tax credit on your federal tax return, or view the ACA Provisions for Individuals (PDF, 281KB) document from the IRS.

    How do I claim a premium tax credit on my federal tax return?
    For any tax year, if you receive advance credit payments in any amount or if you plan to claim the premium tax credit (a tax credit designed to help lower your monthly costs for health insurance purchased through Covered California), you must file a federal income tax return for that year.

    In the first quarter of the year, Covered California will mail IRS Form 1095-A. This form will help you reconcile the Advanced Premium Tax Credit (APTC) you received for the current benefit year to the actual amount of Premium Tax Credit you were eligible for in that year based on the actual Modified Adjusted Gross Income you will report to the IRS on your taxes.

    For more information, visit the IRS website for tax filing tips or ACA tax provisions.

    return to top

  • Hide

    Covered California

    What kinds of changes should I report to Covered California throughout the year, and why is this important?

    You should always report income and family size changes to Covered California when they happen throughout the year. This will help make sure you get the proper type and amount of financial assistance and will help you avoid getting too much or too little in advance. Receiving too much or too little in advance can affect your refund or balance due when you file your tax return.

    For example, if you do not report income or family size changes to Covered California when they happen, the advance payments may not match the amount of credit that you qualify for on your federal tax return. This might result in a smaller refund or a balance due when you file your taxes.

    Make sure to report the following changes to Covered California at (800) 300-1506:

    • Address changes
    • Date of birth corrections
    • Adding or removing a dependent
    • Plan change requests
    • Termination requests

    How do I report income changes to Covered California?

    If you haven't already given Covered California permission to check your income, visit CoveredCA.com.

    You must give Covered California permission to check your income to confirm your eligibility for federal financial help. If you do not do this, you may lose your premium tax credit.

    Once I update my income, when will my premium tax credit appear on my bills?

    Once you have reported your income, Covered California will decide whether it should adjust your premium tax credit. If there is a change to your premium tax credit, the new amount will be reported to Blue Shield of California. Your bill will be updated in one to two billing cycles after the information is received to reflect your most current premium tax credit. In the meantime, please pay the amount billed and Blue Shield will make any necessary adjustments if you are owed a credit.


    return to top

  • Hide

    Claims

    How can I check my claims status and other details?

    After you've logged in to blueshieldca.com, scroll down to the Claims section to see your most recent claims and detailed information for each claim including total billed amount, patient responsibility and more.

    You can also see Claim Status on the Claims page. Your claim status will be one of the following: 

    • Finalized: Claim has been processed.
    • Pending: Claim is in process. Claim details are not available while your claim is pending.
    • Adjustment Pending: A change to the original claim is being processed. You will not see the details of the claim while the adjustment is pending.

    If you need to see a claim that's more than a year old, or if you have other questions, you can call the customer service number listed on your Blue Shield member ID card.

    return to top

  • Hide

    Network vs. non-network services

    How do you calculate the amount a network provider charges me for care?

    Your doctor or hospital will bill Blue Shield for most services. We will determine what you are charged based on our negotiated rates for each covered service. If you have a deductible, you will be responsible for paying the negotiated rate for these services up to the deductible limit. After you have met the deductible limit, we will share most costs with you. This means you will pay a certain percentage of costs for covered services received from Blue Shield providers, and Blue Shield will pay the rest.

    There is a limit to how much you have to spend out of your pocket each year before Blue Shield begins paying 100% for most covered medical services. This is called your plan's out-of-pocket maximum.

    What happens if I see a non-network (or non-participating) provider?

    To make sure you receive the best value and do not have to pay more out of pocket at the time of service, you should use doctors and hospitals in your plan's network.

    With a PPO plan (Preferred Provider Organization), you have the flexibility to receive covered services from providers that are not in your plan's network, but your costs will be higher because we do not have negotiated rates with those providers. Blue Shield will pay a percentage of our allowed amount for covered services, and you will be responsible for all other costs up to the billed amount. If the service isn’t covered, you may be responsible for all billed charges.

    There is also no out-of-pocket maximum for non-network services. PPO networks and participating providers may be different from plan to plan. To ensure you are visiting a participating provider, review your options at Find a Doctor. Remember to log in to blueshieldca.com to find doctors and other providers that accept your plan. All of the search results will list providers that are currently participating in the plan you selected. We make efforts to ensure that our list of providers is current and accurate. However, because providers leave networks from time to time, this list is subject to change.

    If you have an HMO plan, you must visit your primary care physician (PCP) before you receive health care. Your PCP must be part of the Trio ACO HMO Network. If you need to see a specialist, your PCP will refer you to a specialist within the Trio ACO HMO network if one exists. If a specialist for the care you need is not a part of the network, your PCP will refer you to a specialist outside of the network. Only in this situation, where an existing specialist is not offered within your plan’s network or in an emergency situation, will the outside referral or emergency treatment be considered a covered benefit. In all other cases, if you see a non-network provider, your services may not be covered. Please review your Evidence of Coverage for more details. 

    return to top