Blue Shield Medical
Matarozzi Pelsinger Builders offers four different medical plan options through Blue Shield. All of the available options give you access to high-quality, comprehensive care. They differ in the way the cost of care is structured and in the strategies that you can use to control your expenses. Both options are available to those who live outside of California.
Blue Shield Full PPO
The Blue Shield Full PPO plans are traditional plans that give you the greatest flexibility, combined with lower costs when you choose a provider within Blue Shield's broad national PPO network. Choosing health professionals who participate in the Blue Shield PPO network keep your costs lower and eliminate paperwork.
Blue Shield Tandem PPO
The Blue Shield Tandem PPO network is available to all employees, for out-of-state employees it will work the same as the Full PPO. For California employees, this is a smaller network. Tandem includes about 67% of doctors and 93% of hospitals from the broader PPO network. After enrolling in a Tandem PPO plan, you will be matched with a primary care physician in the Tandem PPO network.
You can always reference what Blue Shield network you're using by checking your ID card or looking on www.blueshieldca.com.
More resources
NurseHelp 24/7: Can be used for minor illnesses and injuries, medications, preventive care 24 hours a day, 7 days a week. Call 877.304.0504 or visit www.blueshieldca.com/nursehelp.
Teledoc: Can be used for sinus problems, respiratory infections, colds and flu, allergies, rashes, ear infections, pink eye, and much more. Available 24 hours a day, 7 days a week. Call 800.835.2362 or visit www.blueshieldca.com/teledoc.
Deductible - The amount you must pay for medical services, before the plan pays a benefit. Preventative care is always covered at 100% with no deductible required.
Coinsurance - This is the percentage of the cost you pay for certain services after the deductible has been met. You can think of this as “cost sharing”. For example, once your deductible has been met you could pay 20% for the cost of certain services and the plan could pay 80%.
Copay - The flat fee paid by the member when a medical service is received, i.e. $20 for a doctor's visit or $20 for a prescription.
In Network Provider - An in-network provider is a hospital, doctor, medical group, and/or other healthcare provider contracted to provide services to insurance company customers for a discounted fee.
Using these providers will lessen your medical expenses when using your benefits.
Out of Network Provider - An out of network provider is a hospital, doctor, medical group, or other healthcare provider who are not contracted to provide services to insurance company customers. Because the fees are not negotiated in advance with the insurance company, the provider can charge the member as much as they wish.
Out of Pocket Maximum - The maximum amount a member would have to pay out of their pocket for medical expenses for the year, with the exception of benefit premiums (which come out of your paycheck). Your out-of-pocket maximum includes your deductible, any coinsurance paid and all co-payments (medical and prescription drug).