Page 5 - Premier EE Guide 01-20 - CA- Updated 01.03.2020

BENEFITS

MEDICAL INSURANCE

Option 1 (Trio HMO)
Blue Shield of California | Trio HMO Per Admit 20

With the Blue Shield of California Accountable Care Organization (ACO) Health Maintenance Organization (HMO) plan, you must
choose a Primary Care Physician (PCP) within the Trio ACO network for all of your covered family members. All of your care must
be directed through your PCP. You will receive benefits only if you use the doctors, clinics, and hospitals that belong to the ACO
provider network, except in the case of an emergency or with prior authorization. This plan allows you to receive specialist referrals
from your PCP or you may self-refer to Trio+ specialists within your PCP’s medical group for the same copay. This smaller ACO
network of providers is designed to reduce costs for you by eliminating unnecessary expenses without sacrificing comprehensive,
quality care. You benefit from collaboration, more effective coordination between providers, and the sharing of critical
information that helps drive better overall health.

Option 2 (Access+ HMO)
Blue Shield of California | Access+ HMO Zero Admit 20

With the Blue Shield of California Health Maintenance Organization Access+ (HMO) plan, you must choose a primary care physician
(PCP) within the Blue Shield HMO network. All of your care must be directed through your PCP. 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. This plan allows you to receive specialist referrals from your PCP or you may self-refer to Access+ specialists within
your PCP’s medical group for a higher copay.

Option 4 (HDHP PPO Medical)
Blue Shield of California | Full PPO Savings Two-Tier Embedded Ded 1500/2800/3000

With this plan through Blue Shield, you can pay for qualified healthcare expenses now and grow your savings for future healthcare
needs. This plan combines a High Deductible Health Plan (HDHP) with a special, tax-qualified Health Savings Account (HSA). You can
contribute tax-free money to your HSA up to IRS maximums. The money in your account is yours to pay for current healthcare
expenses - or you can save for future healthcare expenses. Similar to the PPO plan, you have the freedom to choose your doctor
without the requirement of selecting a PCP and you may self-refer to specialists. You may use the Full PPO network whose
negotiated rates provide richer levels of benefits. You may also obtain services using a non-network provider; however, you will be
responsible for the difference between the covered amount and the actual charges.

Finding a Medical Provider
Go to www.blueshieldca.com or call (855) 829-3566 for Trio ACO HMO or (888) 256-1915 for Access+
HMO and PPO. When prompted, please refer to the network name for the plan you’ve selected:
• Trio ACO HMO: blueshieldca.com/networktriohmo
• Access+ HMO: blueshieldca.com/networkhmo
• HDHP PPO: blueshieldca.com/networkppo

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