General Information

General Information

Click on links below for more information on each topic.

Behavioral healthcare services (mental health and substance use disorders) services are a covered benefit. Services may include treatment for anxiety, depression, or other behavioral health problems

Monthly Plan Premium for People who get Extra Help from Medicare to Help Pay for their Prescription Drug Costs.

Best Available Evidence
Information about Extra Help
More Information on Late Enrollment Penalty

With limited exceptions, while you are a member of our plan you must use network providers to get your medical care and services.

We're excited to offer you a new program that helps prevent Type 2 Diabetes. This program will help you learn about ways you can be more active, eat better and lose weight.

It's free and easy! Just call (800) 609-4166 (TTY 711), 24 hours a day, 7 days a week.

Individuals who represent enrollees may either be appointed or authorized. An enrollee may appoint any individual (such as a relative, friend, advocate, an attorney, or any physician) to act as his or her representative and file an appeal on his or her behalf.

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.

For more information on ending your membership, please refer to EOC Chapter 10 Section 2 of your Evidence of Coverage Document.

Learn how to prepare for and recover from disasters and emergencies. Find information you need to be ready to handle a disaster or emergency.

What is Durable Medical Equipment? What equipment is covered in my health plan?

Member Resources

Organization determination means that Blue Shield of California Promise Health Plan would be making a decision about whether items or services are covered or how much you have to pay for covered items or services. Also included are requests for reimbursement of medical service or prescription drug costs.

Coverage determination means that Blue Shield of California Promise Health Plan would be making a decision about whether prescription drugs are covered under your plan. Your benefits as a member of our plan include coverage for many prescription drugs.

To request assistance with a prior authorization, please call Blue Shield of California Promise Health Plan Member Services at (800) 544-0088 from 8 a.m. to 8 p.m., seven days a week, from Oct. 1st – Mar. 31st and 8 a.m. – 8 p.m. weekdays, from Apr. 1st – Sept. 30th. TTY users should call: 711.

What is an Appeal? An appeal is the way for you to challenge our action if you think we made a mistake. It is a formal way of asking us to review and change a coverage decision we have made.

As a Blue Shield of California Promise Health Plan Member, you have a right to file a complaint (grievance) if you have a problem with your medical care or our services. However, the complaint process is used for only certain types of problems. They include quality of care, waiting times, and the customer service you receive.

Medication Transition Policy. What can you do if your drug is not on the Drug List or if the drug is restricted in some way?

We have established measures and systems to conduct drug utilization reviews for all of our members to make sure that they are getting safe and appropriate care.

This program incorporates utilization management tools to encourage appropriate and cost-effective use of Part D medications.

We offer a full range of Pharmacy benefits to our members who are at high risk for medication-related problems. This program is offered to qualified members at no cost and can help them better manage their medications.