Frequently Asked Questions

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.

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.

With Access+ Value HMOSM and Access+ HMO®, pregnancy is a waivered condition. Therefore, benefits for pregnancy and maternity services are not covered for the six-month period from the effective date of coverage, with the exception of services required to treat involuntary complications of pregnancy.
 
However, if you have prior creditable coverage and you apply for coverage within 63 days after termination of prior coverage, Blue Shield will credit the length of time you were covered on your previous health plan toward the six-month period.
 
Please note that for Vital Shield, Vital Shield Plus, Active StartSM, EssentialSM, BalanceSM  and Shield Savings plans, pregnancy and maternity benefits are not covered.

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.

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

The Shield Savings^SM Plans are HSA-eligible, high-deductible health plans.

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.

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.

You can have both types of accounts, but only under certain circumstances. Generally, FSAs make you ineligible for an HSA. You should check with your financial adviser to determine if an HSA and/or FSA is the right fit for you.

The big difference between an HSA and a Flexible Spending Arrangement (FSA) is that HSA contributions not used by the end of the year are not lost. You can keep rolling the money forward in your account each year, even into retirement.

Whatever amount you don’t spend stays in the account to be used for future medical expenses. It will roll over year after year. The funds can continue to earn interest for you.

You own the money in your HSA, so any money deposited into your HSA will remain in your account and automatically roll over from one year to the next.

You may continue to use those funds for qualified medical expenses if you are no longer enrolled in an HSA-compatible health plan; however, you no longer will be able to make contributions to your account. If you regain an HSA-compatible health plan at a later date, you can resume making contributions to your HSA.

Yes. You can use your HSA money for qualified medical expenses as soon as you have money in your HSA -- assuming you are enrolled in an HSA-compatible health plan.

If your HSA financial institution has provided you with a checkbook or debit card, you can pay for care directly from the account. If your HSA does not offer these features, you can pay with your own money and reimburse yourself for the expense from the account later.

If you have not met your deductible, you may be responsible for paying 100 percent of your preventive care services. For some plans your preventive care may be covered 100 percent before your deductible. Check your Evidence of Coverage, Certificate of Insurance, or policy for specifics about your benefits.

Yes, HSAs are like IRAs. They can earn interest and be invested, depending on requirements by your financial institution. The same types of investments permitted for IRAs are allowed for HSAs, including stocks, bonds, mutual funds, and certificates of deposit.

If you pay for your own healthcare coverage you can make individual or lump sum pret-tax contributions.

If you receive health coverage through an employer, pre-tax funds can be deducted from your paychecks. You can also make lump sum contributions, and your employer may make contributions directly or through payroll deductions.

Depending on the HSA you select and your individual tax situation, after-tax contributions may be deductible on your federal tax returns, even if you do not itemize deductions. Remember, unused funds in your HSA will accumulate year after year, tax-deferred.

Yes. You can each have and contribute to an HSA as long as neither of you has family coverage.

The U.S. Department of Treasury states that for 2009, if you have individual HSA-compatible health plan coverage, your contribution is $3,000; Your limit is $5,950 if you have a family coverage. If you are age 55 or older, you can also make additional "catch-up" contributions (see below). These amounts will continue to increase for inflation.

As for how often, you can contribute in a lump sum or in any amounts or frequency you wish. However, the financial institution that holds your account can impose minimum deposit and balance requirements. The same is true if you are receiving contributions from an employer.

An HSA is not something you purchase; it’s a savings account into which you deposit money on a tax-advantaged basis to pay for qualified medical expenses. Note that the financial institution you set up your HSA with may charge monthly service fees for your account just like any other savings account.

Individuals can open an HSA if they are enrolled in an HSA-compatible health plan.

When you enroll in an HSA-compatible health plan, you have the option to open an HSA. Once you open an HSA, you contribute money to your HSA through pre-tax or post-tax contributions. You can use the money in your HSA to pay for qualified medical expenses. Many financial institutions will provide a debit card or checks for easy access to your HSA funds. Any money you don’t use in one year simply gets rolled over to the next year.

* Individual Health Insurance 2006-2007: A Comprehensive Survey of Premiums, Availability, and Benefits, America’s Health Insurance Plans, January 2008

HSA-compatible health plans are high-deductible health plans that often have lower premiums and dues than Blue Shield health plans that are not HSA-compatible. These high deductible plans can be used with an HSA to obtain tax advantages. To open an HSA you must enroll in an HSA-compatible health plan first.

An HSA is a personal savings account that allows you to pay for qualified medical expenses with tax advantaged dollars. You (and/or your employer) contribute money to an HSA through pre-tax or post-tax contributions. The money contributed to the account is not subject to federal income tax at the time of deposit. Funds in an HSA roll over and accumulate year after year if not spent. All money in your HSA is owned by you.

