Blue Shield Add Chiropractic, $0 Copay Telemedicine

Blue Shield of California will continue to offer both their PPO and Trio HMO health plans throughout the State in 2021. While they are not offering any new plans, Blue Shield has added some new covered services to their direct off-exchange and Covered California plans.

Chiropractic Services

The direct off-exchange Silver 1950 and Silver 2600 HDHP will cover chiropractic services. The network of chiropractors will be the American Specialty Health provider network. The Silver 1950 will have $15 copayments per visit and 35% coinsurance under the Silver 2600 HDHP after the deductible has been met. Both plans have an annual limit of 15 visits.

Telemedicine

Teledoc or online consultations with a physician will be $0 copay for many PPO plans. This includes mental health services. This is benefit that was already included in the Blue Shield Trio HMO plan. For the High Deductible Health Plans (HDHP) the calendar year deductible will not apply. The telemedicine consultations are an easy way to address health concerns initially, such as Covid-19 symptoms. Telemedicine can also be accessed for behavioral mental health issues for assistance with addiction, anxiety, depression, stress, abuse, grief, and more. Psychiatrists can prescribe necessary medications from a limited drug formulary.

2021 PPO Plan Guide

House Calls

Blue Shield Trio HMO members in many areas have access to Heal telemedicine and house call. Similar to Teledoc, the Heal physician will first determine that you or your household is not at risk for a Covid-19 transmission. If there is no risk for infection, the Heal physician can schedule a house call to treat many healthcare issues such as respiratory infections, ear infections, sprains, muscle or joint injuries, or strep throat. Heal services have now been extended to Sacramento, El Dorado, Yolo, Place, and Nevada counties.

Trio HMO members are also enrolled in the Health Savings program. The Health Savings program offers discounts on groceries at participating super markets. The discount is taken off at the time of purchase. Some of the grocers participating include Safeway, Vons, Ralphs, and Walmart.

LifeSpring, a free meal delivery service, is also available to Trio HMO members experiencing a serious illness. In addition to meals, Trio HMO members can also use the Call the Car benefit. Call the Car is free non-emergency medical transportation for medical appointments, dialysis or other healthcare service appointments. Blue Shield Case Managers will determine eligibility for the Call the Car program.

2021 HMO Plan Guide

Dental

Blue Shield of California will offer their dental PPO and HMO products through Covered California. These plans will conform to the Covered California standard family dental benefit design.

Pharmacy

On January 1, 2021, Blue Shield will transition to CVS Health for pharmacy claim processing. New member ID cards with updated pharmacy information will be sent out to all existing members for 2021. The change will not affect the use of non-CVS network pharmacies and will not impact mail order drugs.

Medical Groups and Hospitals

The Trio HMO plans will be adding PIH Health in Southern California. The addition of PIH Health means 390 more full time doctors. PIH Health also has two hospitals, one in Whittier and one in Downey. The PPO plans will continue contract with Cedars Sinai, Hoag, UCSF, UCLA Health, and Scripps.

Cost Sharing

While there have been very modest changes to member cost sharing for 2021, most members will see an increase in their maximum out-of-pocket amount. The standard Bronze, Silver, and Gold plans will have the max. out-of-pocket increased from $7,800 to $8,200 per individual for in-network providers. The Bronze HDHP max. out-of-pocket increases from $6,900 to $7,000. The Silver 2600 HDHP max. out-of-pocket is set at $6,850.

Coinsurance has also been modified for some plans. The Silver 1950 coinsurance for 2021 will be 25%, up from 20%. Gold plans will have the copayment for office visits and urgent care increased to $35. The copayment imaging under the Gold plan will drop from $275 to $150.

Rates

In general, rates for the new non-grandfathered plan will decrease 3.4% for Trio HMO and decrease 2.4% for the PPO plans. However, because you are a year older from 2020, the rate increase based on age may wipe out any overall decrease to the rate base.

Blue Shield Plan Information

Below are the documents Blue Shield had posted. It will be updated as more documents are posted. The Evidence of Coverage documents include a detailed Summary of Benefits along with specific exclusions.

You can visit Blue Shield Quote and Enroll website to get a quote for direct off-exchange plans. Subsidies are available through Covered California. You can call me and I can help you determine if you are eligible for Covered California or if an off-exchange Blue Shield plan is a better option.

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