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Blue Shield

Blue Shield of California Retiree Medical Plan Information

Blue Shield was founded in 1939 and was one of the first health plans in the United States. As a not-for-profit, California based company, Blue Shield is committed to partnering with the County to provide the best possible benefits that meet the needs of our Retirees.

This page provides valuable tools, resources, and additional information to assist employees with the transition to Blue Shield of California medical plans.

Resources


Website: blueshieldca.com

Non-Medicare Plans

Customer Service
(800) 642-6155


Medicare Plans

Customer Service
(800) 776-4466

Find a Medicare Provider

Find a Non-Medicare Provider

Transition of Non-Medicare Prescriptions

SilverSneakers Information

Discover More
(Non-Medicare Plans)



Benefit Summaries

Medicare Plans

Non-Medicare Plans

   
Evidence of Coverage

Medicare Plans

  • Blue Shield 65 Plus (HMO) High Option EOC
  • Blue Shield 65 Plus (HMO) Low Option EOC
  • Blue Shield PPO Medicare COB – CA and Out of State EOC

Non-Medicare Plans

  • Blue Shield Signature (HMO) High Option EOC
  • Blue Shield Signature (HMO) Low Option EOC
  • Blue Shield PPO High Option – CA and Out of State EOC
  • Blue Shield PPO Low Option – CA and Out of State EOC

Frozen Plans – Not eligible for any new enrollments. These EOC’s apply to existing subscribers only.

  • Blue Shield Signature HMO COB with PDP (FROZEN Plan) EOC and PDP
  • Blue Shield PPO Hybrid COB with PDP (FROZEN Plan) EOC and PDP

Medicare Prescription Drug Plan

  • Blue Shield Group Medicare Prescription Drug Plan (GPDP) EOC
Frequently Asked Questions

Medicare FAQ’s

  1. Who do I contact for information on the Blue Shield Medicare plans?
  2. I am currently receiving care for a medical condition from a provider that’s not in the Blue Shield network. What do I do?
  3. How do I know if my current prescription will be covered?
  4. How do I find a network doctor or hospital?
  5. How do I know if I live in the Blue Shield 65 Plus HMO plan service area?

Non-Medicare FAQ’s

  1. Who do I contact for information on the Blue Shield Non-Medicare plans?
  2. I am currently receiving care for a medical condition from a provider that’s not in the Blue Shield network. What do I do?
  3. How do I know if my current prescription will be covered?
  4. How do I find a network doctor or hospital?
  5. How do I find a Shield Signature Personal Physician’s provider number and medical group/IPA number?

Medicare FAQ’s

  1. Who do I contact for information on the Blue Shield Medicare plans?
    You may contact Blue Shield directly at Toll Free Customer Service for Medicare plans by calling (800) 776-4466.

  2. I am currently receiving care for a medical condition from a provider that’s not in the Blue Shield network. What do I do?
    If you’re currently receiving care for a medical condition from a provider that’s not in the Blue Shield network– including acute and serious chronic conditions, planned surgeries, and terminal illnesses – Blue Shield will arrange for continuation of your care during the health plan transition to Blue Shield of California. Continuation of care allows you to continue to see your current non-network provider during the course of your treatment while still receiving the network level of benefits.

    For more questions about prior authorization or to initiate authorization, simply call your dedicated Blue Shield Member Service team for Medicare plans at (800) 776-4466.

  3. How do I know if my current prescription will be covered?
    Blue Shield’s Drug Formulary is a list of our preferred prescription drugs. It’s best to check it in advance, since our list may differ from your former health plan’s formulary. Just go to blueshieldca.com and click on Pharmacy to access our drug database and formulary selection.

    If you have new prescription, talk with your Doctor about your options for generic, brand, and non-formulary options that Blue Shield has to offer.

    If you have an existing prescription, you can visit the website at blueshieldca.com/pharmacy to see if your medication is in the list of preferred prescription drugs or you may also call your dedicated Blue Shield Member Services team for Medicare plans assistance at (800) 776-4466.

  4. How do I find a network doctor or hospital?
    It’s easy to find a provider using Blue Shield’s website, just follow the steps below. If you don’t’ have access to the Internet and need help finding a provider, simply contact your dedicated Blue Shield Member Services team at (800) 642-6155 or TTY (866) 216-9926 for personal assistance. They are available from 7 a.m. to 7 p.m., Monday through Friday.