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.

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.

The Shield Spectrum PPO^SM Savings Plans 2400/4800 and 4000/8000  are HSA-eligible, high-deductible health plans.

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.

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.

The Evidence of Coverage and Health Service Agreement (EOC), or Policy for Individuals and Families (Policy), are the official plan contracts. They explain in full all the terms of plan coverage, including benefits, copayments or coinsurance, exclusions, limitations and how to access coverage.

Some Blue Shield plans provide chiropractic and/or acupuncture coverage. You can also save money through the Mylifepath Alternative Health Services Discount Program, a standard feature on all Blue Shield plans, by receiving discounts on the following services: Acupuncture Chiropractic Massage therapy Please note that none of the terms and conditions of Blue Shield's health plans applies to these discount services as these discounts are not part of your health plans' covered services.

Yes. All of our individual and family health plans include benefits for oral contraceptives, diaphragms and injectable contraceptives.

Yes. All of our individual and family health plans include coverage for preventive care such as physical examinations, immunizations, well-baby care and gynecological exams when a preferred provider is used.

If you're a Blue Shield individual and family plan member, you can add on one of our optional dental PPO or HMO plans for an additional cost. There is no coordination of dental benefits between health and dental plans. If you are an Access+ HMO® member, you have basic dental benefits, called Access+ Dentist, included in your plan. Access+ HMO members can choose to purchase the more generous dental PPO or HMO plan instead of receiving Access+ Dentist services. Our Essential plans also include dental coverage benefits.

Yes. Special YouthCareSM rates are available for all of our plans. YouthCare plans provide your children with the same healthcare benefits we offer in our individual adult and family plans, at special rates for children under the age of 19. You can even select a different plan for each child whether or not you have a Blue Shield plan of your own.

Yes. Sometimes it may better suit your healthcare needs or budget to place family members on different types of plans.

Our Shield Spectrum PPO Savings Plans 2400/4800 and 4000/8000 are HSA-eligible, high-deductible health plans.

HSAs are tax-advantaged personal savings or investment accounts intended for payment of medical expenses that may be used in combination with qualifying high-deductible health plans.

Each of the five Shield Spectrum PPOSM plans provides a wide range of benefits, a choice of providers and many fixed copayments before meeting the deductible. In general, Shield Spectrum PPO plans with lower deductibles have higher monthly dues/premiums. Shield Spectrum PPOSM Savings Plans, our high-deductible health plans that are compatible with a Health Savings Account, can help meet essential healthcare needs, and are often selected by people who go to the doctor occasionally. Our EssentialSM Plans* are individual-only plans that offer a calendar year out-of-pocket maximum that is met when the deductible is satisfied. Active StartSM Plans* are affordable plan options that combine no medical plan deductible with lower generic drug copayments and low copayments for office visits and preventive care. Active Start, Vital ShieldSM 2900 and Essential plans provide individual-only coverage and do not provide maternity benefits. Shield Spectrum PPO Savings Plan 4000/8000 does not provide maternity benefits.

While a majority of services require that you meet your plan deductible first, many benefits, such as generic prescriptions, well-baby care and physical and gynecological examinations with a preferred provider are covered before you have satisfied your plan deductible with most plans. Please note that some plans have a brand-name drug deductible and you must first meet this deductible before benefits for brand-name drugs will be covered.

Many health plans include a deductible. You must satisfy this amount each year before Blue Shield makes payments towards covered services. Depending on your plan design, some services may be covered by Blue Shield before your deductible is met. The EOC/Policy for the plan includes more details about what services are available before meeting the deductible. In addition, if your plan has a deductible and you have family coverage, a family deductible applies. Each individual's deductible is satisfied once the family deductible is met. For example, if the family deductible is equal to twice the individual deductible, and two people in the family satisfy their deductible, then the deductible is satisfied for all family members covered under the plan for the remainder of the calendar year. The family deductible can be met by any family member or combination of family members.

The federal Health Insurance Portability and Accountability Act (HIPAA) makes it easier for people covered under existing group health plans to maintain coverage regardless of pre-existing conditions when they change jobs or are unemployed for brief periods of time. If you meet all specified conditions, you may be eligible for a guaranteed issue plan in accordance with HIPAA, and we will automatically accept your application without underwriting. For more information, please call our account representatives at (888) 568-3560 Monday through Friday, 8 a.m. to 8 p.m. PST.

Residents of California who are ineligible for Medicare and not over the age of 65. In most cases, approval will be based on your health history. If you do not qualify for a guaranteed issue plan, you will be medically underwritten.