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County of San Bernardino –
Retirees
Effective January 1, 2020
Aim higher with Blue Shield
• Large networks mean you’ll find doctors you like close to home or work
• Collaboration with doctors and hospitals to
deliver “accountable care” -- you benefit from combined knowledge and expertise
• As a mission-driven nonprofit, we’re reforming the system with an eye on quality and affordability
High performance
• Care programs to improve and maintain your health no matter what your health status
• Customized care programs for members with complex or advanced conditions based on needs and preferences – not “factory medicine”
High touch
• Website / mobile app provide suite of 24/7 resources to simply, conveniently manage your family’s health care
• Teladoc video/phone visits that bring care to you
High technology
• Discounted wellness products and services to encourage healthier lifestyles and make your healthcare dollars go further
High value
2
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“There are some big differences between plans.Which one’s right for me?”
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Blue Shield plans for retirees
• Shield Signature Plans – non-Medicare
• Shield Signature – High
• Shield Signature – Low
• NEW – TRIO HMO Plan – non-Medicare
• Medicare Integrated Plans
• Blue Shield 65 Plus (HMO) – GMAPD High
• Blue Shield 65 Plus (HMO) – GMAPD Low
• Blue Shield of California Medicare Rx Plan (PDP)
• Medicare Coordination of Benefits PPO Plan
• Shield Spectrum PPO plan – COB
Health plans include:
Pharmacy benefits
NurseHelp 24/7
Teladoc
Health programs
Trio HMO Plan
This chart is intended to provide a high level summary of plan benefits. The Evidence of Coverage and
Plan Contract should be consulted for a complete description of plan benefits and coverage.
Annual deductible None
Calendar-year
copayment maximum
$3,000 per individual
$9,000 per family
Office visits $50/visit
Inpatient hospital $1,000/admission
Outpatient surgery $750/surgery
Ambulance services $250/transport
Emergency services
No direct admission
Direct admission
$250/visit
$1,000/admission
Diagnostic lab/x-ray $0
Retail drug copayments $10/$30/$50/$50
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Blue Shield’s fastest-growing HMO, keeping
members highly satisfied with convenient access
to care among known, local providers
• New in 2020!
• Use Heal doctor-on-demand services via phone, web, or mobile; first visit is $0!
• $0 same day Rx delivery with Heal
• $0 copay for Teladoc
• Choose your own doctor, specialists and pharmacies within the Trio network
• Access Teladoc doctors for phone or video appointments, 24/7/365 with $0 copay
• End-to-end service from Shield Concierge, our dedicated support team to help you make care decisions, manage your plan benefits, and transfer medical records
• Engage in digitally-enabled wellness programs
• Access urgent and emergency care coverage anywhere in the world
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House calls, hotel calls—a doctor when and where you
need one for urgent, primary, and preventive care
“I’m at a conference but in my hotel bed with a bad sore throat. I want to seea doctor.”
• Book a doctor on demand to come to you (home, office, or hotel) via phone, web, or mobile
• More convenient than a visit to the Emergency Room
• Access for all Blue Shield PPO and Trio members in select service areas in California, as well as Georgia, DC and Northern Virginia.
• Cost is typically the same as a visit to your doctor* and vary by plan type. For Trio and Tandem, the first visit is $0, with free, same-day Rx delivery after 1/1/20
• Available 8 a.m. to 8 p.m., 365 days a year
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Imagine this:
* Exception: PSP members must pay the full cost of the visit until their deductible is met
LifeSpring: Free meal delivery for Trio members
Intended to provide eligible Trio members
with convenient and nutritious meals while
recovering from serious illness.
Prepared meals are geared towards
people with special dietary requirements.
Available statewide. A Blue Shield Case
Manager determines member eligibility
and meal service delivery frequency.
Call the Car: Non-Emergency
Transportation for Trio members
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This is a non-emergency transportation
service for eligible Trio members
undergoing recovery from serious illness.
Intended to provide eligible members
with reliable transportation to and from
their medical appointments to help with
their recovery.
A Blue Shield Case Manager determines
member eligibility.
Trio HMO or Shield Signature?
A good choice if you’d like…
POS
A select, integrated provider network that provides you with more coordinated care:
• Teladoc 24/7 phone/video doctor visits
for $0 copay after 1/1/20
• Digitally-enabled wellness programs
• Covered urgent and emergency care
while traveling
• Heal at-home doctor visits; first visit $0
after 1/1/20.
