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Blue Shield of California

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 Employees.

The plans offered by Blue Shield are:

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


Frequently Asked Questions

  1. When can I select Blue Shield as my medical plan?
  2. When will I receive my subscriber ID cards?
  3. How do I know if my Doctor is in the Blue Shield network?
  4. I am a new enrollee, can I continue to see my current Personal Physician after I enroll with Blue Shield?
  5. What happens if I don’t select a Personal Physician? (this applies to new enrollees only)
  6. Is Loma Linda a part of the Blue Shield Network?
  7. Is there mandatory mail-order for maintenance medication?
  8. How does mail-order prescription work? What do I need to do?
  9. How do I check to see if my medication is on Blue Shield’s formulary?
  10. I am a new enrollee, what do I do if I am in the middle of receiving care for a medical condition?
  11. I am a new enrollee, I have received authorization for a medical procedure, but it takes place after my Blue Shield coverage go into effect. Do I need to get a new authorization?
  12. I have a disabled dependent over the age of 26. What do I need to do or provide to keep them covered?
  13. Is chiropractic care covered under the Blue Shield plans?
  14. How does Level 2 benefits access work? How do I access them?
  15. I am on the HMO plan. Can I self-refer for OB/GYN?
  16. I have legal custody of my Grandchild. Are they eligible for coverage?
  17. How do I get a replacement ID card?
  18. I received a bill from my Physician for services that I believe should be covered by the plan. What do I do?
  19. How do I get a copy of the plan Evidence of Coverage (EOC)?

1. When can I select Blue Shield as my medical plan?

You can select one of the Blue Shield plans for your medical benefit when you experience a Qualifying Event or during the Annual Open Enrollment period.

For 2013 the Open Enrollment period is from June 3 - 21, 2013.

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2. When will I receive my subscriber ID cards?

Those who selected Blue Shield as their medical plan will receive their ID cards, mailed to their home, within two weeks of enrollment.

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3. How do I know if my Doctor is in the Blue Shield network?

You can call Blue Shield at (800) 642-6155 or use the provider search tool located on Blue Shield’s website at http://blueshieldca.com/fap. Instructions on how to use this tool can be found here.

Mid-Year Provider changes, for existing members, should not be made at open enrollment. To make these changes, please call Blue Shield customer service at 800-642-6155

Please note that during Open Enrollment you will need to provide the nine digit provider number and the associated nine digit medical group number for your selected physician and medical group.

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4. I am a new enrollee, can I continue to see my current Personal Physician after I enroll with Blue Shield?

Yes, if your Personal Physician is in the Blue Shield network you can keep your same doctor.

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5. What happens if I don’t select a Personal Physician? (this applies to new enrollees only)

If you do not select a Personal Physician at the time you enroll, Blue Shield will automatically assign a Personal Physician to you and your enrolled family members. But if you want, you can change your Personal Physician by calling your dedicated Blue Shield Member Service team at (800) 642-6155.

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6. Is Loma Linda a part of the Blue Shield Network?

Loma Linda Hospital is part of both the Blue Shield HMO and PPO networks where Doctors may refer patients to Loma Linda Hospital for specialty care. However, there are currently no Medical Groups in the Blue Shield HMO network that contract with Loma Linda Hospital for routine medical care.

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7. Is there mandatory mail-order for maintenance medication?

Mail order prescriptions are completely voluntary with Blue Shield.

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8. How does mail-order prescription work? What do I need to do?

As a new member with Blue Shield of California, mail service pharmacy is available through PrimeMailĀ®.

PrimeMail offers three months of prescription for two months copay.

Your physician can submit a new prescription to PrimeMail electronically, by phone, by fax, or by mail.

To start using PrimeMail, you must first register. There are three easy ways to do so: online, by phone, or by mail.

  • To register online -- Log into blueshieldca.com, select Pharmacy, and click on the MyPrimeMail.com link in the Mail-Service Pharmacy section. Go to the My Account page in the upper right corner of the page to enter your contact information.
  • To register by phone – Call PrimeMail at (866) 346-7200, or if you use TTY equipment, call TTY/TTD (866) 346-7197. A representative can mail a new prescription order form to you or complete registration for you during the call.
  • To register by mail – Complete the PrimeMail order form included with this letter, or print one out by logging into blueshieldca.com and selecting Pharmacy, then choosing MyPrimeMail.com in the Mail-Service Pharmacy section and clicking on Order New. You can complete the form online and then print it, or print out a blank form and complete it by hand. Simply mail the completed form to:

    PrimeMail Pharmacy
    P.O. Box 27836
    Albuquerque, NM 87125-7836<

PrimeMail Pharmacy
P.O. Box 27836
Albuquerque, NM 87125-7836

Once you’ve registered, you can order prescription refills or check the status of your order by logging into your account at blueshieldca.com, selecting Pharmacy, and then clicking on MyPrimeMail.com under the Mail-Service Pharmacy section. Or, you can call PrimeMail at (866) 346-7200 or TTY/TTD (866) 346-7197.

