Page 11 - Tender Greens EE Guide 01-20

Blue Shield | HMO
Narrow Network Option: SaveNet
Full Network Option: Access+

With the HMO plans, you must choose a primary care physician (PCP) or medical group within the network. All of your care
must be directed through your PCP or medical group. Any specialty care you need will be coordinated through your PCP and
will generally require a referral or authorization. You will receive benefits only if you use the doctors, clinics, and hospitals that
belong to the medical group in which you are enrolled, except in the case of an emergency. You can choose from two
network options, both with the same benefits, but the narrow network option is offered at a lower paycheck cost.

Blue Shield | PPO HDHP PPO: Access to Care
With the PPO HDHP plan, you can pay for qualified healthcare expenses The PPO and the PPO HDHP plans are
now and grow your savings for future healthcare needs. This plan Preferred Provider Organization (PPO) plans
combines a High Deductible Health Plan (HDHP) with a special, tax- and use Blue Shield’s “PPO” network. PPO
qualified Health Savings Account (HSA). You and Tender Greens can plans allow you to direct your own care. You
contribute tax-free money to your HSA up to IRS maximums. The money have the freedom to choose your doctor
in your account is yours to pay for current healthcare expenses - or you without the requirement of selecting a PCP
can save toward future healthcare expenses. More details about the and you may self-refer to specialists. You
HDHP medical plan are located on page 15. may use a network provider whose

negotiated rates provide richer levels of
Blue Shield | PPO benefits with claim forms filed by the
The PPO plan requires that you meet a calendar year deductible before providers. You may also obtain services using
Blue Shield starts paying for certain services. Once the deductible has a non-network provider; however, you will be
been met, most services will be covered at a coinsurance or a copay. responsible for the difference between the
For certain services, such as office visits and urgent care, Blue Shield has covered amount and the actual charges, and
waived the deductible and cost sharing begins immediately. you may be responsible for filing claims.

Finding a Medical Provider
Go to www.blueshieldca.com or call (888) 256-1915.
Under ‘Plan Type’ select ‘2020 Employer Group Plans (101+
Employees), then select the subplan:
• Narrow Nework HMO: Refer to the “SaveNet HMO” network
• Full Nework HMO: Refer to the “Acess+ HMO” network
• PPO HDHP: Refer to the “PPO ” network
• PPO: Refer to the “PPO” network

Blue Shield Mobile App

Download the Blue Shield of California mobile app for greater
access to your insurance information.

Features:
• Find a Doctor
Educational Video • View your personalized plan
Health Insurance Terms • Access your ID card digitally
http://video.burnhambenefits.com/terms
Located for free on the Google Play or Apple App Store.

11
Team Member Benefits
Team Member Benefits 11