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Medical Benefits

Blue Shield | HMO Medical Plans
With the Blue Shield of California Health Maintenance Organization (HMO) plans, you are required to select a Primary Care
Physician (PCP) within the Blue Shield HMO Provider Networks. You will have the choice of two networks:

• Trio ACO HMO® Network provides access to 10,000 doctors in 24 California counties. With Trio HMO, discover:

 Lower premiums – providing the potential to reduce employee contributions
 Enhanced customer service with Shield Concierge
 With Trio plans, members get access to Shield Concierge – personalized and coordinated customer care
assistant. One simple phone call connects members to a team of health experts who are ready to answer their
health-related questions. In doing so, this Trio feature helps reduce an employer’s administrative burden and
improves member experience with one number for members to call for comprehensive white-glove service.
 Coordinated care—Thanks to a unique plan design, members can expect a better – and more efficient – care
experience.
 Blue Shield of California and medical groups, such as Facey and Axminister Medical Group have teamed up to work
toward a more streamlined healthcare experience. Together, they are helping to provide members with clinical care
that is more personalized and easier to access. Click on this link to find out more about this special partnership
https://files.marcomcentral.app.pti.com/bsc/A49206-FACEY.pdf. Included in these networks are hospital affiliations
such as Providence Holy Cross Medical Center, Providence St. Joseph Medical Center, Henry Mayo Newhall
Memorial Hospital and more.

• Access+ HMO® Network provides access to more than 40,000 doctors in California.

Once you select your PCP, your PCP will coordinate all of your medical care. 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.
Any specialty care you need will be coordinated through your PCP and will generally require a referral for authorization. Blue
Shield offers online tools, including a mobile app, so you can make appointments, refill prescriptions and more.

HMO Plan Highlights:
• To be eligible for the HMO plan, you must reside in the Blue Shield of California HMO service area
• You must select a PCP from Blue Shield’s pre-approved list of healthcare providers. You must select a provider who
participates in the TRIO network
• If you need specialist care, you’ll need a referral from your PCP. If you choose to use the Access+ Specialist benefit you
must select a personal physician who is affiliated with a medical group or IPA that is an Access+ provider group, which
offers the Access+ Specialist feature. You should then select a specialist within that medical group or IPA.
• Each family member may choose his or her own Blue Shield HMO network PCP

Blue Shield | PPO Medical Plan
With the Blue Shield Preferred Provider Organization (PPO) plan, you have the free-
dom to choose your doctor without using a Primary Care Physician (PCP) and you may
self‐refer to specialists. You may use a PPO provider whose negotiated rates provide Finding In-Network
richer levels of benefits with claim forms filed by the providers. Medical Providers

PPO Plan Highlights: • For Access+ HMO : Go to
• You are not required to select a PCP blueshieldca.com/networkhmo
• As a PPO member, you may use a PPO provider outside of the PPO plan network, • For Trio HMO: Go to blueshield-
ca.com/networktriohmo
but you will pay more out-of-pocket and may be responsible for filing claims. If • For PPO: Go to
you visit a non-network provider or health care facility, the plan will pay benefits blueshieldca.com/pponetwork
only up to the “allowed amount,” which is based on a limited fee schedule. You
will have to pay any charges above the allowed amount (in addition to your regu-
lar co-insurance).
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