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2016/17 Enrollment Guide



Access+ HMO

About the Blue Shield Access+ HMO plan
Selecting a primary care physician
Pharmacy benefits
Behavioral health benefits
Away From Home Care program
Emergency and urgent care outside California

About the Blue Shield Access+ HMO plan

With the Access+ HMO® plan, you’ll have no annual deductibles or claim forms, only affordable copayments each time you see a physician. You’ll need to select your primary care physician (PCP), who is responsible for the overall coordination of your care. As an Access+ HMO member, you also have the option to self-refer to a specialist within your PCP's medical group or Independent Practice Association (IPA) for a higher copayment.*

* If your PCP participates in our Access+ SpecialistSM program, you may go directly to a specialist in your PCP's medical group or IPA without a referral for a slightly higher copayment. Medical groups and IPAs that participate in the Access+ Specialist program have an A+ in our online and printed directories and on your Blue Shield member ID card.

Selecting a primary care physician

When you enroll in the Access+ HMO plan for the first time, you will need to choose a primary care physician (PCP) for you and your covered dependents. Each enrolled family member can choose a different PCP. To find a PCP, visit Find a Provider.

You can change your PCP by calling Blue Shield Member Services.

Pharmacy benefits

Pharmacy benefits for Access+ HMO members are administered by Navitus Health Solutions.

Behavioral health benefits

Blue Shield Access+ HMO behavioral health benefits include inpatient and outpatient mental health and substance abuse care for issues such as:

  • Depression
  • Alcohol/drug abuse
  • Mental illness
  • Marriage and family counseling

The services are provided by Blue Shield’s Mental Health Service Administrator (MHSA) network. To access care:

  1. Find a Provider online or call Blue Shield’s MHSA at (877) 263-9952.
  2. Obtain prior authorization by calling Blue Shield’s MHSA before you receive services.
  3. Make an appointment for preauthorized services with the network provider you’ve selected.

For more information about behavioral health benefits, please see the Access+ HMO plan Evidence of Coverage.

Away from Home Care program

The Away From Home Care® program gives HMO 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 benefits in the Access+ HMO plan.

Emergency and urgent care outside California

Through the BlueCard® Program, Access+ HMO members can access 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 may 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.