• Is birth control for women covered?

• What is a guaranteed issue plan?

• How do deductibles work?

• If I choose a plan with a deductible, do I have to meet my deductible before receiving services?

• What is the difference between Blue Shield's PPO plans?

• What is a Health Savings Account (HSA)?

• Can individual family members have different plans?

• Can I get coverage for just my children?

• Who is eligible to apply for Blue Shield individual and family plan coverage?

• Is preventive care covered?

• Is pregnancy a waivered condition?

• Is alternative care covered?

• What is the Evidence of Coverage and Health Service Agreement/Policy?

• Do short-term health insurance plans cover prescription drugs?

• Short-Term Health Plans.

• What's the difference between a PPO and an HMO?

• Is my doctor or hospital part of the Blue Shield network?

• How soon can I get coverage?

• Is there an exclusion for pre-existing conditions?

• Can I get dental coverage through Blue Shield?

Is birth control for women covered?
Yes. All of our individual and family health plans include benefits for oral contraceptives, diaphragms and injectable contraceptives.

What is a guaranteed issue plan?
The federal Health Insurance Portability and Accountability Act (HIPAA) makes it easier for people covered under existing group health plans to maintain coverage regardless of pre-existing conditions when they change jobs or are unemployed for brief periods of time. If you meet all specified conditions, you may be eligible for a guaranteed issue plan in accordance with HIPAA, and we will automatically accept your application without underwriting. For more information, please call us at (888) 568-3560.

How do deductibles work?
Many health plans include a deductible. You must satisfy this amount each year before Blue Shield makes payments towards covered services. Depending on your plan design, some services may be covered by Blue Shield before your deductible is met. The EOC/Policy for the plan includes more details about what services are available before meeting the deductible. In addition, if your plan has a deductible and you have family coverage, a family deductible applies. Each individual's deductible is satisfied once the family deductible is met. For example, if the family deductible is equal to twice the individual deductible, and two people in the family satisfy their deductible, then the deductible is satisfied for all family members covered under the plan for the remainder of the calendar year.

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If I choose a plan with a deductible, do I have to meet my deductible before receiving services?
While a majority of services require that you meet your plan deductible first, many benefits, such as generic prescriptions, well-baby care and physical and gynecological examinations with a preferred provider are covered before you have satisfied your plan deductible with most plans. Please note that some plans have a brand-name drug deductible and you must first meet this deductible before benefits for brand-name drugs will be covered.

What is the difference between Blue Shield's PPO plans?
Each of the five Shield Spectrum PPOSM plans provides a wide range of benefits, a choice of providers and many fixed copayments before meeting the deductible. In general, Shield Spectrum PPO plans with lower deductibles have higher monthly dues/premiums. Shield Spectrum PPOSM Savings Plans, our high-deductible health plans that are compatible with a Health Savings Account, can help meet essential healthcare needs, and are often selected by people who go to the doctor occasionally. Active Start PlanSM 25 and 35* are affordable plan options that combine no medical plan deductible with lower generic drug copayments and low copayments for office visits and preventive care. Active Start Plans provide individual-only coverage and do not provide maternity benefits. Shield Spectrum PPO Savings Plan 4000/8000 does not provide maternity benefits.

What is a Health Savings Account (HSA)?
An HSA is an individually owned, tax-advantaged investment or personal savings account that can be established with a high-deductible health plan. These accounts are portable -- you can take them with you if you change jobs -- and may be accumulated over the years and distributed on a tax-free basis to pay, or reimburse, qualified medical expenses as defined by the IRS.

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Can individual family members have different plans?
Yes. Sometimes it may better suit your healthcare needs or budget to place family members on different types of plans.

Can I get coverage for just my children?
Yes. Special YouthCareSM rates are available for all of our plans. YouthCare plans provide your children with the same healthcare benefits we offer in our individual adult and family plans, at special rates for children under the age of 19. You can even select a different plan for each child whether or not you have a Blue Shield plan of your own.

Who is eligible to apply for Blue Shield individual and family plan coverage?
Residents of California who are ineligible for Medicare and not over the age of 65. In most cases, approval will be based on your health history. If you do not qualify for a guaranteed issue plan, you will be medically underwritten.

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Is preventive care covered?
Yes. All of our individual and family health plans include coverage for preventive care such as physical examinations, immunizations, well-baby care and gynecological exams when a preferred provider is used.

Is pregnancy a waivered condition?
A waivered condition is excluded from coverage for charges and expenses incurred six months from the effective date of coverage. A waivered condition only applies to a condition for which medical advice, diagnosis, care or treatment (including prescription drugs) was recommended or received from a licensed health practitioner during the six months immediately preceding the effective date of coverage.

Is alternative care covered?
Most Blue Shield plans provide chiropractic coverage. The Active Start Plans also cover acupuncture. You can also save money through the mylifepath alternative health services discount program, a standard feature on all Blue Shield plans, on the following services by receiving discounts of at least 25% off the provider's usual charge or the program's maximum fee schedule: Acupuncture Chiropractic Massage therapy Please note that none of the terms and conditions of Blue Shield's health plans applies to these discount services as these discounts are not part of your health plans' covered services.

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What is the Evidence of Coverage and Health Service Agreement/Policy?
The Evidence of Coverage and Health Service Agreement (EOC), or Policy for Individuals and Families (Policy), are the official plan contracts. They explain in full all the terms of plan coverage, including benefits, copayments or coinsurance, exclusions, limitations and how to access coverage.

Do short-term health insurance plans cover prescription drugs?
After you meet your deductible, Blue Shield Life short-term health insurance plans cover 70% of the first $5,000 of allowable amounts for all covered services (including prescription drugs) and 100% of the allowable amount for covered services in excess of $5,000.

Short-Term Health Plans

Blue Shield of California Life & Health Insurance Company offers two different short-term health plans. The plans offer similar benefits, but have a few key differences.

Option One

Choose the length of time you want coverage for -- from 30 to 185 days   Make a single payment

Option Twelve

Receive continuous coverage month to month for up to 12 months   Monthly billing available

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What's the difference between a PPO and an HMO?
There are many differences between them, but the most significant difference is how you access care. If you're covered by a PPO plan, you may visit any licensed doctor. In an HMO plan, you need to access non-emergency care through a designated Personal Physician to be covered. You can choose your own Personal Physician or we can assign one to you.

Is my doctor or hospital part of the Blue Shield network?
We offer an extensive network of physicians throughout California. To see if your doctor, hospital or other provider is part of our network, use the Find a Provider tool.

How soon can I get coverage?
It can take four to six weeks to review your application. If you need coverage sooner, Blue Shield of California Life & Health Insurance Company offers short-term health insurance that can be effective almost immediately if you qualify. Please note that if you currently have group coverage, enrolling in a short-term health insurance plan may cause you to be ineligible for a guaranteed issue individual plan in the future.

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Is there an exclusion for pre-existing conditions?
For our Blue Shield PPO plans, benefits will not be provided for pre-existing conditions in the first six months of coverage. This exclusion may be waived if you have prior creditable coverage. You may have prior creditable coverage if your previous health plan covered the services in question and your application for Blue Shield coverage was received by us within 63 days of terminating your previous plan coverage.

Can I get dental coverage through Blue Shield?
If you're a Blue Shield individual and family plan member, you can add on one of our optional dental PPO or HMO plans for an additional cost. If you are an Access+ HMO® member, you have basic dental benefits, called Access+ Dentist, included in your plan. Access+ HMO members can choose to purchase the more generous dental PPO or HMO plan instead of receiving Access+ Dentist services. There is no coordination of dental benefits between health and dental plans.