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affordability and coordinated care start here.

blueshieldca.com

Your 2020 Trio HMO health plan guide

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Welcome to Blue Shield

With a Trio health maintenance organization (HMO) plan, you no longer have to choose between the hospitals you want and the prices you can afford. Enjoy our select networks of doctors, specialists, hospitals, and labs – all working together for you.

Use this guide to get the most from your plan, from accessing care when and where you need it to saving money with wellness discounts.

Contents

Register for your online account . . . . . . . . . . 3

Get started . . . . . . . . . . . . . . . . . . . . . . 3

Your plan details . . . . . . . . . . . . . . . . . . . 5

Accessing care. . . . . . . . . . . . . . . . . . . . 6

Health and well-being . . . . . . . . . . . . . . . 8

New highlights for 2020

• Teladoc virtual care with $0 copay

• $0 copay for your first Heal™ house call

• Healthy Savings® grocery discounts

• Meal delivery and transportation for qualified members, at no additional cost

Healthy Savings is an independent entity that administers services on behalf of Blue Shield of California.

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Register for your online account

Get started

View or print your Blue Shield member ID card.

Find a provider with our Find a Doctor tool.

View your billing, claims, benefits, deductibles, and copayments.

View or change your primary care physician (PCP).

Get smart tips to control your healthcare costs and many other helpful resources.

Register at blueshieldca.com/register.Creating your online member account is the first important step to making the most of your health plan, and it takes only a few minutes:

Go to blueshieldca.com/register.

Follow the instructions and create your username and password.

You’re registered! Now you have 24/7 secure access to your plan information and a wide range of resources, all in one place.

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• Now that you are registered, find helpful information for new Trio members at blueshieldca.com/triowelcome.

• Get familiar with your benefits at blueshieldca.com/gettingstarted. You can view and print plan documents that provide details about plan benefits and other available programs and services.

Shield Concierge is your team of experts – customer service representatives, registered nurses, pharmacists, pharmacy technicians, health coaches, and social workers – all working together for you.

They can help you:

• Understand your plan benefits

• Find a new doctor

• Answer questions about your doctor’s instructions or medication

• Enroll in health and wellness programs

• And much more

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Your primary care physician (PCP)Your PCP is your first point of contact and provides routine care, preventive screenings, vaccinations, and refers you to specialists. Learn more about PCPs at blueshieldca.com/triopcp.

To view or change your PCP, call Shield Concierge or log in at blueshieldca.com/login.

Go mobile and put your plan in your pocketYou can get health plan and healthcare services information anytime, anywhere through the Blue Shield website and mobile app. You can download the mobile app on the App Store® or Google Play™.

Print a Blue Shield member ID cardYou will receive your member ID card in the mail. In the meantime, you can view and print a copy of your card through your online account at blueshieldca.com/login. Covered family members will receive their own ID cards, which will also list their PCPs.

View your claims While you’re logged in to your online account, you can see your most recent claims and detailed information for each claim, including total billed amount, patient responsibility, and more. Sign up for automated claims alerts and we’ll send you an email when your finalized claims are available to view online.

Log in to your online account and take the Wellness Assessment – which measures your overall well-being and provides insights into

your physical, emotional, and social health.

App Store is a service mark of Apple Inc.

Google Play is a trademark of Google LLC.

Need help registering?

Please call Shield Concierge at the number on your Blue Shield member ID card.

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Your plan details

Review your benefits Download a copy of your Evidence of Coverage and Health Service Agreement, or EOC, from blueshieldca.com/welcome to get a detailed description of your plan’s benefits and what’s covered. Enter your member ID number to see your plan documents. While there, you can also access the Summary of Benefits and Coverage (SBC) forms, which provide a summary of benefits as well as examples of coverage for certain services.

Look up medicationsPrescription drugs are one of the most commonly used benefits. To see which drugs are covered by your plan, view the Blue Shield Drug Formulary* at blueshieldca.com/pharmacy. Drugs are placed into four categories called “tiers,” which determine your out-of-pocket costs. Information about what you pay by drug tier can be found in the Summary of Benefits of your Blue Shield Evidence of Coverage (EOC).

