Page 9 - Optima Tax EE Guide 01-19 CA_FINAL

Medical Plan Choices

Blue Shield | HMO Plans
With the HMO plans, you must choose a primary care physician Shield Concierge
(PCP) or medical group within the network. All of your care must be (855) 829-3566
directed through your PCP or medical group. Any specialty care you
need will be coordinated through your PCP and will generally require If you enroll in the Trio HMO medical
a referral or authorization. You will receive benefits only if you use plan, you’ll have access to the Shield
the doctors, clinics, and hospitals that belong to the medical group in Concierge, a team of registered
which you are enrolled, except in the case of an emergency. nurses, health coaches, social
workers, pharmacy technicians,
Two HMO Plan Options are Available: pharmacists, and customer service
• Trio HMO representatives.
• Access+ HMO The Shield Concierge can help you
with:
Blue Shield | PPO Plans • Locating a new doctor or
The PPO plans allow you to direct your own care. If you receive care specialist
from a physician who is a member of the network, a greater • Coordinating your care for an
percentage of the entire cost will be paid by the insurance plan. existing health condition or if you
However, you are not limited to the physicians within the network are about to undergo surgery
and you may self-refer to specialists. If you obtain services using a • Transferring your prescriptions or
non‐network provider, please note that you will be responsible for medical records
the difference between the covered amount and the actual charges, • Helping you understand your plan
and you may be responsible for filing claims. benefits
• Getting answers to your drug and
Two PPO Plan Options are Available: medication questions
• PPO High • Answering questions about your
• PPO Low doctor’s instructions

Finding a Medical Provider
Go to www.blueshieldca.com. When prompted to enter a plan
type, select “2019 Employer Plans (101+ Employees)” and refer to
the sub-plans noted below:
• Trio HMO: Refer to the “Trio ACO HMO”
• Access+ HMO: Refer to the “Access+ HMO”
• PPO High & Low: Refer to the “Blue Shield of California PPO”

Educational Video
Health Insurance Terms
http://video.burnhambenefits.com/terms

Employee Benefits 9