Your PPO plan

Thank you for choosing Blue Shield.

As a PPO plan member, you have a lot of flexibility. The benefits of being a PPO plan member are:

• You have access to our Exclusive PPO Network, which is the only statewide PPO network and includes more than 50,000 doctors and 350 hospitals across California.
• You are not required to see a primary care physician first to access care and you can see any doctor or specialist that you want in the network without a referral.
• You have the flexibility to see providers outside your plan’s network, but you will get a discounted rate and pay less out of pocket when you see network providers.
• You have free access to Shield Support, personalized support to help you navigate the healthcare system and manage certain health conditions.
• You have access to urgent and emergency care when traveling throughout the country and abroad with the BlueCard® Program.
• Plus, there are many other ways to access care.
   

5 easy steps to receiving care

1. Get your ID Card

You will receive a new ID card if you are a new enrollee or if you just made a change to your current coverage. Please review the information on your card to ensure it is accurate.

Make sure to keep your card handy so your information is easily accessible when you visit a doctor, hospital, or specialist.

If you have not yet received your new ID card and your coverage has begun, please call the following:

If you’d like to access an electronic version, order a new ID card or print a temporary one log in or register for an online account.

• If you signed up for your plan through Covered California, call (855) 836-9705
• If you signed up directly through Blue Shield, call (888) 256-3650

2. Register for your account

If you haven’t registered yet, use your member ID number to register for a blueshieldca.com online account.

Log in to see your personalized account information.

With your online account, you can:

• Find a doctor in your plan’s network
• View or change your PCP online, if desired, once your plan is effective
• View your billing, claims, benefits, deductibles, and copayment information, updated daily
• Chat with a nurse for health advice with NurseHelp 24/7SM
• Learn about our wellness programs and sign up to participate
• Use the Treatment Cost Estimator tool to review out-of-pocket expenses and saving 

3. Find a Doctor

You can use our Find a Doctor tool to search for doctors, specialists, hospitals, and more online. Simply log in to find information about the doctors and hospitals that are in your plan's network.* Doctors do leave the network from time to time, so it’s a good idea to call the doctor’s office to confirm that the doctor is still in your network. Also, if this is your first time seeing this provider, please remember to call the provider's office to ensure that they are accepting new patients.

A PPO plan does not require you to choose doctors who belong to a medical group. We are contracted with individual physicians as well as multi-specialty medical groups so you can get many of your healthcare needs in a single location.

Your primary care physician

We’ve matched you with a primary care physician (PCP) because we believe that the relationship you build with your PCP is important to your overall health and well-being. You are not required to see a PCP and you don’t need to visit one first to receive care. However, we recommend having a PCP for yourself and your dependents. You can also change your PCP.

View your PCP information in your online account at blueshieldca.com when your plan is effective and find out more about PCP matching , including step-by-step instructions on how to change your PCP.

4. Visit your doctor

If you need care, choose the type of doctor you need to see (PCP or specialist) and call that doctor’s office to make an appointment. Be sure to choose a doctor in your plan’s network to save on out-of-pocket costs and don’t forget to bring your Blue Shield ID card with you to your visit

Many preventive care services such as routine physical exams, screenings, and vaccinations are covered 100% under your plan when you visit a doctor or your PCP in your plan’s network.

For other services, you will pay a small fee, known as a copayment, to your doctor for each visit. In most cases, the copayment to see a specialist is different from a general office visit with a PCP.

Can’t get in to see a doctor? With a Blue Shield membership, you have many other ways to access care.

5. Pay for your care

How you pay for care from network providers

You will get the best value when you see a doctor in your network. Your doctor or hospital will bill Blue Shield for most services. We will determine what you can be charged — the allowable amount — based on our negotiated rates for each service.

If you have a deductible, you will be responsible for paying 100% of the negotiated rate for certain services subject to a deductible until you reach the deductible limit. After the deductible limit has been met, we will share most costs for covered services with you. This means you will pay a certain percentage of costs, or coinsurance, 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.

How you pay for care from non-network providers

With a PPO plan, you have the flexibility to receive covered services from providers that are not in your plan’s network, but your costs will be significantly higher because we do not have negotiated rates with those providers. And, in some instances, services provided by a non-network provider are not covered. If a service isn’t covered, you may be responsible for all billed charges.

To save money and get the most value out of your health plan, it’s important to choose doctors in your plan’s network.

For more details about covered services, see your Evidence of Coverage and Health Services Agreement.

• Learn more about paying for health care
• See "How your plan works" (includes an explanation of the healthcare terms above)