Mail service prescriptions Receive up to a 90-day supply of covered maintenance drugs for chronic or long-term conditions delivered to your home or office, with no charge for shipping, through CVS Caremark®. Go to blueshieldca.com/wellness/drugs/mail-service-prescriptions to get started, or call (866) 346-7200.

Review your dental coverageRegister at yourdentalplan.com/bsca to view a summary of your dental plan benefits, download your dental ID card, track your claims, view your account balance, and more.

Review your vision coverage Register at blueshieldcavision.com to view a summary of your vision plan benefits, track your claims, check eligibility, and more. There are no ID cards for vision plans.

If you don’t have dental or vision coverage, learn more about our plans at blueshieldca.com/ifpspecialty.

* A drug formulary is a list of preferred medications maintained by Blue Shield for its prescription drug benefits. This list includes both generic and brand-name drugs approved by the federal Food and Drug Administration (FDA).

$ Save money with generic drugs

A generic drug has the same active ingredient, works in the same way, and is certified by the FDA to be as safe and effective as its brand-name counterpart, but it usually costs less. Using a generic drug instead of a brand-name drug is one of the easiest ways to reduce your prescription costs.

Ask your doctor if a generic drug is right for you.

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One card. Many ways to get the care you need.From routine checkups to emergencies and everything in between, your Blue Shield ID card gives you access to a quality network of healthcare providers. Whether you’re home, on vacation, or fighting a fever in the middle of the night, here’s a guide to getting the care you need when and where you need it.

Accessing care

Your primary care physician (PCP)When to see: Preventive and routine care, and for referrals to specialists

Your PCP is your first point of contact for your health care, will treat your common illnesses and injuries, and refer you to specialists. A referral from your PCP is required to see any specialist. Learn more about PCPs at blueshieldca.com/networkifphmo.

SpecialistsWhen to see: Specialty care

Specialists are medical doctors with specialized training to treat a specific type of condition, illness, or disease. Trio HMO members must receive a referral from their PCP to visit a specialist. Choose from physicians in our Trio ACO HMO Network. Find doctors at blueshieldca.com/networkifphmo.*

Emergency room (ER) or urgent care?When to go to the ER: Life-threatening or disabling conditionWhen to go to urgent care: Non-emergency care

If you’re experiencing a life-threatening or disabling emergency, call 911 or go to the nearest emergency room. For non-emergencies, when your doctor is not available, an urgent care center may save you time and money.† Find one near you at blueshieldca.com/networkifphmo.

TeladocWhen to use: After-hours, non-emergency care How: Web, phone, or mobile app

If you can’t get to your PCP, or if urgent care is unavailable, then Teladoc is a convenient, $0 copay option. With Teladoc, U.S. board-certified physicians can identify and treat many common conditions and prescribe medications 24/7/365 by web, phone, and mobile app. Sign up at teladoc.com/bsc.

* We work hard to make sure our list of providers is current and accurate. However, because providers leave networks from time to time, you are encouraged to check with the provider before using their services.

† Source: “Urgent Care or the ER - Which is the Right Choice?” Health alerts, Johns Hopkins Medicine, January 2011.

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Heal on-demand house callsWhen to use: Can’t make it to the doctor? Let the doctor come to you.

With HealTM, you can have a licensed doctor come to you for primary, urgent, or preventive care for the same price as a copay. As a special offer, members can get their first visit for a $0 copay. Visit the website GetHeal.com to check for service availability in select California locations.

NurseHelp 24/7When to use: Around the clock for non-emergency health adviceHow: By phone or chat

Whenever you have a health-related question or concern, or just need help deciding whether or not you should be seen by a doctor, use NurseHelp 24/7SM to get immediate and reliable health advice 24/7 from a registered nurse. Call toll-free (877) 304-0504 or log in at blueshieldca.com/login to chat with a nurse online.

BlueCard ProgramWhen to use: Care when traveling

The BlueCard Program gives you and your family access to emergency and urgent care when you travel. For domestic travel outside California, call (800) 810-BLUE to find BlueCard providers. For international travel, call (804) 673-1177, 24 hours a day, to locate a Blue Shield Global Core Network provider.

Find a DoctorIt’s quick and easy to use the Find a Doctor tool to find a network doctor, hospital, or other provider in the Trio ACO HMO Network. For a faster search, log in at blueshieldca.com/networkifphmo.

