Medical Plans

Blue Shield of California

General Info

SVUSD offers one PPO plan and one HMO plan to certificated and management employees who are scheduled to work more than 50%, and classified employees who are scheduled to work more than 30 hours per week. SVUSD offers an HMO plan to classified employees who work between 20 and 30 hours per week. Below is a brief outline of the PPO and HMO plans. For more detailed coverage and cost information, please browse the "Documents" section below.

Blue Shield of California PPO: Calendar year deductible and co-insurance and/or copayments apply. Employees and covered dependents may access physicians and hospitals of their choice. However, it is the responsibility of the employee to verify if physicians and hospitals of their choice are in-network or out-of-network. Higher copays and coinsurance apply for out-of-network services.

Blue Shield Access + HMO: Services are offered with no deductible and minimal copayments. With the HMO plan, you and your covered dependents will select your own Primary Care Physician (PCP) and medical group from the Blue Shield HMO Directory to coordinate your care. HMOs manage healthcare to ensure physicians/hospitals selected are in-network providers/facilities. There is no coverage for out-of-network services.

Note: Blue Shield HMO Chiropractic services are accessed through American Specialty Health Plans. To access a provider, call 800-678-9133 and provide ASH with you first and last name and Blue Shield ID number.

New for 2017

TELADOC

The Teledoc feature won't replace your PCP, but it is a convenient and affordable option for care when you're in need of care now, are considering the ER or Urgent Care, on vacation, or for short term prescription refills.

SHIELD CONCIERGE

(855) 599-2657

It will replace our current Member Services. Shield Concierge is Blue Shields' integrated service model that is designed to improve and expand customer service. Through Shield Concierge members will have access to a team that includes registered nurses, health coaches, social workers, pharmacists, pharmacy technicians, and customer service representatives who will provide comprehensive information and personalized one-on-one support.


MAIL SERVICE & SPECIALTY PHARMACY SERVICES

CVS Caremark will be the new mail service pharmacy provider and CVS Specialty will be the exclusive provider for specialty pharmacy. Members who were using the prior providers were sent letters notifying them of the change. Most prescriptions with outstanding refills will be transferred to the new providers, but payment information could not be transferred so members will need to register with the appropriate vendor.

Documents

Contact

Blue Shield Concierge customer service can be reached at: 855-599-2657. Customer service can assist with changing PCP or medical group, checking the status of a claim, billing questions, etc.

Visit Blue Shield to view the provider directory or register for the patient portal.

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