Blue Shield regulatory notices:
Review our policies regarding claims, visits to providers, out-of-pocket costs and billing, to help you understand your health insurance coverage.
California's Health Benefit Exchange program is known as "Covered California." Individuals and small employers meeting requirements may enroll in the exchange.
Claims Payment Policy and Practices for Qualified Health Plans (QHP)
Claims Payment Policy and Practices for Qualified Dental Plans (QDP)
Right to receive confidential communications
You may ask to receive Blue Shield of California communications containing your protected health information by alternate means, or at alternate locations, by submitting a Confidential Communications Request.
You may use the Confidential Communications Request form (PDF, 71 KB) to request that Blue Shield of California communicate your protected health information to a confidential address.
The Machine-Readable Files (MRF) provision of the Transparency in Coverage Final Rule (TCFR) requires health plans to disclose negotiated provider rates. These files are collections of data read by machines, and are not intended for member use.
No Surprise Billing
Learn about your rights and protections against surprise medical bills when treated by an out-of-network provider, at an in-network hospital or ambulatory surgical center.
Surprise medical bills: your rights and protections (PDF, 87 KB)
Updates to deductible
If your plan has a deductible, or out-of-pocket maximum, you have the right to receive updates about your progress toward meeting these amounts. Just sign on to your member account online anytime, or call us. You can get your most current accrual information, or choose how you’d like to receive future updates.
As you use your benefits, we’ll send you accrual updates according to your current communication preferences.
Your telehealth choices
You may receive services from network providers on an in-person basis or via telehealth, if available. Contact your primary care provider, treating specialist, facility, or other health professional to learn whether telehealth is an option. Network telehealth and in-person services are subject to the same timeliness and geographic access standards. If your plan has out-of-network benefits, they are subject to your plan’s cost sharing obligations and balance billing protections.
You have the right to access your medical records. Records of the care you receive from third-party corporate telehealth providers will be shared with your primary care provider (PCP). Your record will be made accessible in an electronic patient record system or provided in a different manner unless you opt out. Costs incurred for services received through the third-party corporate telehealth provider are available at in-network cost-sharing rates. Out-of-pocket costs shall accrue to any applicable deductible or out-of-pocket maximum.