Blue Shield Promise Cal MediConnect Plan

Members

Resources

General Information

Please click on links below for more information on each topic.


Prior Authorizations (Organization and Coverage Determinations) / Exceptions

Please click on the links for contact information and forms needed for organization determinations, coverage determinations, and exceptions.


Appeals & Grievances Process and Forms

Please click on the links for information if you have a problem or a complaint.


Pharmacy and Medication-related Resources

Please click on links below for more information on each topic.

Materials and Publications

Summary of Benefits
You have choices about how to get your Plan benefits. Tips for comparing your plan choices
Annual Notice of Change
You are currently enrolled as a member of Blue Shield Promise Health Plan. Next year, there will be some changes to the plan's costs and benefits. This booklet tells about the changes.
Enrollment Instructions and Forms
To Enroll in Blue Shield Promise Cal MediConnect Plan You can: Call Customer Care Operations at (855) 905-3825 (TTY; 711), 8:00 a.m. to 8:00 p.m. seven days a week. Call Heath Care Options at 1-844-580-7272, Monday through Friday from 8:00 am to 6:00 pm. TTY users should call 1-800-430-7077.
Multi-Language Insert
We have free interpreter services to answer any questions you may have about our health or drug plan. To get an interpreter, just call us at (855) 905-3825.
Evidence of Coverage (EOC) / Member Handbook
This booklet gives you the details about your Cal MediConnect health care and prescription drug coverage from January 1 – December 31, 2019.
Dental Information
Certain dental services are available through the Medi-Cal Dental Program. Dental benefits are available in the fee-for-service delivery system, known as Denti-Cal.
Provider & Pharmacy Directories
This directory provides a list of Blue Shield Promise Health Plan's network providers and it should be used to assist in your selection of a plan health care provider.
Prescription Drug Information – Formulary (List of Drugs)
A formulary is a list of health plan-covered drugs. The Blue Shield Promise Health Plan Formulary lists drugs, in consultation with a team of health care providers...
Privacy Notice
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
ID Card
See Plan's ID card sample. Request your Blue Shield Promise Health Plan Member ID Card.
Welcome Letter
Welcome Letter samples in your preferred language.


Material ID: H0148_19_028_WEB
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