Help topics & frequently asked questions

Please reach out to your broker or Blue Shield account representative. If you're not sure who to contact, see our Contact us page.

If you have tried the login and/or password reset option, and are still not able to access your account, please contact Employer Services: (800) 325-5166

Within Billing & Payments on Employer Connection, you can:

• View a single bill for all your Blue Shield medical and specialty product plans.
• Search, sort, and filter your bill to find the information you're seeking quickly.
• Download current and past Blue Shield invoices to your computer.
• Set up automatic payments or make one-time payments.
• Receive scheduled email alerts for your bill.
• View payment history, including all debit and credit postings.
• Generate and download billing reports.

You can set up an email alert within Billing & Payments to notify you when it's ready, which is typically 15 days prior to the last day of the month.

You can choose anyone to make online bill payments by giving them billing access.

There are two types of billing access. First is the Billing View access, which only allows individuals to view bank accounts and payments that have been set up. Second is the Billing Maintenance access, which lets them set up bank accounts, make one-time payments, and create automatic payments.

Yes, you can easily start recurring payments by selecting the Auto Payments link under the Billing & Payments tab. There are two options for recurring payments: either two days before the due date or when the invoice is generated. Auto payments must be made for the total amount due.

Yes, you can set up one-time payments. Select the Make a Payment link under the Billing & Payments tab. One-time payments will be posted to your account the night that the payment is set up. One-time payments can be set up for any amount over .01 cent, including amounts greater than or less than the balance due. If a payment is made for more than the total amount due, the balance will be applied to your next invoice.

You can cancel auto payments up to two days before the scheduled payment.

To add a bank account, select Payment Options under the Billing & Payments tab. Then select the Add a new account link. You will need your account number and routing number.

No. Online bill payments can be made using only a checking or savings account.

Yes, we will send a paper bill. You can also choose to receive an email notification when your online bill is available. In My Profile, select Notifications to set your preferences.

Yes, you can pay multiple invoices at once. If you have multiple subgroups for your account, you can set up more than one payment at a time for each subgroup with an outstanding balance.

No, this is a service that Blue Shield provides at no additional cost.

Yes, by selecting My Profile and clicking Edit above the Subscription selection.

• Medical claims: members can submit and view their claims when logged into their account on blueshieldca.com.
• Dental claims: To check the status of a dental claim, members should contact Member Services at the number on their Blue Shield dental ID card.
• Vision claims: Members do not need to submit a claim form when using a network provider. When using a non-network provider, the employer, member and/or provider may be required to complete a Vision Claims form (C-4669-61). Please refer to the claim form to determine which areas will need to be completed. Members may be expected to pay the full amount when using a non-network provider. They will be reimbursed after submitting a claim form. Mail completed claim form(s) and documentation to:

Blue Shield of California
P.O. Box 25208
Santa Ana, CA 92799-5208

• Pharmacy claims: If a prescription was filled out at a non-participating pharmacy, members can submit a completed claim form along with a detailed receipt. (Check the Evidence of Coverage (EOC) or Certificate of Insurance (COI) to determine if this applies to the members plan). Reimbursement will be based on whether Blue Shield covers the medication and any applicable copayment, coinsurance percentage, copayment penalty, and/or pharmacy deductibles. Members can obtain additional claim forms by contacting the Customer Service phone number listed on the back of their Blue Shield ID card.
  
  New members who did not receive a Blue Shield ID card during the first 30 days of becoming a Blue Shield member and need a prescription, may pay the pharmacist for the entire cost of the prescription and then submit a claim form to Blue Shield to receive reimbursement for any covered medication

Yes, members can find information to submit a claim, including a downloadable form.

Please visit our member COBRA / Cal-COBRA page for detailed information.

Eligibility may vary based on your group size, headquarters location, and other factors. Generally, a group must be headquartered in California with more than half of employees residing in the state. To be eligible for group coverage, an  organization must have at least one full-time employee other than the owner/sole-proprietor or spouse of owner/sole proprietor. Please see our Eligibility page for details on eligibility criteria.

