Your Trio HMO plan

Thank you for choosing Blue Shield.
Trio HMO plans are designed to give you access to a quality network of doctors and hospitals at an affordable price.

What’s so great about being a Trio HMO member?

• You have access to our leading Trio HMO Network, which includes more than 15,000 doctors in California and hospitals like Dignity Health, Hoag Memorial, John Muir, PIH Health, Providence, St. Joseph, St. Jude, and UC San Francisco.
• Your plan includes Shield Concierge, a dedicated team of healthcare experts and customer service representatives ready to assist you with any of your needs or healthcare questions.
• You are matched with a primary care physician who will coordinate your care with other specialists and care providers. 
• You have access to urgent and emergency care when traveling throughout the country and abroad with the BlueCard® Program
• Plus, there are many ways you can access care, including Teladoc, so you can speak to a doctor via phone, online chat, or video.

5 easy steps to receiving care

Follow these five steps to get the most of your Blue Shield plan and membership: 

1. Get your ID card

You will receive a new ID card if you are a new enrollee or if you just made a change to your current coverage. You will receive an ID card for each covered member, which will include member name, member ID, group number, plan type, and PCP.

When you receive your ID cards, please review the information on your cards, including your PCP and the associated medical group. Call Shield Concierge at the number on the back of your card to request changes or report any errors. If you make any changes, you’ll receive a new ID card.

Make sure to keep your card handy so your information is easily accessible when you visit a doctor, hospital, or specialist.

If you have not yet received your new HMO ID card and your coverage has begun, please call the following:

• Call customer service at (844) 250-2873
• If you’d like to access an electronic version, order a new ID card, or print a temporary one, log in or register for an online account.
    

2. Register for your online account

If you haven’t registered yet, use your member ID number to register for a blueshieldca.com online account.

Log in to see your personalized account. With your online account, you can:

• Find a doctor in your plan's network
• Change your PCP online, if desired, once your plan is effective
• View your billing, benefits, facility-related claims, deductibles, and copayment information
• Chat with a nurse for health advice with NurseHelp 24/7SM
• Learn about our wellness program, Wellvolution®, and sign up to participate
    

3. Find a doctor

You can use our Find a Doctor tool to change your PCP and search for specialists, pharmacies, urgent care centers, and more in your network. Simply log in to find information about the doctors and hospitals that are in your plan's network.* Doctors do leave the network from time to time, so it’s a good idea to call the doctor’s office to confirm that the doctor is still in your plan's network. Also, if this your first time seeing this provider, please remember to call the provider’s office to ensure that they are accepting new patients.

Services are only covered when you use providers in your network. Services from non-network providers are only covered in the case of emergency. Your PCP will refer you to specialists that are part of the same medical group. If you need a specialist who is not in that medical group or in the Trio HMO Network, you may be referred out of network and still receive covered benefits. For full details, please review your Evidence of Coverage and Health Service Agreement or Policy.

Your primary care physician
Your primary care physician (PCP) is your first point of contact for your health care. Your PCP will treat your common illnesses and injuries and refer you to specialists. If you're a new member or recently changed to a Trio HMO plan, we’ve matched you with a PCP so you can start getting care right away. Each member covered by your plan can have his or her own PCP, and you can change your PCP if you’d like.

Learn more about PCP selection and get step-by-step instructions on how to make a change.
  

4. Visit your doctor

When you’re ready to see a doctor, call the doctor’s office to make an appointment. Be sure to bring your Blue Shield ID card with you to your visit. If you’re planning to see a specialist, make sure you have a referral from your PCP.

Many preventive care services such as routine physical exams, screenings and vaccinations are covered 100% under your plan when you visit a doctor or your PCP in your plan’s network.

For other services, you will pay a small fee, known as a copayment, to your doctor for each visit. In most cases, the copayment to see a specialist is different from a general office visit with a PCP. For more details, see your Evidence of Coverage and Health Services Agreement.

Can’t get in to see a doctor? With a Blue Shield membership, you have many other ways to access care.
  

5. Pay for your care

You must see a doctor in your plan’s network. Your doctor or hospital will bill Blue Shield for most services, and we will then charge you the allowable amount.

Once you meet your deductible, Blue Shield will share most costs for covered services with you. This means you will pay a certain percentage of costs, or coinsurance, for covered services received from Blue Shield providers, and Blue Shield will pay the rest.

There is a limit to how much you have to spend out of your pocket each year before Blue Shield begins paying 100% for most covered medical services. This is called your plan’s out-of-pocket maximum.

Receiving care from non-network providers

Services from non-network providers are only covered in the case of emergency treatment; or, if a specialist for the care you need is not in your plan's network, then your PCP will refer you to one outside the network.

Your PCP will refer you to specialists that are part of the same medical group. If you need a specialist who is not in that medical group or in the Trio HMO Network, you may be referred out of network and still receive covered benefits.

For full details, please review your Evidence of Coverage and Health Services Agreement. 

• Learn more about paying for health care
• See "How your plan works" (includes an explanation of the healthcare terms above)