Blue Shield Plan, Benefits, and Rates
Discover the great features and savings our Access+ HMO® plan offers
Learn about our Access+ HMO plan in 5 minutes or less
Our interactive video will help you to:
- Select topics that interest you
- Find network doctors
- Explore wellness programs and more
Maternity care that fits into your life
The Maven Maternity Program is designed to give you and your partner digital and virtual support for your pregnancy and postpartum needs – at no extra cost. You can also get support if you have experienced a pregnancy loss.
Access+ HMO Plan
Available in these counties for 2024:
• Los Angeles
• Orange
• Riverside
• San Bernardino (excluding the following ZIP codes: 92242, 92280, and 92363)
• San Diego
• Ventura
Important Notification
We will no longer offer this plan in the following counties for 2024:
• Fresno • Kern (excluding the following ZIP codes: 93516, 93527, 93528 and 93554 to 93556) • Kings • San Luis Obispo • Santa Barbara
NOTE: For more detail, click here. (PDF, 111 KB).
Important Notification
We will no longer offer this plan in the following counties for 2024:
• Fresno • Kern (excluding the following ZIP codes: 93516, 93527, 93528 and 93554 to 93556) • Kings • San Luis Obispo • Santa Barbara
NOTE: For more detail, click here. (PDF, 111 KB).
Plan highlights
- Large provider network
- No annual deductible
- $0 copayment for preventive care
- $30 copayment for office visits
- Self-refer to a specialist†
- Teladoc - Talk to a doctor anytime, anywhere
- An extensive pharmacy network, including Safeway/Vons, Costco, and CVS
Plan features
- Large provider networkWe know that choice is important to you. Access+ HMO offers you access to one of the largest networks of doctors and hospitals in California. For a complete listing of Blue Shield providers, visit Find a Doctor.
- Self-referral for specialty careAccess+ SpecialistSM makes it easy to self-refer to a specialist within your medical group or IPA for a consultation.†
- Maternity programGet support before, during, and after your pregnancy
- Contraceptive careContraceptive coverage available at no cost to members.
- Chiropractic and acupuncture servicesVisit any chiropractic or acupuncturist in the ASH network.
- Emergency care around the worldYou’re covered for emergency care around the world whether or not the provider is in your plan’s HMO network.
- NurseHelp 24/7SMRegistered nurses are available to answer your health questions at any time, every day.
- Urgent careFor non-emergencies, you can receive care at an urgent care center that’s affiliated with your doctor’s medical group or IPA. Your cost will usually be lower than the cost for a hospital emergency room visit.
- Virtual careTeladoc gives you around-the-clock access to board-certified doctors who are ready to treat many medical issues. With Teladoc's convenient phone and online video appointments, you can avoid a trip to the doctor's office. You pay only $20 each time you use Teladoc. To learn more, go to teladoc.com/bsc or call Teladoc at (800) Teladoc (835-2362)
- Preventive careLearn how your preventive care benefits can help keep you healthy.
- Biometric screeningVisit your primary care doctor and receive a biometric screening as part of your preventive benefits at no additional charge. Your biometric screening will gather key indicators such as total cholesterol, blood pressure, BMI, triglycerides, and fasting glucose numbers.*
- Wellness assessmentHealth Risk Assessment is an online tool that helps you discover potential health risks and recommends positive steps to control those risks at no additional charge*
- Treatment cost estimatorTreatment cost estimator helps you budget for your expenses.
- Wellvolution®The next generation of Wellvolution offers best-in-class apps and lifestyle change programs to help you achieve your health goals at no additional cost to you.
- Mobile appManage your health care from anywhere with the Blue Shield of California App. Learn more about our mobile features and download the Android™ or iPhone® app today.
- Discount programsAs a Blue Shield member, you'll have access to significant discounts on alternative care services and maintenance prescription drugs. The Alternative Care Discount Program‡ provides members with discounts of 25% on a variety of alternative services, including massage therapy.
- Shield supportGet support managing your health needs for conditions such as diabetes, depression, chronic pain, cancer, and others. Services include personalized health coaching, care plan development, provider coordination, and more.
- Member ServicesYour Member Service representatives are based in California and trained on all the features and benefits of the FEHBP health plans. Call us at (800) 880-8086. Monday through Friday, 7 a.m. to 7 p.m. Or visit us online at blueshieldca.com – any time, day or night.