A broader HMO network thatoffers more choice of doctors.
• Choose your own doctor (Level 1), self-
refer to physicians (Level 2) for office
visits only
• Teladoc 24/7 phone/video doctor visits
for low copay
• Digitally-enabled wellness programs
• Covered urgent and emergency care
while traveling
1LifeReferrals 24/7 available to groups with 101+ employees.
Shield Signature Trio HMO
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Trio HMO Plan or Shield Signature Low Option
Trio HMO Shield Signature – Low Option
Annual deductible None Annual deductible None
Calendar-year
copayment maximum
$3,000 per individual
$9,000 per family
Calendar-year
copayment maximum
$3,000 per individual
$9,000 per family
Office visits $50 Office visits $50 Level 1 / $80 Level 2
Inpatient hospital $1,000/admission Inpatient hospital $1,000/admission
Outpatient surgery $750/surgery Outpatient services $750/surgery
Ambulance services $250/transport Ambulance services $300/transport
Emergency services
No direct admission
Direct admission
$250/visit
$1,000/admission
Emergency services
No direct admission
Direct admission
$250/visit
$1,000/admission
Diagnostic lab/x-ray $0 Diagnostic lab/x-ray $0
Retail drug copayments $10/$30/$50 Retail drug copayments $10/$30/$50
This chart is intended to provide a high level summary of plan benefits. The Evidence of Coverage
and Plan Contract should be consulted for a complete description of plan benefits and coverage. 11
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“How can I get the most out of my healthcare dollars?”
Programs designed to help you live
better with illness, recover from acute
conditions, and have a more seamless
healthcare experience
Shield Support Program
Nurse support, home visits, self-management
tools and workshops to help members with:
• Behavioral health
• Cancer
• Chronic Conditions, e.g. Coronary Artery Disease, Heart Failure, Diabetes, COPD, Asthma
• Catastrophic injury
• Musculoskeletal conditions & pain management
• Stroke
• LGBTQ health needs
• Transplant process
• Plus: ER utilization, post-discharge from hospital, opioid use, high cost and direct referrals
Support to manage your health
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Contact Teladoc: 1-800-Teladoc
“I feel like I have the flu, but I don’t want to wait in the ER on a Friday night.”
Log in to your Teladoc account or call Teladoc, 24/7/365, to request a phone or online video consult-ation for primary care services.
Step 1
Contact Teladoc
Step 2
Talk with a doctor
Step 3
Resolve the issue
Step 4
Settle up
Step 5
Smile<10 MinutesAverageWait Time
A board-certified doctor reviews your Electronic Health Record (EHR) and consults with you, just like an in-person visit.
The doctor recommends a treatment for your medical issue. If a prescription is needed, it’s sent electronically to the pharmacy of your choice.
Your medical issue gets resolved, and you save time and money!
• $0 copay for HMO and PPO plans (lower cost than an office visit).
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Imagine this:
Online and in-person programs for both general wellbeing and disease reversal
Proven and backed by doctors’ methods for results
Largest collection of scientifically-backed apps
A personal digital health coach, taking guesswork out of your health strategy
A new way to achieve your health goals
Included with your health plan at no additional cost
Take charge of your
health with Wellvolution
You choose
areas of focus
We help with digital tools,
personalized weekly task
plans, and helpful information
when you need it
Go it alone or join a
support community –
online or in person
Trust in a hand-picked
network of tools that are
scientifically proven to
bring results
Create new plans as your goals
change to keep Wellvolution
giving you important
information and help
Connect to your phones
and/or other fitness-trackers
you already own -- no new
equipment needed
01 02
03 04
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Your health journey
now has a plan
Visit wellvolution.com to get started on your personal proven path.
Wellness discount programs
Save on alternative healthcare services from
participating practitioners.
25% or more off usual and customary fees for:
• Acupuncture
• Massage therapy
• Chiropractic services
Discounts also available for health and wellness
products like vitamins and supplements.
Alternative care
Lose those extra pounds and keep them off with
nationally recognized lifestyle change programs.
•Enroll in weight management programs at no
additional charge through our Wellvolution®
Diabetes Prevention Program.