Please allow 10 to 14 days for delivery of your prescriptions to your home or office. Standard delivery is free of charge. Refills can also be processed online.

If you have any questions about your mail service prescriptions, PrimeMail’s specially trained service representatives and on-site pharmacists are available 24 hours a day, seven days a week, at the telephone numbers listed above.

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9. How do I check to see if my medication is on Blue Shield’s formulary?

It’s easy to access the Blue Shield Drug Formulary to see if your medication is in the list of preferred prescription drugs. For your convenience, we have downloaded the most recent formulary list which can be found here. Pharmacy for the drug database and formulary selection can also be found on the Blue Shield website at www.blueshieldca.com.

If you don’t have access to the Internet or need help, simply contact your dedicated Blue Shield Member Services team at (800) 642-6155 for personal assistance or to request a copy of our formulary.

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10. I am a new enrollee, what do I do if I am in the middle of receiving care for a medical condition?

If you are in the middle of receiving treatment for a medical condition please call Blue Shield at (800) 642-6155 and ask for assistance with transition of care. Blue Shield will assign you a Case Manager to guide and assist with your specific transition of care needs.

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11. I am a new enrollee, I have received authorization for a medical procedure, but it takes place after my Blue Shield coverage go into effect. Do I need to get a new authorization?

If you have been scheduled for treatment that required prior authorization from your former health plan carrier, it is likely that this treatment will now need to be authorized by Blue Shield. Let your Personal Physician know that your coverage has changed to Blue Shield to ensure your services are properly authorized under your Blue Shield medical plan.

For more questions about prior authorization or to initiate authorization, simply call your dedicated Blue Shield Member Service team at (800) 642-6155.

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12. I have a disabled dependent over the age of 26. What do I need to do or provide to keep them covered?

An “Initial Certification” is required under the Blue Shield Plans. Coverage for that dependent will continue subject to the Initial Certification and any subsequent annual certifications.

Two criteria are required:

  • The disabled dependent over the age of 26 must be chiefly dependent upon the subscriber for support and maintenance
  • The Subscriber must submit a Physician’s written certification from the Personal Physician of such disabling condition

Proof of continuing disability and dependency must be provided as requested by the plan, but not more frequently than 2 years after the initial certification and then annually thereafter. Please note, however, that if the treating physician has certified the disability for a specific period of time, re-certification of continuing disability and dependency would be required based on the expiration date of the certification.

If you have questions regarding a dependent with a disability that is over the age of 26, please call your dedicated Blue Shield Customer Service at (800) 642-6155.

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13. Is chiropractic care covered under the Blue Shield plans?

Chiropractic care is a covered benefit for the Shield PPO and Shield Needles PPO plans, but is not a covered benefit for the Shield Signature HMO plan. Blue Shield does, however, offer through their Alternative Care Discount Program a 25% discount for Chiropractic services (and other additional services). For more information and details, please visit www.blueshieldca.com or call your dedicated Blue Shield Member Service team at (800) 642-6155.

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14. How does Level 2 benefits access work? How do I access them?

You can access your level 2 benefits by simply making an appointment with a Blue Shield PPO physician. You do not need a referral. Level 2 services cover physician office visits and those procedures that would normally occur in the office during that visit. Level 2 benefits may not be used for services such as outpatient surgery or hospitalizations.

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15. I am on the HMO plan. Can I self-refer for OB/GYN?

Yes, you can self-refer to an OB/GYN, within your medical group, at any time during the year, for any OB/GYN related services. You do not need a referral and you will not have to pay an additional copay.

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16. I have legal custody of my Grandchild. Are they eligible for coverage?

Grandchildren are not considered to be a qualified dependent under the Blue Shield plans and cannot be enrolled for coverage. The only exception to this is if you have court appointed legal custody (Legal custody only lasts until age 18.)

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17. How do I get a replacement ID card?

You can logon to your account on blueshieldca.com and print a new ID card or call your dedicated Blue Shield Member Service team at (800) 642-6155 to order a replacement card.

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18. I received a bill from my Physician for services that I believe should be covered by the plan. What do I do?

Call your dedicated Blue Shield Member Service team at (800) 642-6155. They can assist you with any questions you have regarding claims or bills for service.

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19. How do I get a copy of the plan Evidence of Coverage (EOC)?

You can download a copy of your EOC by visiting the County’s website at http://www.sbcounty.gov/hr/bc_plan.aspx or you can all your dedicated Blue Shield Member Service team at (800) 642-6155 to request a hard copy be mailed to you.

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Blue Shield Resources

Website: blueshieldca.com

Toll Free Customer Service: (800) 642-6155

For more information click on the following links:

Blue Shield Logo
Employment Division
157 West Fifth Street, First Floor | San Bernardino CA 92415-0440
Phone: (909) 387-8304 • TTY Users: 711 • Fax: (909) 387-5792

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