Individual and Family Health Insurance

Am I covered while traveling?

Yes. With all Blue Shield health plans, benefits will be provided anywhere in the world in the case of an emergency. Blue Shield PPO members are also covered for care worldwide through the BlueCard program. Check your Evidence of Coverage/Policy for specific provisions.
 
If you're looking for answers to more specific questions, check out these health and dental frequently asked questions.

Is pregnancy a wavered condition?

A waivered condition is excluded from coverage for charges and expenses incurred during the six-month period beginning as of the effective date of coverage. A waivered condition only applies to a condition for which medical advice, diagnosis, care or treatment (including prescription drugs) was recommended or received from a licensed health practitioner during the six months immediately preceding the effective date of coverage.

Is there an exclusion for pre-existing conditions?

For our Blue Shield PPO plans, benefits will not be provided for pre-existing conditions in the first six months of coverage. This exclusion may be waived if you have prior creditable coverage. You may have prior creditable coverage if your previous health plan covered the services in question and your application for Blue Shield coverage was received by us within 63 days of terminating your previous plan coverage.

How soon can I get coverage?

It can take four to six weeks to review your application.

Is my doctor or hospital part of the Blue Shield network?

We offer an extensive network of physicians throughout California. To see if your doctor, hospital or other provider is part of our network, use our Find a Provider  tool.

What's the difference between a PPO and an HMO?

There are many differences between them, but the most significant difference is how you access care. If you're covered by a PPO plan, you may visit any licensed doctor. In an HMO plan, you need to access non-emergency care through a designated Personal Physician to be covered. You can choose your own Personal Physician or we can assign one to you.

Am I covered while traveling?

Yes. With all Blue Shield health plans, benefits will be provided anywhere in the world in the case of an emergency. Blue Shield PPO members are also covered for care worldwide through the BlueCard program. Check your Evidence of Coverage or Policy for specific provisions.

If you're looking for answers to more specific questions, check out these health and dental frequently asked questions.

Is pregnancy a waivered condition?

A waivered condition is excluded from coverage for charges and expenses incurred during the six-month period beginning as of the effective date of coverage. A waivered condition only applies to a condition for which medical advice, diagnosis, care or treatment (including prescription drugs) was recommended or received from a licensed health practitioner during the six months immediately preceding the effective date of coverage.

Is there an exclusion for pre-existing conditions?

For our Blue Shield PPO plans, benefits will not be provided for pre-existing conditions in the first six months of coverage. This exclusion may be waived if you have prior creditable coverage. You may have prior creditable coverage if your previous health plan covered the services in question and your application for Blue Shield coverage was received by us within 63 days of terminating your previous plan coverage.

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