FAQs for members on grandfathered plans

If you enrolled in your current plan on or before March 23, 2010, then you have a grandfathered plan. You can also check your ID card. If the subscriber ID number starts with XEN or XEZ, you have a grandfathered plan.

Log in and use our Find a Doctor tool to find out if your doctor is still in Blue Shield’s network.†*

If you’re considering a different Blue Shield plan, you will need to check if your current doctor is in your new plan’s network before you apply.

If you are considering a new PPO plan:

Any new Blue Shield PPO plan you are considering will have access to the Exclusive PPO Network, which has fewer providers than your current plan’s network, the Full PPO Network. The Exclusive PPO Network may not have the same participating healthcare providers, but it includes 64,771 providers, 331 hospitals, and 1,081 urgent care centers statewide.

When choosing a new PPO health plan, it’s important to use doctors in your network because you’ll have lower out-of-pocket expenses than if you see non-network providers. If you choose a provider outside of the network, any covered services you receive from that provider will result in you having to pay more; and in some cases, you could be responsible for the entire bill. With a new PPO plan your financial responsibility will be significantly higher when you receive services from providers outside of your plan’s network.

Find doctors and hospitals in the Exclusive PPO Network.†*

If you are considering a Trio HMO plan:

If Trio is available in your area, you can apply for a Trio HMO plan, which uses the IFP Trio HMO Network.* Learn more about Trio HMO and find out if it’s available in your area and see how much you can save on monthly premiums.

With a Trio HMO plan, you are only covered for services if you see a provider in network except in the case of emergency treatment; or, if a specialist for the care you need is not in your plan’s network, then your primary care physician will refer you to one outside the network.

Starting January 1, 2025, you will have the option to select a virtual PCP through Accolade Care, a virtual medical group, and schedule phone or video appointments.

Your coordinated care may include referrals to:

• Virtual care from doctors from more than twenty specialties such as dermatology, cardiology, and urology
• Virtual visits to behavioral health professionals such as therapists, psychiatrists, and psychologists
• In-person visits to physicians, specialists, and labs when your virtual PCP deems it necessary

You’ll have options to connect with virtual care providers with same day, next-day, and even after-hours appointments typically available. A referral from your virtual PCP will be required to see a specialist or in-person provider.

To take part, simply choose a primary doctor through Accolade Care. You can easily select one inside your Blue Shield online account or by calling Shield Concierge at (844) 250-2872 (TTY: 711).

Find doctors and hospitals that are in the IFP Trio HMO Network.†*

Once you are ready to move into a new Blue Shield PPO or Trio HMO plan, contact your broker, or call us at the number on your medical ID card. Also, make sure to see if you qualify for financial help by using our subsidy calculator. 

If you are considering a dental,* vision,* or life insurance* plan:

Blue Shield has a wide range of dental HMO and PPO plans that you can purchase with your medical plan directly through Blue Shield or sold directly through Covered California. You can also enroll in a dental plan sold directly through Blue Shield separately without a medical plan. You can even consider enrolling in the Specialty Duo* plan which is a dental and vision package plan.

Our vision plans are sold only through Blue Shield and can be paired with or without a medical plan. 

With Blue Shield’s dental, vision, and life insurance plans, you get a first line of defense for your family’s overall health and well-being. Once you are ready to enroll into a new Blue Shield dental or vision plan, give us a call at (800) 660-3007 (TTY: 711).