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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12. 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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