Providence OptionPLUS HMO Plan
The Providence OptionPLUS HMO plan is only available to caregivers of Providence Health & Services.
About the Providence OptionPLUS HMO plan
Selecting Personal Physician (Primary Care Provider)
Transitioning to the Providence OptionPLUS HMO plan
Behavioral Health Benefits
Away From Home Care® Program
Emergency and Urgent Care Outside of California
The Providence OptionPLUS HMO plan was developed exclusively by Blue Shield of California in collaboration with Providence Health & Services for Providence Southern California employees.
The difference between the Providence OptionPLUS HMO Plan and the Blue Shield Access+ HMO plan is the provider network. If you enroll in the Providence OptionPLUS HMO plan, you will have access to a smaller, specially selected network of Providence-affiliated medical groups and affiliated Personal Physicians and specialists than are available in the Blue Shield Access+ HMO plan. Below is a list of the Providence Southern California acute care hospitals that are included in the Providence OptionPLUS HMO network:
- Providence Little Company of Mary Medical Center Torrance
- Providence Little Company of Mary Medical Center San Pedro
- Providence Holy Cross Medical Center
- Providence Tarzana Medical Center
- Providence Saint Joseph Medical Center
Providence Saint John’s Health Center (effective January 1, 2015)
As a Providence OptionPLUS HMO plan member, you have the option to self-refer to a specialist within your Personal Physician’s medical group or Independent Practice Association (IPA) for a higher copayment.*
When you enroll in the Providence OptionPLUS HMO plan for the first time, you will need to choose a Personal Physician (Primary Care Physician) for you and your enrolled dependents. Each enrolled family member can choose a different Personal Physician. If you do not select a Personal Physician at the time of enrollment, Blue Shield will automatically assign a Personal Physician to you and your enrolled family members. You can can change your Personal Physician by calling Blue Shield Member Services. To search for a Personal Physician, go to Find a Provider.
If you or any of your covered dependents are currently receiving care from a specialist that is not in the Providence OptionPLUS HMO provider network, you will have a 90-day transition period, from January 1, 2013 through March 31, 2013, to find and transition to an Providence OptionPLUS HMO provider. During the transition period you and your dependents can continue to see your current provider and receive benefits at the network level of coverage while you are looking for a new provider in the Providence OptionPLUS HMO network. To search for a network provider, go to Find a Provider. If you have any questions or need help finding an Providence OptionPLUS HMO provider, please call Blue Shield Member Services.
Providence OptionPLUS HMO plan behavioral health benefits include inpatient and outpatient mental health and substance abuse care for issues such as:
- Alcohol/drug abuse
- Mental illness
- Marriage and family counseling
Providence OptionPLUS HMO plan members only have access to MHSA network providers and services are provided by Blue Shield’s mental health service administrator (MHSA) network. Visit Find a Provider to search for a mental health provider.
The Away From Home Care® program gives Providence OptionPLUS HMO plan members who are students, long-term travelers, workers on extended out-of-state assignments, and families living apart the convenience and flexibility of coverage for extended periods across the country. To learn more about Away From Home Care and whether your family is eligible, please call Blue Shield Member Services. Please note that Away From Home Care is not available in all areas and states, and benefits from the host plan may differ from the OptionPLUS HMO plan.
Through the BlueCard® Program, Providence OptionPLUS HMO plan members can access emergency and urgent care services across the country and around the world. You can receive urgent care services from any provider; however, using the BlueCard Program can be more cost-effective and eliminate the need for you to pay for the services when they are rendered and submit a claim for reimbursement. To locate a BlueCard provider, please call (800) 810-BLUE or go to Find a Provider.
* If your Personal Physician participates in our Access+ SpecialistSM program, you may go directly to a specialist in your Personal Physician’s medical group or IPA without a referral, for a slightly higher copayment. Medical groups and IPAs that participate in the Access+ Specialist program are designated with an A+ in our online and printed directories and on your Blue Shield member ID card.