    Blue Shield 65 PlusSM (HMO) plan
    • Go to blueshieldca.com/findaprovider
    • Next to Select a Plan, click on the Select button
    • Under Medical Plan, choose Blue Shield 65 Plus (HMO), then select Blue Shield 65 Plus (HMO)
    • Group as the sub plan, then click Set Plan
    • Select the type of provider that you are searching for
    • Click on Advanced Search to further filter your search, such as by name, specialty, languages spoken, facility type, and more
    • Enter your city and state or ZIP code, then click Find Now
  5. How do I know if I live in the Blue Shield 65 Plus HMO plan service area?
    In order to be eligible to enroll in the Blue Shield 65 Plus (HMO) plan, you must live within the 65 Plus HMO plan service area. To find a listing of the ZIP codes in this service area, please refer to the Blue Shield 65+ (HMO) plan Benefit Summary or Evidence of Coverage (EOC) form.


Non-Medicare FAQ's:

  1. Who do I contact for information on the Blue Shield Non-Medicare plans?
    You may contact Blue Shield directly at Toll Free Customer Service for Non-Medicare plans by calling (800) 642-6155.

  2. I am currently receiving care for a medical condition from a provider that’s not in the Blue Shield network. What do I do?
    If you’re currently receiving care for a medical condition from a provider that’s not in the Blue Shield network– including acute and serious chronic conditions, planned surgeries, and terminal illnesses – Blue Shield will arrange for continuation of your care during the health plan transition to Blue Shield of California. Continuation of care allows you to continue to see your current non-network provider during the course of your treatment while still receiving the network level of benefits.

    For more information, call Blue Shield Member Services at (800) 642-6155 or TTY (866) 216-9926 for personal assistance. They are available from 7 a.m. to 7 p.m., Monday through Friday.

  3. How do I know if my current prescription will be covered?
    Blue Shield’s Drug Formulary is a list of our preferred prescription drugs. It’s best to check it in advance, since our list may differ from your former health plan’s formulary. Go to blueshieldca.com and click on Pharmacy to access our drug database and formulary selection.

    If you have new prescription, talk with your Doctor about your options for generic, brand, and non-formulary options that Blue Shield has to offer.

    If you have an existing prescription, you can visit the website at blueshieldca.com/pharmacy to see if your medication is in the list of preferred prescription drugs or you may also call your dedicated Blue Shield Member Services team for Non-Medicare plans assistance at (800) 642-6155.

  4. How do I find a network doctor or hospital?
    It’s easy to find a provider using Blue Shield’s website, just follow the steps below. If you don’t’ have access to the Internet and need help finding a provider, simply contact your dedicated Blue Shield Member Services team at (800) 642-6155 or TTY (866) 216-9926 for personal assistance. They are available from 7 a.m. to 7 p.m., Monday through Friday.

    Shield Signature HMO plan
    • Go to blueshieldca.com/findaprovider
    • Next to Select a Plan, click the Select button
    • Under Medical Plan, select Shield Signature. Then, choose either the PPO or HMO network and select Done.
    • Click on the type of provider that you are searching for.
    • Select Advanced Search to further filter your search, such as by name, specialty, facility type, and more.
    • Enter your city and state or ZIP code, and then click on Find Now.
    Shield Spectrum PPO plan
    • Go to blueshieldca.com/findaprovider
    • Next to Select a Plan, click the Select button
    • Under Medical Plan, choose Blue Shield of California PPO Network and select Set Plan
    • Click on the type of provider that you are searching for.
    • Select Advanced Search to further filter your search, such as by name, specialty, facility type, and more.
    • Enter your city and state or ZIP code, and then click on Find Now.
  5. How do I find a Shield Signature Personal Physician’s provider number and medical group/IPA number?
    When you enroll in the Shield Signature HMO plan for the first time, you’ll need to choose a Personal Physician for you and your enrolled dependents. You can choose a different Personal Physician and medical group for each enrolled family member. If you pick a doctor you have already seen, please let Blue Shield know that you are an existing patient.

    When you enroll in the HMO plan, you’ll need your Personal Physician’s provider number and medical group/Independent Practice Association (IPA) number. It’s easy to find this information and search for a Personal Physician using the Blue Shield website. Just follow the steps below:

    • Go to blueshieldca.com/findaprovider
    • Next to Select a Plan, click the Select button
    • Under Medical Plan select Shield Signature. Then, choose the HMO network and select Done.
    • Click on the Doctor as the type of provider that you’re searching for.
    • Select Advanced Search and choose HMO Personal Physicians under Doctor Type or Specialty.
    • Enter your city and state or ZIP code, and then click on Find Now.
    • From your search results, click on the physician’s name to find the provider number and medical group/IPA number.
    If you don’t select a Personal Physician at the time of enrollment, Blue Shield will automatically assign a Personal Physician to you and your enrolled family members. You can change your Personal Physician by calling Blue Shield Member Services at (800) 642-6155 or TTY (866) 216-9926 for personal assistance. They are available from 7 a.m. to 7 p.m., Monday through Friday.