1. What is the difference between the Blue Shield PPO and the Blue Shield HMO?
The Blue Shield PPO plan is a Nationwide network that allows members to self-refer. The Blue Shield California-based HMO plan requires the member to select a Primary Care Physician in order to access care. Your PCP will provide or coordinate all of your medical care.
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2. If I select the Blue Shield HMO, do I need to select a Primary Care Physician?
Yes. You and each covered family member must select a PCP from the HMO Provider Directory. Your PCP will provide or coordinate all of your medical care. Family members can select different physicians or medical groups.
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3. How do I find a Primary Care Physician?
Easy Instructions for Finding a Doctor Online are provided in your HMO Enrollment Packet. Enter www.mylifepath.com in your Web browser’s window. Click on “find a provider” and follow the prompts under “Guest”, or call Blue Shield Customer Service at 800-642-6155.
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4. How does the Blue Shield HMO work for out-of-state students?
Blue Shield has a Guest Membership Program for dependents that live out of state. Call
800-642-6155 and ask for the guest membership coordinator to determine if it is available for your dependent. If your dependent resides outside an HMO service area, they would only be covered for emergency or urgent care services.
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5. If I am an out-of-state retiree, will the Blue Shield PPO work for me?
Yes. Blue Shield has the Blue Card Program. This allows members to see a Blue Cross/Blue Shield physician in their state. Call (800) 810-2583 to find a provider outside of California.
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6. How do deductibles work on the Blue Shield PPO plan?
The $500 individual/ $1,000 family deductible is on a calendar year basis.
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7. If my District has tiered medical and composite dental rates, can I elect individual medical coverage and family dental coverage?
Yes, an employee can elect employee only coverage for medical and family coverage for dental. However, if the employee waives medical coverage, they waive the entire package including dental or vision coverage.
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8. If my spouse loses his/her coverage, may I enroll him/her outside of Open Enrollment?
Yes, a special enrollment is allowed within 30 days when other coverage is lost due to termination or reduction in hours. A certificate of creditable coverage (HIPAA) is required along with the applicable change forms.
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9. How do I enroll my newborn child or new spouse?
New dependents must be enrolled within 30 days of birth, adoption or marriage. Contact your district Benefit Coordinator for the applicable forms.
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10. Why did I receive an Urgent Dependent Certification Notice?
In order to be eligible for medical, dental or vision benefits, children ages 19-24 must be an IRS dependent or full-time student (minimum 12 units). SIG sends the certification notice annually in the month prior to the child’s birthday. This information is then forwarded to Blue Shield, Kaiser, Delta Dental & VSP.
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11. I forgot to return my child’s Dependent Certification Notice. Now what?
If it is after the stated termination date or the child has received a COBRA notice, his or her coverage has been terminated. Reinstatement is possible within 30 days of termination; otherwise that dependent must wait until open enrollment (July 1st). Contact SIG for further instruction.
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1. How do I notify SIG of my new mailing address?
Contact your District Benefit Coordinator for a SIG Enrollment/Change form. Once SIG is notified, we will forward the information to Blue Shield, Kaiser, Delta Dental and/or VSP.
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1. What is Best Doctors?
Best Doctors is a benefit offered to you and your dependents as part of your benefits plan. The program gives you the opportunity to have your medical condition evaluated by a world-renowned expert doctor to ensure the diagnosis and treatment are on target.
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2. How do I enroll?
Employees and their dependents are automatically enrolled in this program. This free, voluntary and confidential service is available to all employees and dependents covered under a SIG medical plan. The program begins January 20, 2009.
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3. How does the process work?
You or your dependent may contact Best Doctors at 1-866-904-0910 if you are unsure of an existing diagnosis or treatment and would like to have your case reviewed. A Member Advocate will talk to you to obtain information about your diagnosis and treatment plan during this “intake” stage. You will need to authorize Best Doctors to obtain your medical records and tests from health care providers. Upon receipt of your authorization, Best Doctors will obtain your medical records and select an expert doctor from their database of more than 40,000 doctors to review your case. The expert’s review is returned to Best Doctors and an easy-to-understand report is prepared and sent to you and your treating physician. A Member Advocate is available to review the report of the expert doctor’s findings with you. This provides you and your treating physician the answers you deserve to confidently choose the most appropriate next steps together.
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4. Will I need to be examined by Best Doctors or by an expert doctor?
No. A Member Advocate will collect your information over the phone, and Best Doctors will compile all of your medical records and test results. The information is transferred to a world-renowned physician who will evaluate your case. You will receive a written report with the findings—all without leaving your home.
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5. Who pays for the medical record copying expenses?
There is no cost to members who use the Best Doctors benefit, which includes medical record collection.
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6. How long does the process take from start to finish?
As each case is unique, review time can vary. Typically, you will receive a report from Best Doctors six weeks after you authorize Best Doctors to collect your medical records.
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7. Will my health insurance raise my rates if I use Best Doctors?
No. This is a service provided to you at no additional cost and is held confidential from your health plan and your employer.
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8. Will my employer know that have contacted Best Doctors?
No. The service is completely confidential and information is not provided to your employer.
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9. What will my doctor say if I use this service?
Best Doctors does not replace your relationship with your current doctor. Rather, we offer additional resources and support to you and your treating doctor. Typically, treating physicians appreciate having additional information from expert doctors about a member’s cases. Your Member Advocate can provide you guidance on how to talk to your doctor about the report.
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10. Who are the Best Doctors experts?
We draw from our database of 40,000 world-renowned expert doctors who specialize in the specific medical issues each member is faced with.
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11. What do I need to do to get started?
All you need to do is call 1-866-904-0910. Our Member Advocate will help get your information and collect all of your questions that you need answered.
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