•Save on Weight Watchers with special rates on
three- and 12-month subscriptions. Monthly pass is
also available for unlimited local meetings each
month, plus free eTools.
Weight management programs
Enroll in one of the most flexible gym membership
programs to stay committed to your health goals.
•Work out at any facility within our wide network
of more than 10,000 national fitness locations.
•Work out as often as you need while tracking
progress to your goals online.
•If you are a Medicare-eligible member, you
have access to gyms and fitness classes with
coverage provided by our SilverSneakers® fitness
program.
Fitness and exercise
Save on eye services at participating providers
whether or not you have vision care benefits.
Discount Provider Network – Save 20% on eye
exams, frames and lenses, contacts, and more.
MESVision Optics – Competitive prices on
contacts, glasses and eye care accessories.
QualSight LASIK – Save on LASIK surgery at more than 45 surgery centers in California.
NVISION Laser Eye Centers – Get a 15% discount
for laser services.
Vision discounts
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Overview
The ‘Fitness your way’ program provides eligible members
access to 10,000+ participating fitness centers nationwide
for $25 per month with a one-time $25 enrollment fee.
• Eligible Blue Shield California members enroll via the ‘Fitness your way’ website or by phone
• Members download a membership card on the website to use at a fitness center immediately
• Enrolled members pay Tivity Health through a recurring
payment every month
• Members can visit multiple locations – no need to select only one fitness location
• The offer is available to Blue Shield members and covered dependents age 18 or older
Blue Shield of California
Fitness your way by Tivity Health
SilverSneakers® Fitness Program(Blue Shield 65 Plus HMO members only)
SilverSneakers provides a basic membership to any participating
Fitness center location across the country. Program includes:
• Access to conditioning classes, exercise equipment, pool, sauna and
other available amenities
• Signature SilverSneakers Fitness Program classes, designed specifically
for older adults and taught by certified instructors
• Fun social activities and events, including health education seminars
• Access to an exclusive member online community at
www.silversneakers.com/member.
• SilverSneakers® Steps is a personalized fitness program for members
who don’t have convenient access to a SilverSneakers location within
15 miles of their home.
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Discount vision programSave 20% at participating providers on:
• Routine eye exams
• Frames, lenses, tints & coatings
• Extra pair of glasses
• Hard contact lenses
Vision and hearing discount programs
QualSight LASIK
20% discount on
traditional and custom
LASIK surgery.
Nvision Laser Eye Centers
15% discount on
LASIK procedures.
EPIC Hearing Service
30-60% off MSRP on major brand
hearing aids and related
professional services.
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Coverage right down to your identity
AllClear ID identity protection available for all eligible*
Blue Shield members—at no extra charge!
*Blue Shield Federal Employees Program, Medicaid, Medicare Advantage HMO, and Medicare Prescription Drug Plan members are not eligible.
• ID theft monitoring services
• Credit monitoring services, with lost wallet protection
and fraud resolution
• Identity repair services
100% success in resolving financial
identity theft cases in the U.S.
Access services by calling (855) 904-5733, Monday to Saturday, 6 a.m. to 6 p.m. PST, or visiting blueshieldca.allclearid.com
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Registering on blueshieldca.com is easy
• Have your member ID number and email address handy.
• Create a username and password, select security Qs and As.
• Search for network doctors, hospitals and other facilities
• Get information about medical and pharmacy benefits
• Print copies of your Blue Shield ID card
• Learn about Blue Shield programs and services
• Get secure access to medical and pharmacy benefits, claims and more
• Email Member Services with questions such as claims issues, benefits, providers, etc
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Redesigned, rebuilt app for easy use
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We’re here to help
• Member Services
• Shield Signature, TRIO, Shield Spectrum PPO plans
(855) 829-3566
7:00 a.m. to 7:00 p.m., Monday through Friday
• Blue Shield 65 Plus HMO
(800) 776-4466 [TTY: (800) 794-1099]
7:00 a.m. to 8:00 p.m., seven days a week from October 1 through February 14. However, after February 14, calls will be handled by our automated phone system on weekends and holidays
• Blue Shield of California Medicare Rx Plan PDP
(888) 7766-4466 [TTY: (888) 238-6482]
7:00 a.m. to 8:00 p.m., seven days a week from October 1 through February 14. However, after February 14, calls will be handled by our automated phone system on weekends and holidays
Thank youWe look forward to caring for you
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