employer connection

HMO Plans

Small Groups (2 to 50)

Blue Shield's Access+ HMO® and Local Access+ HMO® offer easy-to-understand copayments and comprehensive healthcare coverage for your small business.

These plans can provide a wide range of benefits, predictable out-of-pocket costs, and the Access+ HMO plans offer access to one of the largest HMO networks in California. And with 17 Access+ HMO and Local Access+ plans to choose from, your employees can pinpoint the type of coverage that meets their needs. The HMO plans are part of the new Simply Shield portfolio, designed to deliver clear and simple healthcare coverage for small businesses. Download the overview of our HMO plan family (PDF, 134KB).

HMO plan families:

Premier HMO Plans

Representing our richest benefits for the small group market, the Access+ HMO and Local Access+ HMO Premier plans have lower out-of-pocket maximums and offer a range of benefit plans to choose from with predictable costs for many covered services.

Premier HMO PlansCopayment
Maximum 
Office
Visits 
Inpatient
Hospitalization
Services
(Facility) 

Access+ HMO Premier 151 OR
Local Access+ HMO Premier 151 

$1,500/$3,000

$15

$150/day
up to 3 days
max

Access+ HMO Premier 251 OR
Local Access+ HMO Premier 251 

$2,500/$5,000$25$250/day
up to 3 days
max

Access+ HMO Premier 351 OR
Local Access+ HMO Premier 351 

$3,500/$7,000

$35$350/day
up to 3 days
max

Access+ HMO Premier 451 OR
Local Access+ HMO Premier 451 

$4,500/$9,000$45$450/day
up to 3 days
max

Enhanced HMO Plans

The Access+ HMO and Local Access+ HMO Enhanced plans feature the comprehensive coverage of an HMO at a lower rate than Premier plans with a range of benefit plans to choose from.

Enhanced HMO PlansCopayment
Maximum 
Office
Visits 
Inpatient
Hospitalization
Services
(Facility) 

Access+ HMO Enhanced 151 OR
Local Access+ HMO Enhanced 151  

$2,000/
$4,000

$15

15%

Access+ HMO Enhanced 251 OR
Local Access+ HMO Enhanced 251  

$3,000/
$6,000
$2525%

Access+ HMO Enhanced 351 OR
Local Access+ HMO Enhanced 351 

$4,000/
$8,000

$3535%
Access+ HMO Enhanced 401 $4,500/
$9,000
$4040%

Access+ HMO Enhanced 451 OR
Local Access+ HMO Enhanced 451 

$5,000/
$10,000
$4545%

More Local Access+ HMO Coverage Throughout California

You also have the choice to offer the larger network Access+ HMO® plans and depending on where your employees live or work, they may receive potential savings by choosing Local Access+ HMO® plans, featuring a select network of providers. You can keep your employees covered, and get potential savings of up to 12% off comparable Blue Shield Access+ HMO® plans. Local Access+ HMO is available in all or a portion of 15 counties1 and now with full coverage in Orange County. Learn more about the Local Access+ HMO network for small groups.

Access Baja Plan 10

If your employees want healthcare coverage in Baja California, Mexico, our Access Baja® HMO plan may meet their needs, it includes:

  • Quality healthcare coverage for your clients' employees and their dependents who prefer accessing services in Mexico
  • A flexible "split family contract" option that allows employees working in California to enroll in a Blue Shield health plan in California, while dependents living in Mexico enroll in an Access Baja HMO plan for coverage in the Access Baja service area
  • A choice of personal physicians, specialists, pharmacies, and hospitals in Baja California
  • Affordable copayments, or no charge for preventive health services, and no annual plan deductible
  • Comprehensive benefits including doctor visits, preventive care, prescriptions, and hospitalization
  • Worldwide urgent and emergency care coverage through the BlueCard® Program (PDF, 69KB) Spanish-speaking member services with toll-free customer service available in Mexico and the United States

For small groups, the Access Baja HMO Plan 10 must be offered2 alongside another Blue Shield plan(s).

The Access Baja HMO service area is generally defined as the municipality of Tijuana or Mexicali, Baja California, Mexico; and the area in California (U.S.), within a 50-mile radius from the U.S./Mexico border crossing point at San Ysidro and Calexico, California.

Care received through providers in Mexico in the Access Baja HMO Plan will be care that is consistent with generally accepted medical standards in Mexico. Find out more about medical care in Mexico. Note: Access+ SpecialistSM and Access+ Satisfaction® do not apply to the Access Baja HMO plans.


Employers located in certain California counties whose eligible employees live or work in the Local Access+ HMO service area, have the option of choosing any of the Access+ HMO plans or any of the Local Access+ HMO plans, but not both One HMO plan option must be selected; both options are not available to combine. The Local Access+ HMO plans have the same benefits as our Access+ HMO plans.

The Access Baja HMO Plan 10 can only be offered to employees and dependents who reside or work in an Access Baja HMO service area. The Access Baja HMO service area is the municipality of Tijuana and Mexicali, Baja California, Mexico and the area in California (U.S.), within a 50-mile radius from the U.S./Mexico border crossing point at San Ysidro and Calexico, California. More information about the Access Baja HMO service area can be found in the Benefit Summary Guide (A16609).