Important annual reminders
As a Blue Shield of California plan member, you have a wealth of resources and information at your fingertips once you’re registered on blueshieldca.com. Some of that information includes the below topics we're required to tell you about each year.
When you are registered and logged into blueshieldca.com, you can:
- Check your personal benefits information, including what’s covered, copayments and coinsurance, our standards for timely access to different types of care, and more.
- See Preventive Health Guidelines that recommend immunizations, screenings, and more.
English (PDF, 214KB)
Spanish (PDF, 170KB)
- Read the Member Rights & Responsibilities statement, which includes descriptions of what you can expect from us.
For HMO members
For PPO members
- Medicare members – your Evidence of Coverage contains a chapter on "Rights and Responsibilities."
For MAPD members
For Medicare PDP members
- Search for network doctors, hospitals, and other healthcare providers.
- Find programs to help members manage chronic conditions. You'll see program descriptions and links to apply for some of the programs.
- Get information about our Quality Improvement and Patient Safety programs, including our progress toward goals to improve clinical care and customer services. You can also read about the quality program for our mental health service administrator.
- Learn about our Utilization Management program (PDF, 84 KB), describing how Blue Shield helps to ensure that you receive the most appropriate care and services, including new technologies and pharmaceuticals.
- Learn how our Shield Support care management program can help you live better with chronic conditions, recover from acute conditions, and have a more seamless healthcare experience. A phone number is available to self-refer to this program.
- View information about prior authorization procedures, pharmacy benefit, and the generic drug policy in the Drugs and Pharmacy section. We post updates to the formulary and medication policies quarterly.
- Use member-exclusive tools to check symptoms, treatment options, and more.
If you’d prefer to receive printed copies of the documents or provider directories mentioned above, just call customer service, the first number on the back of your Blue Shield member ID card.
Other information you might find useful:
- We are committed to protecting the privacy of your personal information. Our HIPAA Notice of Privacy Practices (“HIPAA Notice”) describes your privacy rights and how we protect, use, and disclose your health information. Our HIPAA Notice has been updated and, if you have not already done so, you should carefully review the revised HIPAA Notice. You can review and print a copy of our HIPAA Notice by going to the blueshieldca.com privacy page. You may also request a copy of our HIPAA Notice by calling the customer service phone number on the back of your Blue Shield member ID card.
If you disagree with a decision we’ve made, you have the right to file a grievance. You can call the customer service number on your Blue Shield ID card or log in to blueshieldca.com and go to the file a grievance page. There are instructions on the website and information about how to obtain an independent medical review. There is more information about grievances and independent medical reviews in your Evidence of Coverage (EOC).
Grievance information from the state Department of Managed Health Care
The California Department of Managed Health Care (DMHC) is responsible for regulating healthcare service plans. If you have a grievance against your health plan, you should first telephone your health plan at (800) 424-6521 and use your health plan’s grievance process before contacting the DMHC. Using this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you.
If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health plan, or a grievance that has remained unresolved for more than 30 days, you may call the department for assistance.
You may also be eligible for an Independent Medical Review (IMR). If you are eligible for an IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental in nature, and payment disputes for emergency or urgent medical services.
The DMHC also has a toll-free telephone number (1-888-HMO-2219) and a TTY line (1-877-688-9891) for the hearing and speech impaired. The department’s website www.hmohelp.ca.gov has complaint forms, IMR application forms, and instructions online.
Grievance information from the California Department of Insurance (CDI)
The CDI is responsible for regulating health insurance. The Department’s Consumer Communications Bureau has a toll-free number (1-800-927-HELP (4357) or TTY 1-800-482-4833) to receive complaints regarding health insurance from either the insured or his or her provider.
If you have a complaint against Blue Shield of California Life & Health Insurance Company, you should contact Blue Shield Life first and use their grievance process. If you need the Department’s help with a complaint or grievance that has not been satisfactorily resolved by Blue Shield Life, you may call the Department’s toll-free telephone number from 8 a.m. to 5 p.m., Monday to Friday (excluding holidays).
You may also submit a complaint in writing to:
CDI, Consumer Communications Bureau
300 S. Spring Street, South Tower
Los Angeles, California 90013
or through the CDI website.
- You can make a difference by becoming an organ donor. In fact, one person can save or help as many as 60 people. To register, visit Donate Life California.
- If you’re a woman who has undergone a mastectomy, you’re covered under the federal Women’s Health and Cancer Rights Act for mastectomy-related services, including all stages of reconstructive surgery and surgery to achieve symmetry between the breasts, prostheses, and treatment of complications such as lymphedema. If you have any questions about these benefits, check your EOC, or call customer service.
Blue Shield of California complies with applicable state laws and federal civil rights laws and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.
Blue Shield of California cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, país de origen, ascendencia, religión, sexo, estado civil, género, identidad de género, orientación sexual, edad ni discapacidad.
Blue Shield of California 遵循適用的州法律和聯邦公民權利法律，並且不以種族、膚色、原國籍、血統、宗教、性別、婚姻狀況、性別認同、性取向、年齡或殘障為由而進行歧視。
Timely access to care
You are entitled to timely access to care. We ask providers to meet these wait time standards.