A list of the network providers will appear in the search results.* You can use the filters and the map to narrow and personalize your results.

* We work hard to make sure our list of providers is current and accurate. However, because providers leave networks from time to time, you are encouraged to check with the provider before using their services.

Heal is a trademark of Get Heal, Inc.

NurseHelp 24/7 is a service mark of Blue Shield of California.

Learn more about the many convenient ways to access care through Blue Shield of California at blueshieldca.com/getcare.

When to use: Whenever you have a health-related question or concern, you can get immediate and reliable health advice24/7 from a registered nurse over the phone.Call toll-free (877) 304-0504. (If it’s an emergency, call 911.)

NurseHelp 24/7

When to use: If you can’t get to your PCP, or if your PCP isunavailable, then Teladoc is a convenient alternative. With Teladoc, board-certified physicians can diagnose and treat many common conditions and prescribe medications 24/7/365via web, phone and mobile app. Sign up at teladoc.com/bsc.

Teladoc

When to see: If you’re experiencing a life-threatening emergency, or something that could permanently harm your body, call 911 or go to the nearest Emergency Room. For non-emergencies, an urgent care center may save you time and money. Find one near you at blueshieldca.com/fap.

Emergency Room or Urgent Care?

When to see: Your Primary Care Physician (PCP) is for annual check-ups and most routine medical needs. For more complex health problems, you may need to see a specialist, a medical doctor with specialized training to treat a specific type ofcondition, illness or disease. Choose from 46,000+ doctors atblueshieldca.com/fap.

Primary Care Physicians & Specialists

One card.Many ways to getthe care you need.

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From routine check-ups to emergencies and everything in between, your Blue ShieldID card gives you access to a diverse network of healthcare providers. Whether you’re home, on vacation, or fighting a fever in the middle of the night, here’s a guide to getting the right care at the right time.

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Wellvolution personalized diet and lifestyle programs Make healthier choices with your diet, exercise, sleep, and overall health. We have partnered with some of the highest-quality health providers and well-being apps to ensure you are living your best life possible. There are over 60 programs to choose from, ranging from general well-being to helping you prevent, treat, and possibly reverse serious chronic conditions. With the right tools, coaching, nutrition counseling, and health professional support, you can make small changes today for a healthier tomorrow.

Well-being programsA hand-selected set of scientifically backed well-being programs, designed to help generally healthy members achieve their health goals of sleeping better, lowering stress, exercising more, eating better, or quitting smoking.

Weight-loss programsSpecifically designed to help you make changes that fit your lifestyle and promote a healthy weight. You can lose weight and keep it off with coaching support and a personalized step-by-step plan for decreasing cravings, hunger, and weight without dieting.

Disease prevention programsWorking to reduce risk of type 2 diabetes and heart disease, prevention programs provide you with a health coach and an individualized plan that meet your unique needs by addressing several areas of your life, including physical activity, nutrition, sleep, and stress management. Most members see an average loss of 3 to 4 pounds per week, a reduction in medications they take, and normalization of blood sugar and blood pressure.

Chronic condition reversal programsTurn back the clock and reverse the course of chronic conditions like high cholesterol, hypertension, type 2 diabetes, and more with help from physicians, health coaches, and a supportive patient community. Our high-touch reversal programs, often incorporating in-person or digital coaching options, are focused on normalizing A1C levels, managing weight and blood pressure, and lowering medication dependence in a matter of weeks.

All Wellvolution® programs are 100% covered by Blue Shield of California.

How it works We’re here to help you find the most effective health and well-being programs that match your personal needs and lifestyle. We’ve vetted numerous health coaches and applications so you’ll get meaningful results. And it’s all covered by your plan.

Once you receive your Blue Shield member ID card, go to Wellvolution.com to set up your profile and

preferences and pick your program.

Wellvolution is a registered trademark of Blue Shield of California. Wellvolution and all associated digital and in-person health programs, services, and offerings are managed by Solera, Inc., a health company committed to changing lives by guiding people to better health in their communities.

Health and well-being

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Wellness discounts

You can take advantage of lower prices on a variety of helpful programs, services, and products to manage your overall health. From contact lenses to massages, Blue Shield wellness discounts* can help you save money.