Plan benefits at-a-glance
| Benefits | You pay |
|---|---|
| Medical services provided by physicians | |
| Preventive diagnostic and treatment services provided in the office | Office visit copayment: $30 primary care; $40 specialist |
| Preventive care exam | Nothing |
| Teladoc (video or phone consultation) | $20 per consult |
| Lab, X-ray, and other diagnostic tests | Nothing |
| Services provided by a hospital | |
| Inpatient | $750 per admit |
| Outpatient | $300 per treatment or surgery |
| Emergency room (in-area or out-of-area) | $200 copayment per visit |
| Urgent care | $20 copayment per visit |
| Maternity care | |
| Prenatal care | Nothing |
| Screening for gestational diabetes for pregnant women | |
| Delivery | |
| Postnatal care | |
| Prescription drugs | |
| Retail pharmacy (30-day supply) | $10 per Tier 1 prescription |
| $50 per Tier 2 prescription, applicable to $250 deductible | |
| 50% per Tier 3 prescription, $50 minimum/$200 maximum, applicable to $250 deductible | |
| 30% per Tier 4 prescription, up to $250 max (excluding specialty drugs), applicable to $250 deductible | |
| Network Specialty Pharmacy – 30% per Tier 4 prescription, up to $250 max (includes home self-injectable and specialty drugs) | |
| Retail pharmacy (90-day supply) | $30 per Tier 1 prescription |
| $150 per Tier 2 prescription, applicable to $250 deductible | |
| 50% per Tier 3 prescription, $150 minimum/$600 maximum, applicable to $250 deductible | |
| 30% per Tier 4 prescription, up to $750 max (excluding specialty drugs), applicable to $250 deductible | |
| Mail service (90-day supply) | $20 per Tier 1 prescription |
| $100 per Tier 2 prescription, applicable to $250 deductible | |
| 50% per Tier 3 prescription, $100 minimum/$400 maximum, applicable to $250 deductible | |
| 30% per Tier 4 prescription, up to $500 max (excluding specialty drugs), applicable to $250 deductible | |
| Dental care | |
| Accidental injury benefit | $30 per office visit, or $50 per treatment or surgery |
| Optional non-FEHB dental plan (Blue Shield Dental HMO or PPO plans) | You pay total premiums plus various copayments |
| Vision care | |
| Vision care | $30 per office visit |
| Protection against catastrophic costs (your catastrophic protection out-of-pocket maximum) | |
| Surgical, medical, Rx, mental health, and substance use disorder | Nothing after you have met your $5,000 Self Only/$10,000 Self Plus One/Self and Family enrollment per year out-of-pocket (OOP) max. Some costs do not count toward this protection. |
| Chiropractic services | |
| Chiropractic services (up to 20 medically necessary visits per year) | $10 per visit |
2024 Plan Rates
|
Southern Rates - Plan SI
|
Self (SI1)
|
Self Plus One (SI3)
|
Self and Family (SI2)
|
|---|---|---|---|
|
Premium rate bi-weekly
|
$211.41
|
$475.77
|
$464.36
|
|
Premium rate monthly
|
$458.05
|
$1,030.84
|
$1,006.11
|
Resources
Selecting a primary doctor
To select or change your primary doctor simply call Member Services at (800) 880-8086 for help or download and complete a primary doctor/PCP selection form (PDF, 65 KB) instead and mail it to:
Blue Shield of California
Membership-Confidential
P.O. Box 629014
El Dorado Hills, CA 95762-9975
Blue Shield of California
Membership-Confidential
P.O. Box 629014
El Dorado Hills, CA 95762-9975
ACA Summary of Benefits and Coverage
To help you make an informed choice, this plan makes available a Summary of Benefits and Coverage (SBC) explaining your health coverage. The SBC summarizes important information in a standard format to help you compare across plans.
Claims and Appeals
Sections 3, 7, and 8 of your Access+ HMO Contract Brochure (PDF, 1.6 MB) explains:
- how to file a claim with us
- your rights to ask us to reconsider our claim decision
- how to appeal to the U.S. Office of Personnel Management for review of our reconsideration decision for your claim
* Health Risk Assessment and biometric screenings are for members age 18 and older.
†To use this option, members must select a PCP who is affiliated with a medical group or IPA that is an Access+ provider group, which offers the Access+ Specialist feature. Members should then select a specialist within that medical group or IPA. Access+ Specialist visits for mental health services must be provided by a participating mental health service administrator (MHSA) network provider. For ongoing care from a specialist, you’ll need to get a referral from your PCP.
‡The Alternative Care Discount Program is an exclusive offer to Blue Shield Access+ HMO members, made available through an arrangement with American Specialty Health Networks of California, Inc. (ASH Networks) and is not a covered service of any Blue Shield health plan. ASH Networks credentials and manages the program's practitioners. None of the terms and conditions of Blue Shield health plans apply. Blue Shield of California and ASH Networks do not review the program's practitioner services and products for medical necessity or efficacy and makes no representations, claims or guarantees regarding their services or products. Members who use the discount program are responsible for the payment of services provided by participating network practitioners, including payment for cancelled or missed appointments. Members who are not satisfied with services received from the program's practitioners may use the Blue Shield grievance process. Blue Shield reserves the right to terminate this program without notice.
Access+ HMO and Wellvolution are registered trademarks and Access+ Specialist and NurseHelp 24/7 are service marks of Blue Shield of California. Blue Shield and the Shield symbol are registered trademarks of the BlueCross BlueShield Association, an association of independent Blue Cross and Blue Shield plans.
The Blue Shield of California Access+ HMO complies with all applicable Federal civil rights laws, to include both Title VII and Section 1557 of the ACA. Pursuant to Section 1557 the Blue Shield of California Access+ HMO does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, age, disability, or sex (including pregnancy and gender identity).