Below are a variety of resources to give you a better understanding of all your health plan options. If you need more specific information about the health plans available to you, contact your benefits manager.
Conquer open enrollment
Give yourself a better experience this year. Follow these simple steps to help you prepare and transform your open enrollment from a stressful event into an empowering one.
How to choose the right plan for you
We know that selecting a new plan can feel overwhelming. Browse our health plan selection questions below to guide yourself through the process.
Understanding copays and deductibles
It’s easy to forget how something works when you only do it once a year. Here are some common terms to refresh your memory before open enrollment starts.
Blue Shield plans: delivering more than health coverage
- $0 for preventive careVisits for recommended health screenings and preventive care are all covered.
- Urgent and emergency careBlue Shield plans cover urgent care and ER visits across the U.S. and worldwide.
- Extensive pharmacy networkMembers with our pharmacy benefits have access to 68,000 retail pharmacies plus mail-service prescriptions.
- Mental health supportMembers with Blue Shield mental health benefits have access to virtual and in-person therapy and support.
Questions to ask yourself when evaluating your health plan options
Are there specific doctors, specialists, or hospitals that you want access to?
- If yes, you’ll want to make sure these providers are in the plan’s network. Narrow your plan options by eliminating those whose networks do not include these providers. To find out if your providers are in the Blue Shield network for the plans being offered to you, visit our Find a Doctor tool.
Is it important for you to have access to as many California specialists and hospitals as possible in case of illness or injury?
- If yes, you may want to choose a PPO plan (if offered by your employer), as they offer you the most choice and flexibility. With a PPO plan, you can also see providers who are not in the PPO network. However, please be aware that you may pay more for non-network providers than you will for network providers.
Are you and your dependents healthy, and do you usually see your doctor for annual checkups only?
- If yes, a high-deductible health plan (HDHP) might be right for you. HDHPs typically come with lower monthly premiums (but higher plan year deductibles) than other plans. This means that less will come out of your paycheck each month and you’ll only pay out of pocket for the care that you need. After all, why pay more for something you feel you will rarely use?
Do you or your family members have a chronic condition such as asthma, cancer, or diabetes?
- If yes, you will want to compare plan coverage along with estimated copays and deductibles for specialists, hospital stays, medications, medical equipment, etc. Typically, you will have fewer out-of-pocket costs with an HMO plan than a PPO plan, but a smaller network of doctors and hospitals from which to choose.
Do you or any family members take prescription drugs on a regular basis?
- If yes, be sure to review each plan’s prescription drug coverage, including drug copayment tiers and prior authorization and exception request processes. To learn about Blue Shield’s drug coverage, view our Drug Formularies .
Do you anticipate any medical procedures, treatments, or special services in the next year such as surgery, pregnancy, colonoscopy, etc.?
- If yes, compare coverage for the specific medical care you may need such as specialists, hospitals, medication, etc. Typically, an HMO plan covers most of the costs but offers a more limited network of doctors and hospitals than a PPO plan.
Do you travel often for work or pleasure?
- If yes, you may want to choose Blue Shield, as all our plans offer access to Blue plan providers across the country through the BlueCard Program, and around the world through Blue Shield Global Core. Also, with a Blue Shield plan, you are always covered for urgent and emergency care while on vacation or traveling for business anywhere in the world.