Blue Shield of California will offer both PPO and HMO health insurance plans in California for 2018. While their PPO plans will be found in all 19 rating regions of California, their HMO plans may not be available in all counties. Both the PPO and HMO plans will be available through Covered California and off-exchange directly from Blue Shield. Blue Shield will also offer a Silver 1850 PPO and special Silver 70 Off-Exchange plan version only directly from Blue Shield.
With PPO plans you do not need a referral from a primary care physician (PCP) to see a specialist, even though a PCP has been assigned to you. PPO plans do have out-of-network coverage, but carefully read the summary of benefits and evidence of coverage documents for terms, conditions, and exclusions.
The Blue Shield HMO plans are called Trio HMO. You will need a PCP as your direct contact for most health care services. The Blue Shield Trio HMO plans include such medical groups as Dignity Health, Hoag Memorial, John Muir, Providence St. Joseph, St. Jude, and UC San Francisco. Your PCP will refer you to specialists within the network of doctors and providers within his or her medical group. Trio HMO plan will be available in 24 California counties. Trio HMO plan will also include the BlueCard program for urgent care outside of California similar to the PPO plans.
Always confirm your doctors and preferred hospitals are in-network with the Blue Shield of California online provider directory tool.
Blue Shield PPO and HMO Plan Material
Summary of Plan Benefits
The plans are broken in American Indian – Alaska Native, standard HMO Plans and PPO Plans. Not all plans are offered through Covered California.
Evidence of Coverage
These are the big documents that spell out how the plans work, what’s covered, excluded, pediatric dental and vision embedded benefits.
Rate Tables for PPO and HMO Plan By Region