Blue Shield HMO is one of the three medical plans available to eligible participants.
Must use Health Plan Providers
No plan maximum
Your copayment is:
$25 per visit
Your copayment is $100 per confinement
Your copayment is $100
100% preventive care coverage is available in accordance with the Affordable Care Act. Click here for more information.
No charge if authorized
All prescriptions must comply with the formulary unless preauthorized.
|Copayment for Generic||Copayment for Name-Brand|
(up to 30 day prescription)
|Mail Service Pharmacy
(up to 90 days)
No charge in hospital if enrolled within 31 days of birth
Main Telephone Number: 1-800-642-6155
Hearing Impaired (TTY): 1-800-442-8833
The Evidence of Coverage and Disclosure Form booklet describes the terms and conditions of coverage of your Blue Shield health Plan. Click here to view the booklet.
Effective 8/1/11, Substance Abuse Treatment and Mental Health benefits will be available through Blue Shield. Blue Shield HMO participants have access to Blue Shield's Life Referrals 24/7, which is similar to the Member Assistance Program (MAP) formerly available through OptumHealth. This program allows members to access a 24/7 help line (800-985-2405) to speak with a mental health counselor, life coach, or even a financial advisor. As with regular medical benefits, HMO Participants will be required to use Blue Shield's network.
$0 Copay per out patient treatment
$0 Copay per in patient confinement