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Home My WebLink AboutBlue Shield HMO 15 Plan Enrollment GuideEnrollment Guide Offered through PRISM Effective: January 01, 2023 Health Plan Choices: Access+ HMO plan Access+HMO plan highlights For plan details,visit blueshieldca.com/prism. With the Access+HMO plan®,you pay a copayment for most covered services like doctor visits,urgent care and emergency care.Your primary care physician (PCP)coordinates all your care as well as refers you to specialists and hospitals within their medical group/Independent Practice Association (IPA). When you enroll in the HMO plan for the first time,you must choose a PCP for yourself and your covered dependents.Each member of your family can choose a different physician and medical group/IPA. Plan features Coverage for students or families living apart –The Away From Home Care®program offers students, long-term travelers,workers on long-distance assignments and families living apart access to health care from Blue Shield and Blue Cross plans across the country.The program is available in 33 states and the District of Columbia,but availability varies by county within each state.HMO benefits vary by state. Coverage while traveling –You are covered for emergency and urgent care services across the United States and around the world through the BlueCard®and Blue Shield Global Core programs. Chiropractic and acupuncture services –Visit any participating chiropractor or acupuncturist in the American Specialty Health Plans of California,Inc.(ASH)provider network without a referral from your PCP. Emergency care –You’re covered for emergency care around the world regardless of whether the provider is in your plan’s HMO network. 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 mental health service administrator (MHSA)provider network. 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*–Access+SpecialistSM makes it easy to self-refer to a specialist within your medical group or IPA for a consultation. Urgent care –For non-emergencies,you can receive care at an urgent care center that’s affiliated with your doctor’s medical group or IPA.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 Go to blueshieldca.com/networkhmo and select the provider you are looking for.Enter your location,then click Continue. You may need your selected PCP’s ID number when you enroll in the plan for the first time.To find this number,click on the doctor’s name and then select View details under "Primary Care Physician ID." *Tousethisoption,members must selecta PCP whoisaffiliatedwith a medicalgroup orIPAthatis an Access+providergroup,which offers the Access+Specialist feature.Members shouldthen selecta specialist withinthatmedical groupor IPA.Access+Specialist visitsfor mental health services must beprovided byaparticipating mental health service administrator (MHSA)networkprovider.For ongoingcare froma specialist,you’ll need togeta referralfromyour PCP. Access+HMO isa registeredtrademark ofBlue Shield of California. 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 Advocate –Get support managing your health needs for a wide range of conditions from a team specially trained on the specific health benefits and programs available to you.This team can provide health counseling,answer your medical questions,help you resolve issues 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. Wellvolution®–Achieve your health goals with Wellvolution,our digital platform for health and well-being.Wellvolution offers over 50 tested apps and programs to help you exercise more,eat healthier,prevent and reverse disease and more –at no extra cost.Visit wellvolution.com to learn more. LifeReferrals24/7 is aservice markof Blue Shield of California. NurseHelp 24/7is a service mark of Blue Shield of California. *These discount program services are not acovered benefit of your Blue Shield of California,Blue Shield ofCaliforniaLife &HealthInsuranceCompany or self-insured health plan,and noneof the terms or conditionsof the Blue Shield,Blue Shield Life orself-insured healthplan apply. The networks ofpractitionersand facilities inthe discount programsare managed byexternal program administrators,including anyscreening and credentialing of providers.BlueShielddoes notreview the services provided by discount program providers for medical necessityor efficacy,nor does Blue Shield makeany recommendations,presentations,claims or guaranteesregardingthepractitioners,theiravailability,fees,services or products. Some servicesoffered through thediscount program may already be includedaspart of the Blue Shield plan coveredbenefits.Members orself-insured plan participants should access those coveredservices priorto usingthe discount program. Members or self-insured planparticipants who are not satisfiedwith products or services receivedfrom thediscount program may use the grievance process described in their Evidenceof Coverage,Disclosure Form,Evidence ofCoverage andDisclosure Form,Benefit Booklet or Certificate of Insurance/Policy.Blue Shield reservesthe right to terminate this program at anytime without notice. Wellvolution is aregisteredtrademarkof Blue Shield of California.Wellvolution and all associated digital and in-person health programs,services,and offerings are managed bySolera,Inc.,a health company committed to changing lives by guiding people to betterhealth in theircommunities. Programs and services 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 ofCalifornia is anindependent memberof the Blue Shield Association A47203-PRISM (6/21) Blue Shieldof California complieswith applicable state lawsand federalcivil rights laws,and doesnot discriminateon thebasis of race,color,national origin,ancestry,religion,sex,maritalstatus,gender,genderidentity,sexualorientation,age,or disability.Blue Shield ofCaliforniacumpleconlas leyes estatales y las leyesfederales de derechos civiles vigentes,y no discrimina por motivos de raza,color,paísde origen,ascendencia,religión,sexo,estado civil,género, identidad de género,orientación sexual,edad ni discapacidad.BlueShieldof 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。