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Home My WebLink AboutBlue Shield EPO Enrollment GuideEnrollment Guide Offered through PRISM Effective:January 01,2022 Health Plan Choices: EPO Plan EPO Plan highlights For plan details, visit blueshieldca.com/prism. With the EPO Plan, you'll choose from PPO physicians and hospitals. Except for emergencies, you are not covered if you get medical treatment by non-network providers. Plan features Care away from home – You are covered for care across the United States and around the world through the BlueCard® and Blue Shield Global Core programs. Emergency care – You’re covered for emergency care around the world regardless of whether the provider is in your plan’s PPO network. HealTM – Schedule in-person healthcare visits or telemedicine calls with Heal doctors wherever you are – at home, in the office or even in a hotel. You have no copay for the first visit or call. Heal services are available in select locations across California. Mental health and substance use disorder care – You have access to inpatient and outpatient care for issues such as depression, alcohol/substance use disorder and mental illness. You can access these services through Blue Shield’s PPO network and non-network providers. Preventive care – You have access to services defined as routine preventive care. You do not have to pay a copayment or meet the plan’s deductible for these services. Visit blueshieldca.com/preventive to learn more. Specialty care – You can see any specialist in the PPO network when needed without prior authorization from your primary physician. However, some services may require prior authorization. Urgent care – For non-emergencies, you can receive care at an urgent care center. Your cost will usually be lower than the cost for a hospital emergency room visit. Teladoc – You have access to board-certified doctors and licensed mental health professionals with Teladoc's phone and online video appointments. Find your doctor To find providers within California, go to blueshieldca.com/pponetwork and select the type of provider you need. Enter your location, then click Continue. To find providers outside of California go to provider.bcbs.com and enter EMF. Search for the type of provider you need. Heal is a trademark of Get Heal, Inc. ID protection –Protecting your financial well-being is as important as protecting your health.This is why we offer identity protection services.These include credit monitoring,identity repair assistance and identity theft insurance. LifeReferrals 24/7SM –Experienced professionals are ready to help you with personal,family and work issues at any time. NurseHelp 24/7SM –Registered nurses are available to answer your health questions at any time,every day. Prenatal Program –Expectant mothers get 24/7 phone access to nurses and other support during pregnancy. Shield Support –Get support managing your health needs for conditions such as diabetes,depression, chronic pain,cancer and others.Services include personalized health coaching,care plan development,provider coordination and more. Wellness discount programs –Get help saving money and living healthier with a wide range of discount programs*including fitness club memberships;acupuncture,chiropractic services and therapeutic massage;and eye exams,frames,contact lenses and LASIK surgery.Learn more at blueshieldca.com/wellnessdiscounts. LifeReferrals 24/7 is a service mark of Blue Shield of California. NurseHelp 24/7 is a service mark of Blue Shield of California. *These discount program services are not a covered benefit of your Blue Shield of California,Blue Shield of California Life &Health Insurance Company or self-insured health plan,and none of the terms or conditions of the Blue Shield,Blue Shield Life or self-insured health plan apply. The networks of practitioners and facilities in the discount programs are managed by external program administrators,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,presentations,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 plan covered benefits.Members or self-insured plan participants should access those covered services prior to using the discount program. Members or self-insured plan participants who are not satisfied with products or services received from the discount program may use the grievance process described in their Evidence of Coverage,Disclosure Form,Evidence of Coverage and Disclosure Form,Benefit Booklet or Certificate of Insurance/Policy.Blue Shield reserves the right to terminate this program at any time without notice. P ro g r a m s a n d s e r v i c e s The following programs and services are offered with the plan(s) described in this document. Member confidentiality Blue Shield protects the confidentiality and privacy of your personal and health information, including medical information and individually identifiable information such as your name, address, telephone number and Social Security number. To ensure this, Blue Shield requires a signed authorization form for you to access health information for your spouse or dependents over the age of 18. To request an authorization form, call Blue Shield Member Services. Or, you can also download the form by going to blueshieldca.com. Just log in, select Family Members under “Who’s Covered” and then choose Manage Family. Scroll to the bottom of the page to download the Authorization for Release of PHI form. If you don’t have access to the Internet, or you have questions about how Blue Shield protects your privacy and confidentiality, please call our Privacy Office directly at (888) 266-8080. Apple and the Apple logo are trademarks of Apple Inc. App Store is a service mark of Apple Inc. Google Play is a trademark of Google Inc. Blue Shield and the Shield symbol are registered trademarks of the BlueCross BlueShield Association, an association of independent Blue Cross and Blue Shield plans. Find us on social media Follow us on Facebook at facebook.com/BlueShieldCA, Twitter @BlueShieldCA and Instagram @BlueShieldofCA for healthy tips, daily inspiration, member info and support. It’s an easy way to stay connected. Required legal disclaimer when using GP badge: “Google Play and the Google Play logo are trademarks of Google Inc.” Take us with you anywhere Log in to our mobile app and keep your health plan at your fingertips. Our mobile app is available on the App StoreSM and Google PlayTM. Have questions? Get answers to your questions about the health plan(s) described in this brochure or request printed copies of plan documents. Call Member Services:(855)256-9404,7 a.m.to 7 p.m.PST, Monday through Friday. Visit blueshieldca.com/prism Blue Shield of California is an independent member of the Blue Shield Association A47203-PRISM (6/21) 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。