• 25% discount for certain alternative care services such as acupuncture, chiropractic, and massage therapy. Discounts are also available on health and wellness products, including vitamins and supplements.

• 20% discount for vision care services and products such as routine eye exams, frames and lenses, non-prescription sunglasses, and hard contact lenses† – whether or not you have vision care benefits through Blue Shield.

• 30% to 60% discount on hearing aids through EPIC Hearing Service.

• 15% discount for LASIK surgery through the NVISION Eye Centers network providers in Southern California and Sacramento. Discounted rates also available at QualSight LASIK throughout California and nationwide.

• Discounted access to more than 800 gyms and studios across California and more than 10,000 fitness locations nationally through Fitness Your Way™ by Tivity Health®.

* These discount program services are not covered benefits of Blue Shield health plans, and none of the terms or conditions of Blue Shield health plans apply.

The networks of practitioners in the discount program are managed by the external program administrators identified below, including any screening and credentialing of providers. Blue Shield does not review the services provided by discount program providers for medical necessity or efficacy, nor does Blue Shield make any recommendations, representations, claims, or guarantees regarding the practitioners, their availability, fees, services, or products.

Some services offered through the discount program may already be included as part of the Blue Shield health plan covered benefits. Members should access those covered services prior to using the discount program.

Members are responsible for following the payment and appointment policies of external discount programs and practitioners, including those for cancelled or missed appointments. Blue Shield is not responsible for any portion of the costs associated with services accessed through the discount programs. Costs incurred by members through these programs do not count toward their Blue Shield health plan deductible or copayment/out-of-pocket maximum.

Members who are not satisfied with the products or services received from the discount program may use Blue Shield’s grievance process described in the Grievance Process section of the Evidence of Coverage or Certificate of Insurance. Blue Shield reserves the right to terminate this program at any time without notice.

Discount programs are administered by or arranged through the following independent companies:

• Alternative Care Discounts program – ChooseHealthy, Inc., a subsidiary of American Specialty Health Incorporated

• Discount Vision Program – MESVision

• Fitness facilities – Tivity Health

• LASIK – NVISION Eye Centers and QualSight LASIK

Note: No genetic information, including family medical history, is gathered, shared, or used from these programs.

t Discounts are based on the published retail prices when you use a participating provider in the Discount Vision Program network.

‡ Fitness locations are not owned or operated by Tivity Health, Inc. or its affiliates. Fitness Your Way membership entitles member to use of the fitness location facilities and amenities available to the holder of a basic membership at the fitness locations. Facilities and amenities vary by location.

# Fitness Your Way membership fee is $25.00 per month plus applicable sales tax. Individuals must be at least 18 years old to purchase a membership.

Tivity Health, Inc. is an independent vendor that provides solutions to improve health and well-being. Fitness Your Way and Tivity Health are trademarks or registered trademarks of Tivity Health, Inc. Tivity Health is solely responsible for the service provided above. All other brand names, product names, registered trademarks, or trademarks belong to their respective holders. © 2020 Tivity Health, Inc. All rights reserved.

For details, visit blueshieldca.com/wellnessdiscounts.

Fitness access programFocus on your fitness. Start working out and save money now with Fitness Your Way. Once you join, the membership gives you access to 10,000+ fitness locations‡ near where you live, work, and travel nationwide for only $25 a month# – so you can hit the gym or studio when and where it’s convenient for you.

Enroll at fitnessyourway.tivityhealth.com/bsc.

Or call (866) 634-1065, Monday to Friday, 5 a.m. to 5 p.m. Pacific time.

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For more information, call Shield Concierge at the number on your Blue Shield member ID card.

Monday through Friday, 7 a.m. to 7 p.m. Saturday, 8 a.m. to 5 p.m.

Call us

This brochure applies only to Trio HMO plans.

Blue Shield of California complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.

Blue Shield of California cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, país de origen, ascendencia, religión, sexo, estado civil, género, identidad de género, orientación sexual, edad ni discapacidad.

Blue Shield of California 遵循適用的州法律和聯邦公民權利法律，並且不以種族、膚色、原國籍、血統、宗教、性別、婚姻狀況、性別認同、性取向、年齡或殘障為由而進行歧視。