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Before a beneficiary can enroll with Blue Shield Promise Medi-Cal, they must first enroll in the Medi-Cal program by following the steps below:

• Applying for benefits

  Individuals seeking to enroll in the Medi-Cal program must first visit the nearest Department of Social Services (DPSS) / County Welfare Department and apply for benefits. If eligibility is established, the beneficiary is advised to attend an on-site information session administered by Health Care Options - a California Department of Health Services private contractor - to learn about available health care choices.

• Getting Assistance, if needed

  Health Care Options is responsible for educating Medi-Cal recipients about their benefits and how to enroll in a health plan. Beneficiaries needing further assistance or who have questions can contact Health Care Options at (800) 430-4263 or TDD for the hard of hearing: (800) 430-7077. Beneficiaries may also contact Blue Shield Promise Medi-Cal(866) 820-6009 or their doctor’s office and receive assistance with completing the enrollment form.

• Receiving the packet

  Upon receiving beneficiary eligibility information from DPSS, Health Care Options mails each recipient an enrollment packet. The packet contains enrollment materials as well as explains that the beneficiary must choose a health plan, what health plans are available, and that if the enrollment form is not completed and received at Health Care Options in 30 days a health plan will be chosen for them. When Health Care Options chooses a health plan for the beneficiary, it is called default or "automatic assignment."

  Beneficiaries are primarily defaulted because they do not receive the enrollment packet, they do not understand the information because it was sent in English and they speak another language, or they submitted an incomplete enrollment form. Some are defaulted due to administrative and processing errors. Beneficiaries that are defaulted are not prevented from later choosing a health plan of their choice.

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Blue Shield of California Promise Health Plan Enrollment

Enrolling with Blue Shield Promise Medi-Cal largely depends on a beneficiary’s status in the Medi-Cal Managed Care program.

New Beneficiaries

Beneficiaries new to the Medi-Cal Managed Care program who have never completed an HCO form to select a health plan and doctor can:

• Use the information sent in the Health Care Options packet mailed to them. They should look in the L.A. Care Plan Partner Provider Directory or call Blue Shield of California Promise Health Plan Member Services (866) 820-6009 to find a Blue Shield of California Promise Health Plan doctor they want to see.
• Write the doctor's name and I.D. number on the HCO form. Then sign and mail it back to Health Care Options within 30 days. The completed form must be sent back in the envelope provided.

Already enrolled Beneficiaries

Beneficiaries already enrolled or defaulted into a health plan can elect to transfer to Blue Shield Promise Medi-Cal at anytime. To ensure prompt response to a transfer request, beneficiaries and those assisting them must follow the appropriate processes. It is important to:

• Determine the beneficiary’s current affiliation with either the "Commercial" Plan (Health Net: Molina, Health Net Direct or Universal Care) or the Local Plan (L.A. Care) which Blue Shield Promise Medi-Cal is contracted with for Medi-Cal.
• Then request and complete the appropriate form.

Transferring from a Commercial Plan

Beneficiaries enrolled with a Commercial Health Plan wishing to transfer to Blue Shield Promise Medi-Cal, must request and complete a Health Care Options (HCO) form.

• They may call Blue Shield Promise Medi-Cal Health Plan Member Services Department (866) 820-6009 and request a Health Care Options (HCO) form.
• Blue Shield Promise Medi-Cal will mail the HCO form directly to the beneficiary's home address. It cannot be mailed to their PCP or PCP's office.
• The PCP or PCP's office staff may assist the beneficiary in completing the form, but cannot complete the form and have the beneficiary sign it.
• The beneficiary may also contact Blue Shield Promise Medi-Cal and receive assistance in completing the HCO form.
• Beneficiary should mail the enrollment form in the supplied envelope to Health Care Options as soon as possible.

Transferring from the Local Plan (LA Care)

Beneficiaries already enrolled with one of the health plan partners under the Local Plan (L.A. Care) and who wish to transfer to Blue Shield Promise Medi-Cal must request and complete a Plan Partner Transfer form.

• They must call L.A. Care Health Plan Member Services Department (888) 452-2273 and request a Plan Partner Transfer.
• The Plan Partner Transfer form will be mailed directly to the beneficiary's home address. It cannot be mailed to their PCP or PCP's office.
• The PCP or PCP's office staff may assist the beneficiary in completing the form, but cannot complete the form and have the beneficiary sign it.
• The beneficiary should mail the form back to L.A. Care Health Plan as soon as possible.