2017 Individual and Family Plans
In 2017 Blue Shield will offer and HMO plan in addition to their PPO plans in California. Both HMO and PPO plan types will be available either through Covered California or off-exchange directly from Blue Shield.
Blue Shield Trio ACO HMO Plan Guide
Blue Shield PPO Plan Guide
Health Plan Summary of Benefits
PPO Health Plans
Health Plans Silver Seven, Silver 1850, Bronze 5550 only offered off-exchange.
- Bronze 5550 PPO 1-17 (100 KiB)
- Bronze 60 HDHP PPO 1-17 (158 KiB)
- Bronze 60 PPO 1-17 (99 KiB)
- Gold 80 PPO 1-17 (89 KiB)
- Minimum Coverage PPO 1-17 (102 KiB)
- Platinum 90 PPO 1-17 (89 KiB)
- Silver 1850 PPO 1-17 (99 KiB)
- Silver 70 PPO 1-17 (164 KiB)
- Silver 73 PPO 1-17 (98 KiB)
- Silver 87 PPO 1-17 (96 KiB)
- Silver 94 PPO 1-17 (94 KiB)
- Silver Seven 3750 PPO 1-17 (95 KiB)
HMO Health Plans
- Gold 80 HMO 1-17 (72 KiB)
- Platinum 90 HMO 1-17 (70 KiB)
- Silver 70 HMO 1-17 (72 KiB)
- Silver 73 HMO 1-17 (76 KiB)
- Silver 87 HMO 1-17 (79 KiB)
- Silver 94 HMO 1-17 (77 KiB)
Trio ACO HMO Information
American Indian and Alaska Native Health Plans
- AI-AN 0 Cost Share HMO 1-17 (133 KiB)
- AI-AN 0 Cost Share PPO 1-17 (90 KiB)
- Bronze 60 HDHP PPO AI-AN 1-17 (124 KiB)
- Gold 80 PPO AI-AN 1-17 (117 KiB)
- Platinum 90 PPO AI-AN 1-17 (162 KiB)
- Silver 70 PPO AI-AN 1-17 (124 KiB)
2017 Standard Drug Formulary
|Date:||January 24, 2017|
Blue Shield Vision and Dental Plan Guide
Health Plan Evidence of Coverage Documents
The Evidence of Coverage (EOC) documents for Blue Shield are in three sets. First are the Alaska Native – American Indian Plan. Next are the HMO and PPO plans. There are separate EOCs for plans purchased through Covered California and those purchased directly from Blue Shield. Covered California plans will “CC” in the file name.
- American Indian_Alaska Native
- Dental and Vision Plans
- HMO Plans
- HMO Plans Covered California
- PPO Plans
- PPO Plans Covered California
Dental & Vision Evidence of Coverage Documents
- Dental Enhanced HMO 0 EOC BSC 2017 (447 KiB)
- Dental Enhanced PPO 25 500 EOC BSC 2017 (419 KiB)
- Dental Enhanced PPO 50 1250 EOC BSC 2017 (440 KiB)
- Dental HMO EOC BSC 2017 (441 KiB)
- Dental Plus 50 1250 EOC BSC 2017 (442 KiB)
- Dental Plus PPO 25 500 EOC BSC 2017 (421 KiB)
- Dental PPO EOC BSC 2017 (460 KiB)
- Dental Smile PPO EOC BSC (237 KiB)
- Dental Value EOC BSC (182 KiB)
- Dental Vision Specialty Duo EOC BSC 2017 (715 KiB)
- Vision Ultimate 15 25 120 EOC BSC 2017 (377 KiB)
- Vision Ultimate 15 25 150 EOC BSC 2017 (377 KiB)
Important Disclosures for Blue Shield Individual and Family Plans 2017
Claim FormsBlue Shield Vision Claim Form Blue Shield International Claim Form Blue Shield Out of Network Claim Form
- Make sure to select the correct year and plan type before searching for a provider such as a doctor or hospital.
2016 Plan Information
Blue Shield will no longer offer an Exclusive Provider Organization (EPO) network in California for 2016. All existing EPO members will be offered PPO plans in their region. Unfortunately, Blue Shield is calling their new Individual and Family Plan (IFP) network the “Exclusive PPO Network”, even though has nothing to do with the old EPO plans. Blue Shield will be expanding coverage areas to offer plans in the counties of Alpine, Monterey, Sutter and Yuba counties in 2016. A variety of plan outline, benefit summaries, rates, and Evidence of Coverage documents are available for download below.
