Blue Shield Point-of Servive (POS) Medical
Through the vast Blue Shield provider network, the CAPE Blue Shield Classic and Lite plans combine the cost savings of HMO plans with the flexibility of traditional Fee-For-Service plans. Each time you need medical care, you decide who provides your care: your Personal Physician, a Preferred Provider in the Blue Shield network, or any other licensed medical care provider. This plan gives you freedom of choice and puts you in control of your health care needs. Both CAPE Blue Shield plans include prescription drug, mental health, vision, a $20,000 survivor benefit, and chiropractic and acupuncture coverage.
CAPE/Blue Shield Plan Highlights: Diabetic supplies covered at 100%. Enhanced survivor benefit at $20,000. Teladoc program providing access to a Board Certified doctor by phone or face to face through online video chat 24/7/365. Heal, a service that lets you see a doctor at a time and place that's best for you. NEW Travel Assistance Program. Enhanced vision benefits. Enhanced DME/orthotic/prosthetic coverage, acupuncture and chiropractic benefits through ASHP’s provider network (using your CAPE/Blue Shield medical ID card). IMPORTANT REMINDER! Take a moment to complete and submit the Beneficiary Designation Form for the $20,000 Survivor Benefit.
- Essential Eye Care Services: Your well-being is at the heart of everything we do. The connection between your eyes and overall health is important and this expanded access will allow you to get eye care when you need it most.
Chiropractic and Acupuncture: Provided with CAPE Blue Shield coverage, extensive chiropractic and acupuncture benefits are available without a referral from your Personal Physician. Depending on which Blue Shield plan you choose, you will either have a $10 or $15 co-pay per visit with the new benefit of unlimited visits in a calendar year (based on medical necessity). Provider network through American Specialty Health Plans.
- CAPE Blue Shield Discounts: CAPE Blue Shield participants (and covered dependents) may also enjoy discounts on a variety of Health & Wellness programs such as Weight Watchers, 24 Hour Fitness, Club Sport and Renaissance Club Sport facilities. Participants may also find additional discount savings after using their vision, acupuncture and chiropractic benefits (includes providers outside of the above networks).
Click here to download the 2024 CAPE/Blue Shield Lite and Classic Point of Service (POS) brochure.
Click here to download the 2024 Blue Shield Classic and Lite Plans OE brochure.
Levels of Care
The CAPE/Blue Shield Point-of-Service Lite and Classic plans combine typical HMO and PPO coverage with an Out-of-Network option, giving you provider choice and flexibility. While you must select a Personal Physician upon enrollment, you decide who provides your care when seeking medical services. There are three levels of benefits under each plan, as outlined below:
Level I: The HMO Option
When you receive care through your Blue Shield HMO Personal Physician:
- You receive the highest level of benefits.
- There are no deductibles and virtually no claim forms.
- You pay fixed co-payments for most covered services.
- Preventive care services are covered at no charge.
- There is no lifetime dollar maximum.
Level II: The Preferred Plan Option
If you self-refer your care to a Blue Shield Preferred Provider:
- You can choose from more than 51,000 physicians, 380 hospitals, and 40,000 allied health professionals throughout California.
- You rarely have to pay at the time of your visit or bother with claim forms.
- Once you meet your plan's calendar year deductible, you pay only the applicable co-payment for covered services.
- You're not responsible for provider charges above the amount Blue Shield allows for covered services.
Level III: The Non-Preferred Plan Option
If you self-refer your care to a Non-Preferred Provider:
- You may visit any licensed provider.
- You receive the lowest level of benefits, and your Co-payment Maximum will be higher than when you choose a Blue Shield Preferred Provider.
- You may have to pay for services at the time of your visit or be billed afterwards for the entire amount.
- You'll have to file claim forms with Blue Shield.
- You are responsible for paying any difference between the amount Blue Shield allows and the amount billed by the provider.
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Blue Shield Point-of-Service (POS) Medical Insurance
Blue Shield of California
P.O. Box 272540
Chico, CA 95927-2540
www.blueshieldca.com
Member Services 1-855-256-9404
This information is extracted from the Blue Shield POS Plan Member Booklet and is only a summary. Please refer to the Evidence of Coverage for specific and complete plan details. If you have further questions regarding covered services, please contact Member Services at (855) 256-9404. And, you may always contact us at [email protected] or (800) 487-3092.
