Learn about the Shield Signature plan
Plan overview:
As a Shield Signature plan member, you have access to covered services from HMO and PPO network providers:
- HMO (Level 1): You can get care from HMO network providers for Level 1 benefits that have fixed copayments and the lowest out-of-pocket costs.
- PPO (Level 2): You can access care from PPO network providers for Level 2 benefits that allow you to self-refer to doctors for select outpatient services. Typically, your out-of-pocket cost will be higher than the costs for seeing HMO network providers.
More benefit details:
Care from HMO (Level 1) providers
- All family members must select a primary care physician (PCP) when enrolling in the plan. You have the option to choose a different PCP and medical group for yourself and each enrolled member of your family.
- Your PCP coordinates all your care and will refer you to specialists and hospitals within their medical group or Independent Practice Association (IPA).
- Women can self-refer for one annual OB/GYN appointment when they choose an OB/GYN who is in the same medical group or IPA as their PCP.
- You are required to use HMO (Level 1) coverage for inpatient services such as those provided by hospitals and other medical facilities, hospice agencies, and non-physician healthcare practitioners.
Care from PPO (Level 2) providers
- You are responsible for applicable copayments and non-covered charges.
- You can see any doctor or specialist in the PPO network for professional services that are provided in a doctor’s office without a referral from your PCP. Only select outpatient services are covered and must be performed in a doctor’s office. Outpatient services include office visits, consultations, evaluations, and treatments. Refer to your Summary of Benefits for more details.