11 Nov 2015

What we love/hate in 2016…about Blue Shield of CA

11 Nov 2015

This is part of a series of posts to help clients understand the differences between the carriers and plans, and to make the best plan choice for their family in 2016. Maybe “like” and “dislike” are better categories, but what is the Internet for, if not strong opinions?

Blue Shield of California is one of just two remaining carriers that will offer PPO plans in every county in California in 2016. So, what do we love (and hate) about them?


  • The timing wasn’t great for those making decisions during last year’s open enrollment, but Blue Shield’s new contracts with Sutter Health and the UC Medical system vastly expanded their network of providers through 2016 and beyond.
  • Like Anthem, Blue Shield is ditching their limited “EPO” network statewide in 2016, giving subscribers in all counties access to their full PPO, along with BlueCard PPO access when traveling out of state.
  • Blue Shield’s Bronze HSA plan will use an “embedded” deductible and out of pocket maximum for plans with two or more family members, reducing the financial risk for families on that plan.


  • While Blue Shield’s rates are still some of the most competitive available, those who are currently enrolled in an HSA-compatible EPO plan will likely see a larger rate increase than expected for 2016.
  • The Claims department. Most people don’t wind up needing to directly submit a claim for services paid out of pocket, or for out of network services, but the number of times we have been told they “didn’t receive” a submission is unbelievable – in the most literal sense. Fortunately, our client advocate, Madhu Macrae, is here to help!
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