FAQs for plans purchased directly from Blue Shield (off-exchange)

You can view your plan documents by entering your ID number, or view documents for all plans, on our benefits resources page. Or you can log in and find your plan documents in your online account. You can download and keep these documents in your files for future reference. If you need copies mailed to you, please call us at the phone number on the back of your Blue Shield member ID card.

Our Preferred Provider Organization (PPO) plans give you access to the only statewide provider network that includes more than 71,000 doctors, 1,000 urgent care centers, and 325 hospitals.

Blue Shield will also continue to offer Health Maintenance Organization (HMO) plans with access to the IFP Trio HMO Network*.  This network includes access to more than 9,000 virtual and in-person primary care physicians, 33,000 specialists and 309 hospitals, including Dignity Health, Hoag Memorial, Good Samaritan, John Muir, Loma Linda, Scripps, and more.

The benefits of being a Trio HMO plan member are:

• HMO plans are often a budget-friendly option, offering predictable out-of-pocket costs through a coordinated care model.
• Your primary care physician (PCP) is your main point of contact for health care, guiding and coordinating your care, treating common illnesses and injuries, and referring you to specialists when needed. †
• All plans include Teladoc Health® for $0 copay, which allows you to receive medical and mental health care 24/7 over phone or video chat. Even better, for our IFP Trio HMO plans, the Teladoc benefit is not subject to the plan deductible.
• You have the option to select a virtual PCP through Accolade Care, a virtual medical group, with same-day, next-day, and even after-hours video appointments typically available. ‡

Blue Shield’s IFP Trio HMO plans are available in 28 California counties. Before selecting a Trio HMO plan, make sure that the plan is available in your area by visiting  blueshieldca.com/triocheck. Then, review the IFP Trio HMO network to find providers near you.

The benefits of being a PPO plan member are:

• You have access to our Exclusive PPO Network, a statewide PPO network, which includes more than 71,000 doctors, 1,000 urgent care centers, and 325 hospitals across California.
• You have the flexibility to manage your care in the way that works best for you, including direct access to specialists without a referral.
• You’ll keep your out-of-pocket costs low when you receive care from in-network providers.

During open enrollment between November 1 and January 31, the best way to compare plans as a current member is by talking to your broker or by logging in to your member account. If you want to make changes to your plan outside of open enrollment between February 1 to October 31, this will require a Qualifying Life Event. You can also contact Member Services at the number on your ID card for plan-specific questions.

I have or am considering a PPO plan: To make sure you do not pay more out of pocket, you should use doctors and hospitals in your plan’s network. If you choose to use a doctor or hospital that is not in your plan's network, this will significantly increase your costs; or, if the service isn't covered, you will be responsible for all billed charges.

Find doctors and hospitals in the Exclusive PPO Network. *

I have or am considering a Trio HMO plan: Your services are only covered if you see providers in your plan's network except in the case of emergency treatment, urgent services or services received at a Participating Provider facility (Hospital, Ambulatory Surgery Center, laboratory, radiology center, imaging center, or certain other outpatient settings) under certain conditions.

If a specialist for the care you need is not in your plan's network, then your primary care physician (PCP) will refer you to one outside the network. If you choose a virtual PCP, a referral will be required to see a specialist or in-person provider.

Find doctors and hospitals that are in the IFP Trio HMO Network.*

You can set up recurring payments with AutoPay℠ regardless of what Blue Shield plan you select. When you renew with Blue Shield, your automatic payment will automatically adjust to next year's monthly premium starting with your January bill that you will receive in December. Your enrollment in AutoPay will continue unless you cancel the service.

You will receive a new ID card for your 2027 plan if:

• You switched your plan
• There is a change in the cost shares listed on your ID card
• You are a member of the Trio HMO plan and you changed your PCP

Log in to your online account to request a duplicate or replacement ID card.

When you enroll in a plan through Covered California, you may qualify for government financial help, called a subsidy, to help lower your monthly payments. It is available for individuals and families who qualify based on the number of people in the household, income, age, and cost of the second lowest silver level plan in your geographic location.

Learn more about financial help and see if you qualify by using our subsidy calculator.#

Californians are required to be enrolled in and maintain minimum essential coverage throughout the year. This is known as the individual mandate. In other words, if you do not have health coverage, you may have to pay more in taxes. Staying covered can help you to avoid this tax penalty.

The California Franchise Tax Board, which administers the state mandate, will assess the penalties for the coverage year when consumers file their taxes. To find out how much your penalty could be, please use the Individual Shared Penalty Estimator tool.

We are not tax or financial professionals and cannot provide tax or financial advice. If you need help, please get advice from a professional tax preparer or financial advisor.