Renewing medical plan FAQs

Get access to your plan documents and access documents for all plans using our finder tool. Or you can log in and find your plan documents in your online account or access documents for all plans. You can download and keep these documents in your files for future reference. If you need copies mailed to you, please call us at the phone number on the back of your Blue Shield member ID card.

Blue Shield of California is the only insurer in California that continuously offers Preferred Provider Organization (PPO) plans in every ZIP Code across the state. Our PPO plans give members access to the only statewide provider network that includes more than 64,711 doctors, 331 hospitals, and 1,081 urgent care centers.

Blue Shield will also continue to offer Health Maintenance Organization (HMO) plans with access to the IFP Trio HMO Network*. These plans include additional benefits such as access to:

• Shield Concierge, a team of dedicated representatives including nurses, social workers and pharmacists
• Teladoc® for $0 copay, which allows you to receive medical and mental health care 24/7 over phone or video chat

With an HMO plan, your primary care physician (PCP) is your first point of contact for your health care and will treat your common illnesses and injuries and refer you to specialists, when needed.

Trio HMO is available in 28 California counties. Before selecting a Trio HMO plan, make sure that Trio HMO is available in your area by visiting blueshieldca.com/triocheck. Then, review the Trio network to find providers near you.

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).

The benefits of being a Trio HMO plan member are:

• You have access to our quality IFP Trio HMO Network* of more than 352 hospitals, 6,157 primary care physicians, and 24,965 specialists, including Dignity Health, Hoag Memorial, Good Samaritan, John Muir, Loma Linda, Scripps, MemorialCare, and UC San Francisco.
• Your plan includes Shield Concierge, a team of healthcare experts and dedicated customer service representatives ready to answer all your benefits and health-related questions.
• Qualified members recovering from serious illness also have access to a meal delivery program and non-emergency transportation.  

With a PPO plan, you have more flexibility. The benefits of being a PPO plan member are:

• You have access to our Exclusive PPO Network, a statewide PPO network, which includes more than 64,771 doctors, 331 hospitals, and 1,081 urgent care centers across California.
• You can see any doctor or specialist that you want in California without a referral, but you’ll pay less out of pocket when you see a doctor in your plan’s network.
• You are not required to see a PCP first to receive care, but you can partner with one to be your healthcare advocate.

I have or am considering a PPO plan: To make sure you save money and do not pay more out of pocket, you should use doctors and hospitals in your plan’s network. If you choose to use a doctor or hospital that is not in your plan's network, this will significantly increase your costs; or, if the service isn't covered, you will be responsible for all billed charges.

Find doctors and hospitals in the Exclusive PPO Network.*

I have or am considering a Trio HMO plan: Your services are only covered if you see providers in your plan's 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 (PCP) will refer you to one outside the network. If you choose a virtual PCP, a referral will be required to see a specialist or in-person provider.

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

You can set up recurring payments with AutoPay℠ regardless of what Blue Shield plan you select. When you renew with Blue Shield your automatic payment will automatically adjust to next year's monthly premium starting with your January bill that you will receive in December. Your enrollment in AutoPay will continue unless you cancel the service.

Unless you signed up for paperless communications, you will receive a new subscriber ID card for next year. Be certain to begin using your new card starting January 1. To have accurate information on your ID card by January 1, make sure you change your coverage before December 15.

Federally-funded financial help that individuals can apply for and qualify to receive in the form of subsidy is available when enrolling in a plan through Covered California. It is available for individuals and families who qualify based on the number of people in the household, income, age, and cost of the second lowest silver level plan in your geographic location.

There are two types of financial help that can make health coverage more affordable:

1. Premium help: Premium help lowers the cost of your monthly premium and the amount you can get is dependent upon the cost of the second lowest cost silver plan in your areas and the information submitted when you enroll through Covered California including your income, age and household size.

The Advanced Premium Tax Credit (APTC) is a federal tax credit that can be applied in advance as a monthly credit on your billing statement – or at the end of the year in a lump sum when you file your federal income taxes.

2. Cost-sharing reductions: This is federal financial help that will help you pay less for out-of-pocket costs (copays, coinsurance, and deductibles) when you receive healthcare services. Your income and family size may qualify you for cost-sharing reductions through Covered California if you enroll in a Silver-level plan.

Learn more about financial help.