A new kind of health plan

Virtual Blue offers two plan types: an EPO (Exclusive Provide Organization) plan and a PPO (Preferred Provider Organization) plan. Members of either plan do not need referrals to access care, whether virtual or in-person. When accessing virtual care from virtual-only providers, members have access to unlimited virtual primary, specialty, mental health, and urgent care visits for zero or low copays, depending on the specific plan's benefits. For in-person care, Virtual Blue PPO members can see providers in or out of our PPO network at the applicable cost share for their plan. There is no out-of-network option for the Virtual Blue EPO plan. Both EPO and PPO members can also access virtual-only and in-person care anywhere in the U.S., and urgent and emergency care while traveling outside the U.S.

No. Virtual Blue PPO members can also access in-person care from the plan’s in-network or out-of-network providers at the applicable cost share. For the Virtual Blue EPO plan, members can only access in-person providers who are in the PPO plan network (except for urgent or emergency care). Many in-person doctors may also offer virtual care visits; however, these services will be subject to the applicable cost share.

You will be given an opportunity to select a personal Virtual Blue physician (also known as a primary care physician). If you don’t select a personal physician, you will be matched with one. You will have no obligation to see your virtual physician and can continue to see an in-person physician if that is your preference. Members can change their personal Virtual Blue physician at any time.

Yes, you can continue to see your existing in-person doctors and pay the applicable in-network or out-of-network cost share, based on your plan’s benefits. The exact cost share will depend on whether your doctor is in or out of the Virtual Blue plan’s network.

Virtual Blue differs from basic telehealth in several ways. First, Virtual Blue members select their virtual physicians on the criteria that matter to them and can continue to see those physicians on an ongoing basis for virtual preventive, urgent, and chronic care. This is different than traditional telemedicine where you typically see a different physician each time.

Second, Virtual Blue members can choose same-day access to a virtual PCP, who may or may not be their selected physician. In addition, members have access to a virtual health coach, care coordinator, and nurses who support members with health improvement, chronic condition management, and coordination of specialty care. The virtual care team also has access to claims, medical records, and other data that supports each member’s personalized care plans.

Third, Virtual Blue allows members to seek integrated virtual primary care, urgent care, chronic care, mental health, and specialty care through a mobile app or by logging in to blueshieldca.com.

As a Virtual Blue plan member, you will be connected to a virtual team of integrated primary, mental health, and specialty care professionals, plus an established in-person PPO network.

Virtual care services include:

• primary care, including pediatrics, family medicine, and internal medicine
• specialty care that includes 20 specialties
• integrated mental health care for members ages 3 and older, including access to psychologists, psychiatrists, licensed clinical social workers (LCSW), and marriage and family therapists (MFT)
• urgent care
• 24/7 medical support from physicians, as well as a team that includes a certified health coach, care coordinator, and registered nurses

Yes, the virtual-only care team reflects gender and racial diversity. Some physicians also speak more than one language in addition to English, such as Spanish, Mandarin, Farsi, and more. The team also includes doctors and nurses with expertise in areas such as sexual health screening, family planning, mental health issues, and transgender care.

No, there are no physical locations for any Virtual Blue virtual provider. However, both Virtual Blue EPO and PPO members may see other in-network providers for in-person visits, and PPO members may also see out-of-network providers for in-person visits.

Yes, Virtual Blue members will have access to patient reviews and physician biographies through a mobile app or website. Members can select physicians based on the criteria that are most important to them, including gender, race, years of experience, language spoken, and experience with diverse patient populations.

Virtual Blue members, ages 3+, can access unlimited mental health visits for zero or low copays, depending on the specific plan's benefits. Services include psychotherapy, psychiatry medication management, and therapy with mental health specialists, including Licensed Clinical Social Workers (LCSW), Marriage and Family Therapists (MFT), and psychiatrists and psychologists (including PhDs). EPO and PPO members may also seek in-person or virtual mental health services from the plan’s PPO in-network providers (and out-of-network providers for the PPO plan only) at the applicable cost share for their Virtual Blue plan.

Virtual Blue members can choose in-person care at their own discretion, or at the advice of a care professional. Your virtual care team can determine if any medical services cannot be provided virtually and will suggest when you should see an in-person provider, at the applicable cost share for your plan. You do not need a referral from the virtual provider to seek care from an in-person provider. Examples of medical services that cannot be provided virtually include some preventive screenings such as mammograms, lab work, skin procedures such as biopsies or abscess treatments, etc.

Virtual Blue members can find, select, and schedule their virtual provider appointment through a mobile app or by logging in to blueshieldca.com. To find in-person providers, members can use our Find a Doctor tool to search our PPO network.

Members may book virtual visits with virtual providers in minutes by downloading a mobile app or by logging in to blueshieldca.com. Virtual care can also be accessed by phone.

To schedule in-person care, the member’s virtual health coach can assist with booking the appointment or the member can book the appointment directly with the provider. As Virtual Blue is an EPO or PPO product, referrals are never needed for any care.

Yes, in-person providers may share notes with Virtual Blue’s virtual providers with the member’s consent.

The Vitals Kit will include common medical devices such as a blood pressure cuff and thermometer. Depending on your Virtual Blue plan, a Vitals Kit will be sent upon enrollment or after an enrolled member of your household has scheduled their first annual wellness visit. Ideally, members will schedule a doctor’s appointment and take their vitals (blood pressure and temperature) prior to the visit. Members can also use the medical devices during their virtual appointment.

Every enrolled household will receive a Vitals Kit, which can be shared among members of the family. Please consult your physician on how to use these devices.