FAQs

Find answers to some of the most frequently asked questions about Blue Groove.

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    What is Blue Groove®?

    Blue Groove® is Blue Shield’s innovative product designed to address affordability and quality by combining next-generation wellness, advanced member engagement and top-rated provider networks. Ultimately, we want to encourage and support all stakeholders to be more engaged and accountable for helping to ensure good health of members and a future of affordable care.

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    How does it work?

    Blue Groove is designed to make it easier for members to personalize and achieve their health goals while meeting the needs of a wide cross-section of people. Blue Groove features three separate ‘grooves’ designed to help you receive the right care for you: the Main Blue Groove, the Basic Blue Groove, and the Care+ Blue Groove.

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    Which groove is right for me?

    It depends. Are you seeking a plan that encourages your active involvement in managing your health and offers rewards for maintaining your good health with regular screenings and programs? The Main Blue Groove is for you. Do you have a condition (such as heart failure, cancer, diabetes, or hypertension) that could benefit from a team of specialized doctors and other caregivers? We designed the Care+ Blue Groove for you. If your biggest concern is having the freedom to choose any doctor you want, the Basic Blue Groove is for you.

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    Can I change grooves?

    In most cases, you can change grooves only during open enrollment. Members who enroll in the Main Blue Groove must complete a health risk assessment questionnaire and biometric screening for health risk factors within 60 days of enrolling. If they do not complete these two requirements, they will be enrolled in the Basic Blue Groove. You can become a member of Care+ Blue Groove at any time during the year by qualifying based on certain health conditions. If you enroll in the Care+ Groove you must participate in a care plan designed by you and your personal physician champion.

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    Can I sign up for any groove I want?

    Enrollment in the Care+ Groove is limited to individuals who have certain medical conditions. We encourage most individuals to enroll in the Main Blue Groove, but realize that some individuals may find the Basic Blue Groove to be the best fit.

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    Can I have my same doctor?/How do I choose a doctor?

    When you enroll in Main or Care+ Blue Grooves, you agree to select your Personal Physician from the highly rated Hill Physicians medical group. If you do not select a doctor, we will choose one for you. If you enroll in the Basic Blue Groove, you have the option to see any provider at higher rates than our Main Blue Groove.

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    If I enroll in the Main Blue Groove, can I see a specialist easily?

    Yes, your Personal Physician oversees and coordinates your care, including referrals to a specialist. If you want to go to a specialist without a referral from your Personal Physician, but you want to pay a lower copayment than with your PPO option, you can go directly to a specialist in the Main Blue Groove network, instead of the Basic Blue Groove network. If you or your family see a specialist often, you may consider consulting our member service team to ensure you understand your options and the out-of-pocket expenses.

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    Can I go to any pharmacy I want?

    To take advantage of your plan benefits, you will need to have your prescriptions filled at a pharmacy that participates in our network. Our network includes most familiar chain and local pharmacies.

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    Are my prescription drugs covered by Blue Groove?

    You’ll find many major name-brand and most generic prescription drugs covered in the Blue Shield Drug Formulary. To see if your medication is covered, check our site’s Pharmacy section or call our member service team at (877) 275-6565.

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    What do I need to do to remain in the Main Blue Groove?

    After selecting Main Blue Groove during open enrollment, to stay in the Main Blue Groove, you must complete a wellness assessment and a biometric screening within sixty days.

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    Does Blue Groove cover vision and dental, too?

    No, Blue Groove provides comprehensive medical benefits. Ask your employer about your options for vision and dental coverage.

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    Does Blue Groove cover me if I travel out of state or outside the USA?

    Blue Groove provides access to covered services outside of the Blue Groove service area. Covered services vary by groove, please contact Blue Groove customer service for more specific information.

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    Can I cover my entire family with Blue Groove?

    You can cover any family members who live or work inside the Blue Groove service area.

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    Can I have family members in different grooves?

    Yes, under certain conditions. While you must select the same groove at open enrollment for your entire family, as individuals you may then move to different grooves depending on heath conditions or wellness activities. Ask your Blue Groove representative for specifics regarding your family options.

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    Are maternity benefits included?

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    Are Blue Groove doctors assigned to me or do I choose one?

    If you are in the Main Blue Groove, you can choose your Personal Physician or let us assign one to you. If you are enrolling in the Care+ Blue Groove, we will work closely with you to make sure you have a team of specialized doctors and other caregivers who are experts in your condition. If you are in the Basic Blue Groove, you can choose to see any physician at any time.

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