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Blue Shield of California
Access+ HMO and Value HMO

Access+ BrochureDo you or your dependents go to the doctor often?

Quick QuoteIf your answer is "yes" Access+ HMO might be the right plan for you: You'll have access to a wide range of routine and preventive care services, prescription drug coverage and mental healthcare visits for a small copayment or for no out-of-pocket charge at all, without having to meet a deductible.

Please see the following Uniform Plan Matrix for specific benefit details.

Blue Shield of California Access+ HMO plan advantages

  • Affordable $20/$35 office visit copayments
  • $10 copayments for generic drug prescriptions; $35 for brand-name drugs
  • Direct access to a specialists
  • $2,000/$4,000 hospital deductible
  • Preventive Care provided at no extra charge
  • Blue Shield's HMO network has more than 25,000 doctors and 280 hospitals thoughout California
  • Basic dental services with Access+ HMO
  • No lifetime maximum on plan benefits
  • Virtually no claim forms
Personal Care from your Personal Physician

Your relationship with the Personal Physician you choose is the key to your Access+ HMO Plan:

  • Provide or coordinate your necessary medical services
  • Arrange for referrals to specialists and hospitals and other covered non-physician healthcare practitioners
  • Authorize medically necessary Emergency Services. (Your Personal Physician or his or her designee will be available 24 hours a day, seven days a week.)

Blue Shield Monthly RatesSpecial Features of the Access+ HMO Plan

Self-Referral to Specialist - With Access+ Specialist you can go directly to a specialist or other physician in the same medical group or IPA as your Personal Physician, without a referral. When you self-refer, your copayment will be $35/$50 per covered office visit (depending on which plan option you select). To use the Access+ Specialist option, you must belong to a medical group or IPA that is an Access+ Specialist provider group.

Self-referrals to Gynecological Exams and OB/GYN Visits - Women may go to directly to an OB/GYN or family preactice physician in the same medical group or IPA as their Personal Physician for obstetrical/gynecological services - including annual gynecological exams - without a referral.

   

Money-back Guarantee - Blue Shield's member feedback program, Access+ Satisfaction, will refund your usual office visit copayment and provide a postage-paid postcard for your comments if you are ever dissatisfied with the service you receive during a covered office visit with an HMO network physician.

One Decreasing Deductible Plan

The NEW Stand Alone Dental Plans now available...

Blue Shield Dental PlanBlue Shield Dental PlansBlue Shield of California now offers a range of affordable and comprehensive dental plans available to residents of California with or without a Blue Shield health plan. With Blue Shield's broad dental network including nearly 20,000 dental PPO providers and more than 8,600 HMO providers in California it is easy to access one of the largest networks in California.

Blue Shield offers two new PPO dental plans to choose from. The new Smile PPO and the Value Smile PPO dental plans both provide you affordable options to help you stay healthy now and avoid costly dental expenses in the future. The savings you will receive with the Smile PPO plan keep the cost of dental work from taking a deep bite our of your wallet later. The Value Smile PPO plan provides preventive, diagnostic, and some minor restorative services designed to aid in reduction of future costly services. Find out more on these two new plans and how to enroll by clicking here.....

 

To enroll, you must be:

  • Age 64 3/4 or younger
  • A permanent legal resident of California
  • A U.S. resident for at least the lst 3 months
  • The applicant's spouse or domestic partner, age 64 3/4 or younger
  • The applicant's children (under 19 years of age), or the children (under 19 years of age) of the applicant's enrolling spouse or qualified partner or qualified domestic partner;
  • The applicant's unmarried dependent children between the ages of 19 through 22 ("dependent" as defined by the Internal Revenue Service)
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left corner Blue Shield of California Access+ HMO Benefit Matrix right corner
Covered Services
Access + Value HMO
Access + HMO
Deductible $2,000 ($4,000 family) $2,000 ($4,000 family)
Calendar-year copayment maximum (includes the plan deductible - some services do not apply) $4,000 ($8,000 family) $3,000 ($6,000 family)
Lifetime Maximum
(includes deductible)
(Combined for In-Network & Out-of-Network)

No Limit No Limit

* Benefits for covered brand-name drugs are subject to a separate brand-name drug deductible per person for formulary and non-formulary. Access+ Value HMO has a $400 brand-name drug deductible, and Access+ HMO has a $200 brand-name drug deductible.

All the benefits listed in the benefit matrix are covered by the Access+ Value HMO and Access+ HMO plans. Plan services and supplies are covered when performed, prescribed, or authorized by your Personal Physician. Other than the exceptions listed on page 32, services that are not obtained or approved by your Personal Physician will not be covered.

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