Exclusive PPO Network statewide
All Blue Shield of California individual and family plans will be Preferred Provider Organization (PPO) types that allow members to receive services from providers outside of the new Exclusive PPO Network. All plans offered through Covered California will adhere to the 2016 Standard Benefit Design. The same plans will be offered off-exchange directly from Blue Shield for individuals and families who do not qualify for the tax credits. In addition, Blue Shield of California will offer three non-standard benefit design plan in Silver and Bronze metal levels off-exchange.
In 2016 Blue Shield of California will offer three non-standard benefit design plans that will only available for enrollment off-exchange through Blue Shield, not Covered California.
- Silver Seven 3750 PPO – $7 primary office visit copay, $7 lab copay, $7 Tier 1 generic prescriptions, $70 urgent care with a $3,750 medical deductible.
- Silver 1850 PPO – $1,850 medical deductible with lab and X-ray of 30% coinsurance after deductible.
- Bronze 5550 PPO – Combined medical and pharmacy deductible of $5,500, with many benefits offered at 30% after the deductible.
New 2016 providers
Blue Shield has added several hospitals to their Exclusive PPO Network
Hospital – County – (Plan Region)
- Cedars Sinai Medical Center – Los Angeles (16)
- Community Memorial Hospital of San Buenaventura – Ventura (12)
- Medical Center at UCSF – San Francisco (4)
- Ronald Reagan UCLA Medical Center – Los Angeles (16)
- Santa Monica UCLA Medical Center – Los Angeles (16)
- UC Davis Medical Center – Sacramento (3)
- UCSD La Jolla Thornton Hospital – San Diego (19)
- UCSD Medical Center – San Diego (19)
- UCSF Medical Center at Mission Bay – San Francisco (4)
- UCSF Medical Center at Mount Zion – San Francisco (4)
- University of California Irvine Medical Center – Orange (18)
Prescription Drug Tier Structure
A pharmacy deductible will correspond to the new 4 Tiered drug formulary. Some Tier 4 drugs will be moved to the lower Tier 3 copay level if there are already three similar drugs in the 4th Tier for the same drug class and condition.
- Platinum and Gold plans will have a $250 cap per prescription for a 30-day supply of a Tier 4 drug.
- Silver 70 & 73 plans will have $250 cap per prescription for a 30-day supply of a Tier 4 drug after meeting the annual pharmacy deductible of $250. Silver 87 & 94 Tier 4 prescription drug cap is set at $150 per month per drug.
- Bronze plans will receive $500 per prescription cap for all tiered drugs once the $500 annual pharmacy deductible is met.
Dental and Vision Plans
- Covered diagnostic and preventive services (such as X-rays and routine cleanings) will no longer count toward the annual coverage limit for DentalPPO and Specialty Duo Dental Plans.
- Blue Shield has added more HMO and PPO dental providers for greater access for members.
- A new vision plan, Ultimate Vision 15/25/120, in addition to their current Ultimate Vision 15/25/150. The new plan will have lower frame allowance and specialty lens options, but the Ultimate Vision 15/25/120 will also premium than the current Ultimate Vision 15/25/150.
Current EPO members, and some grandfathered plans, that are being withdrawn from the market will also have their current Easy$Pay premium payments cancelled. Members that enroll in a new PPO plan will have to re-establish their online premium payments through Easy$Pay. Members will receive a paper direct bill in lieu of the Easy$Pay if they don’t renew the online payment process. Members whose Easy$Pay is being terminated can call member services or re-enroll online by December 15th to avoid receiving a paper bill for January.
Blue Shield 2016 Disclosures, Plan Guide and Rates
Uniform Health Plan Benefits and Coverage Matrix
2016 Standard & Enhanced Silver benefit design plans offered through Covered California and off-exchange
*Missing are the Enhanced Silver 73 and 94. When Blue Shield makes them available I will post them.