To qualify for small business coverage, your group must have one or more full time employees other than the owner or owner's spouse. A large group has 101+ employees.

Eligibility limitations may vary among groups. Please consult the Group Health Service Contract, Evidence of Coverage, Group Policy/Certificate of Insurance or contact your Blue Shield account manager for special provisions related to your company.

Employer Connection is Blue Shield's web-based plan administration tool that enables employer groups (and their brokers) to securely manage their group account and employees' Blue Shield benefits online. These tools are provided at no extra charge

Once registered, you can securely log in 24/7 to complete actions such as:

• Manager your member roster enrollments and terminations.
• View and manage medical, dental, vision, and life insurance plans in a single place.
• Create and download census and billing reports.
• Conduct open enrollment online.
• Make one-time payments or set up automatic payments.
• Order Blue Shield member ID cards.
• Permit additional users to access your Employer Connection account.

No. This site can be used only by your group administrator(s) or broker(s) to whom your organization has granted administration rights. Your employees and their dependents with Blue Shield coverage can view their benefits on our Member Portal by visiting blueshieldca.com.

Yes, in many cases employer groups can set up data interchange to connect their own employee management system with Employer Connection. However, it is important to note that anytime you submit a member enrollment or maintenance transaction via Employer Connection, be sure to also make the same change to your system of record before your next electronic submission or your data will become out-of-sync.

Follow the prompts from the Employer Connection login page if you have forgotten your password. You will need the account username to reset the password. If you do not know the username, you will need the first and last name of the primary person on the account and their email. If you are still unable to reset your password, please contact Employer Services: (800) 325-5166

First, log in and select "Manage users." Add users with the "add user account" button, delete users, or edit permissions by selecting the "permissions" table or the user's name.

Yes. When terminating a subscriber within Employer Connection, you can enroll the subscriber into COBRA at the end of the termination transaction workflow. For fully-insured groups, Blue Shield will send required COBRA enrollment materials to the subscriber(s) no longer covered under the group plan

Yes. You can manage enrollment in these plans by adding, updating, and terminating coverage online. However, you cannot view the same level of detailed benefits as you can with our medical plans. For details on these plans, please call the following Customer Service numbers:

- Dental HMO (800) 585-8111

- Dental PPO (888) 702-4171

- Life insurance (888) 800-2742, Fax: (800) 329-2742

- Vision (877) 601-9083, Fax: (714) 619-4662

Members can view their benefits and co-payment amounts when logged into their account on blueshieldca.com/login. They can also reference their Member Handbook or Evidence of Coverage (EOC).

EOCs are also provided to group administrators through Health Plan Document Centers (bscabook.com), and it is the responsibility of the group plan sponsor to make these available to plan enrollees. EOCs are available for most group plan members when logged into their account on blueshieldca.com.

Go to Find a Doctor on blueshieldca.com. There, members can search for physicians, dentists, optometrists, chiropractors, hospitals, clinics, behavioral health specialists, and other healthcare providers.

Members can download and submit this Grievance Form or can contact Member Services at the number on their Blue Shield ID card for more information.

Reach out to a Blue Shield representative or your broker to begin the quoting process. You can request a quote here.

Visit our Plan Comparison Tool for small and large group product information.

Yes. Blue Shield of California is a national carrier with nationwide coverage for 100% of U.S. ZIP codes. We offer plans to California-headquartered groups and to groups with employee populations in California.

Visit our Network Comparison Tool to see our network details filtered by region, hospitals, PCPs, specialists, and more.

Yes. You can manage enrollment in these plans by adding, updating, and terminating coverage online. However, you cannot view the same level of detailed benefits as you can with our medical plans. For details on your specialty plans, please call the following Customer Service numbers:

• Dental HMO (800) 585-8111
• Dental PPO (888) 702-4171