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BAY AREA MEDICAL INSURANCE - FAQ

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Bay Area Insurance

agent Dolly Hebert

CA License # 0F60912

Authorized Bay Area

insurance agent for Blue

Shield of California.

          BAY AREA MEDICAL INSURANCE - FAQ      

Questions about individual and family Blue Shield health & dental plans?

Common questions and answers listed below may be of help.

Please contact us or call (650) 580-6337 if you need additional information or assistance.

COMPARE ALL PLANS & RATES HERE

Vital Shield Plus - Our newest and most popular plan, has 5 preventive care office

visits per calendar year, generic drug coverage and a carry over deductible

feature.  Available to individuals and families.

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Do you want a PPO or an HMO plan? Individual PPO Vital Shield 2900 or Vital Shield 900 are popular plans, with two preventive care physicians office visits. Essential Plan 4500, 3000 and 1750 allow three preventive care physicians office visits. Balance Plans 2500, 1700 or 1000 offer PPO Family coverage. Shield Savings 5200, 3500, 4000/8000, 1800/3600, and 2400/4800 are Health Savings Account compatible.

Do you need Maternity coverage? Then PPO Plan 5000, and PPO Plan 2000 and Blue Shield Life PPO 2000 are the plans to look at first.

Do you want  generic and brand name prescription drug coverage? Balance Plan 2500, 1700 or 1000 are the plans to consider first.

Does one family member have special insurance needs? Consider separate coverage with Active Start 35 plan for your children, and/or individual coverage for an adult that may need more extensive benefits than other family members.

Who is eligible to apply for Blue Shield individual and family plan coverage?

Residents of California who are ineligible for Medicare and not over the age of 65. In most cases, approval will be based on your health history. If you do not qualify for a guaranteed issue plan, you will be medically underwritten.

What is a guaranteed issue plan?

The federal Health Insurance Portability and Accountability Act (HIPAA) makes it easier for people covered under existing group health plans to maintain coverage regardless of pre-existing conditions when they change jobs or are unemployed for brief periods of time. If you meet all specified conditions, you may be eligible for a guaranteed issue plan in accordance with HIPAA, and we will automatically accept your application without underwriting. For more information, please call our account representatives at (650) 580-6337 Monday through Friday, 8 AM-7 PM-PST

How do deductibles work?

Many health plans include a deductible. You must satisfy this amount each year before Blue Shield makes payments towards covered services. Depending on your plan design, some services may be covered by Blue Shield before your deductible is met. The EOC/Policy (Evidence of coverage) for the plan includes more details about what services are available before meeting the deductible.

In addition, if your plan has a deductible and you have family coverage, a family deductible applies. Each individual's deductible is satisfied once the family deductible is met. For example, if the family deductible is equal to twice the individual deductible, and two people in the family satisfy their deductible, then the deductible is satisfied for all family members covered under the plan for the remainder of the calendar year.

The family deductible can be met by any family member or combination of family members.

If I choose a plan with a deductible, do I have to meet my deductible before receiving services?

While a majority of services require that you meet your plan deductible first, many benefits, such as generic prescriptions, well-baby care and physical and gynecological examinations with a preferred provider are covered before you have satisfied your plan deductible with most plans. Please note that some plans have a brand-name drug deductible and you must first meet this deductible before benefits for brand-name drugs will be covered.

What are the differences between Blue Shield's PPO plans?

Each of the five Shield Spectrum PPOSM plans provides a wide range of benefits, a choice of providers and many fixed copayments before meeting the deductible. In general, Shield Spectrum PPO plans with lower deductibles have higher monthly dues/premiums. Shield SavingsSM Plans, our high-deductible health plans that are compatible with a Health Savings Account, can help meet essential healthcare needs, and are often selected by people who go to the doctor occasionally. Our EssentialSM Plans* are individual-only plans that offer a calendar year out-of-pocket maximum that is met when the deductible is satisfied. Active StartSM Plans* are affordable plan options that combine no medical plan deductible with lower generic drug copayments and low copayments for office visits and preventive care. Active Start plans, Vital ShieldSM and Vital ShieldPlus plans, Balance plans, Essential plans provide individual-only coverage and do not provide maternity benefits. Shield Savings Plan 3500, 4000/8000 and 5200 do not provide maternity benefits.

What is a Health Savings Account (HSA)?

HSAs are tax-advantaged personal savings or investment accounts intended for payment of medical expenses that may be used in combination with qualifying high-deductible health plans.

Which plan qualifies for a Health Savings Account (HSA)?

Our Shield Savings Plans are HSA-eligible, high-deductible health plans.

Can individual family members have different plans?

Yes. Sometimes it may better suit your healthcare needs or budget to place family members on different types of plans.

Can I get coverage for just my children?

Yes. Special child rates are available for all of our plans. All Blue Shield plans provide your children with the same healthcare benefits we offer in our individual adult and family plans, at special rates for children under the age of 19. You can even select a different plan for each child whether or not you have a Blue Shield plan of your own.

Can I get dental coverage through Blue Shield?

If you're a Blue Shield individual and family plan member, you can add on one of our optional dental PPO or HMO plans for an additional cost. In addition, you now have the option of dental coverage without having to be a Blue Shield health plan member.

If you are an Access+ HMO® member, you have basic dental benefits, called Access+ Dentist, included in your plan. Access+ HMO members can choose to purchase the more generous dental PPO or HMO plan instead of receiving Access+ Dentist services.

Our Essential plans also include dental coverage benefits.

Is preventive care covered?

Yes. All of our individual and family health plans include coverage for preventive care such as physical examinations, immunizations, well-baby care and gynecological exams when a preferred provider is used.

Is birth control for women covered?

Yes. All of our individual and family health plans include benefits for oral contraceptives, diaphragms and injectable contraceptives.

Is alternative care covered?

Some Blue Shield plans provide chiropractic and/or acupuncture coverage. You can also save money through the Mylifepath Alternative Health Services Discount Program, a standard feature on all Blue Shield plans, by receiving discounts on the following services:

Acupuncture   Chiropractic   Massage therapy

Please note that none of the terms and conditions of Blue Shield's health plans applies to these discount services as these discounts are not part of your health plans' covered services.

What is the Evidence of Coverage and Health Service Agreement/Policy?

The Evidence of Coverage and Health Service Agreement (EOC), or Policy for Individuals and Families (Policy), are the official plan contracts. They explain in full all the terms of plan coverage, including benefits, copayments or coinsurance, exclusions, limitations and how to access coverage.

*Underwritten by Blue Shield of California Life & Health Insurance Company