- Bronze 60 HSA PPO 1-16 (630 KiB)
- Bronze 60 PPO 1-16 (633 KiB)
- Gold 80 PPO 1-16 (606 KiB)
- Minimum Coverage PPO 1-16 (641 KiB)
- Platinum 90 PPO 1-16 (606 KiB)
- Silver 70 PPO 1-16 (628 KiB)
- Silver 87 PPO 1-16 (610 KiB)
2016 non-standard benefit design plans offered only off-exchange
2016 Alaska Native and American Indian plans
- 0 Cost-Share AI-AN PPO 1-16 (345 KiB)
- Bronze 60 HSA PPO AI-AN 1-16 (659 KiB)
- Bronze 60 PPO AI-AN 1-16 (657 KiB)
- Gold 80 PPO AI-AN 1-16 (619 KiB)
- Platinum 90 PPO AI-AN 1-16 (608 KiB)
- Silver 70 PPO AI-AN 1-16 (638 KiB)
2016 Evidence of Coverage
- Bronze 5550 PPO EOC 1-16 (874 KiB)
- Bronze 60 HSA PPO EOC 1-16 (718 KiB)
- Bronze 60 PPO EOC 1-16 (714 KiB)
- Gold 80 PPO EOC 1-16 (714 KiB)
- Minimum Coverage PPO EOC 1-16 (715 KiB)
- Platinum 90 PPO EOC 1-16 (714 KiB)
- Silver 1850 PPO EOC 1-16 (874 KiB)
- Silver 70 PPO EOC 1-16 (714 KiB)
- Silver Seven 3750 PPO EOC 1-16 (874 KiB)
2016 Summary of Benefits
- BSC_Bronze 5550 PPO SBC 1-16 (572 KiB)
- BSC_Bronze 60 PPO Dual HSA SBC 1-16 (596 KiB)
- BSC_Bronze 60 PPO Dual SBC 1-16 (589 KiB)
- BSC_Gold 80 PPO Dual SBC 1-16 (564 KiB)
- BSC_Minimum Coverage PPO Dual SBC 1-16 (576 KiB)
- BSC_Minimum Coverage PPO SBC 1-16 (569 KiB)
- BSC_Platinum 90 PPO Dual SBC 1-16 (541 KiB)
- BSC_Platinum 90 PPO SBC 1-16 (531 KiB)
- BSC_Silver 1850 PPO SBC 1-16 (559 KiB)
- BSC_Silver 70 PPO Dual SBC 1-16 (569 KiB)
- BSC_Silver 73 PPO SBC 1-16 (566 KiB)
- BSC_Silver 87 PPO SBC 1-16 (568 KiB)
- BSC_Silver 94 PPO SBC 1-16 (568 KiB)
- BSC_Silver Seven 3750 PPO SBC 1-16 (560 KiB)
- BSC_0_Cost_Share_AI-AN PPO SBC 1-16 (524 KiB)
- BSC_Bronze 60 HSA PPO AI-AN SBC 1-16 (597 KiB)
- BSC_Bronze 60 PPO AI-AN SBC 1-16 (629 KiB)
- BSC_Gold 80 PPO AI-AN SBC 1-16 (587 KiB)
- BSC_Platinum 90 PPO AI-AN SBC 1-16 (594 KiB)
- BSC_Silver 70 PPO AI-AN SBC 1-16 (598 KiB)
Dental and Vision summary of benefits/EOC
*Missing are documents for Enhanced Dental PPO 25/500, Enhanced Dental PPO 50/1250, Ultimate Vision plans, and Specialty Duo Vision Plan. When they become available from Blue Shield I’ll post them.
- Dental HMO EOC SOB 1-16 (439 KiB)
- Dental PPO EOC SOB 1-16 (465 KiB)
- Enhanced Dental HMO 0 EOC SOB 1-16 (443 KiB)
- Specialty Duo Dental SOB 1-16 (643 KiB)
- Ultimate Vision 15-25-120 1-16 (65 KiB)
- Ultimate Vision 15-25-150 1-16 (65 KiB)
Blue Shield of California used to be a not-for-profit health and life company that has pledged to limit its net income to 2% of revenue. In August of 2014 the California Franchise Tax Board stripped Blue Shield of their tax exempt status. Unlike in other states, Blue Shield of California is separate from Anthem Blue Cross of California.
2015 Individual and Family Plans
Files available for download.
The EOC folder contains the Evidence of Coverage for various individual and family plans offered by BSC for 2015. They are consolidated meaning that the BSC_EPO_EOC_1_15 covers all the EPO or Exclusive Provider Organization plans from Bronze to Platinum. The Minimum Coverage and Health Savings Account (HSA) will have separate EOCs. Always make sure you are selecting the proper plan type as an EPO plan type has different rules than the PPO plan type.
The SOB or Summary of Benefits folder contains the specific documents for each plan. For example, the Silver PPO SOB will have the specific deductible, copayment and coinsurance amounts for that plan.
- AI AN IFP Rates 2015 (3.7 MiB)
- Blue Shield 2015 EPO Summary (5.2 MiB)
- Blue Shield 2015 Native Am Summary (6.6 MiB)
- Blue Shield 2015 PPO Summary (5.2 MiB)
- Incorrect Renewal Staying Covered Guide 2015 (1.7 MiB)
- PPO EPO IFP Rates 2015 (3.9 MiB)
- Provider Directory Settlement Blue Shield FAQs (157 KiB)