| Dear SFHSS Retiree Member, Beginning January 1, 2025, Blue Shield Medicare PPO, using the national Blue Cross Blue Shield Association’s network, will replace the UnitedHealthcare Group Medicare Advantage PPO Plan, which will end on December 31, 2024. Below are answers to frequently asked questions for this Medicare PPO transition as well as a website and phone number to Blue Shield's Concierge Service team who are dedicated to answer any questions you may have regarding this change. SF HSS will be sending you more information leading up to Open Enrollment. Please make sure your address, email, and phone number are updated in the SF Employee Portal by logging into myapps.sfgov.org and selecting the Employee Portal tile. Then, click on the My Information tab in the upper left-hand corner and click on the pencil icon to edit your contact information. Best regards, San Francisco Health Service System |
| BLUE SHIELD RESOURCES Custom Blue Shield Website for SFHSS: blueshieldca.com/sfhss. Blue Shield’s Medicare Concierge for SFHSS Members: (800) 370-8852 available 8 a.m. to 8 p.m. PST daily. |
| FREQUENTLY ASKED QUESTIONS (FAQ) ACCESS TO DOCTORS & SPECIALISTS 1. How can I check to see if my doctor already accepts the new Blue Shield Medicare PPO plan? Visit the webiste above. Select Retiree, then Provider Search tool to search specifically for 3 types of Blue Shield providers: within California, outside California, and for nationwide Medicare Participating providers. If you cannot find your current doctor or specialist in the Provider Search tool, please call Blue Shield at (800) 370-8852. They will gladly confirm whether your doctors will accept the new Blue Shield MAPD-PPO plan. 2. I was enrolled in the SFHSS Blue Shield Medicare HMO plan previously, and I like the UnitedHealthcare Medicare plan better. How will Blue Shield be able to provide the same service? Unlike the previous Blue Shield Medicare HMO plan, this is a new Blue Shield Medicare PPO plan designed to mirror the current UnitedHealthcare Medicare PPO plan design. Therefore, you will have the same copays and rich benefits you currently enjoy. You will have the same access to all the Medicare participating providers you have today as long as they bill Blue Shield. 3. What will my co-pays be to see my current doctor or specialists? The new Blue Shield Medicare PPO plan has the same copays as your current UnitedHealthcare Medicare PPO plan with $5 Primary Care Physicians and $15 Specialists copay. You should not notice any change in your cost share. 4. I live out-of-state and I want to keep seeing my current doctors who know me and my medical needs. They tell me they do not accept Blue Shield of California, because we are not in California. How can I keep seeing my current doctors? We realize the word ‘California’ in the plan’s name may confuse providers outside of California. Blue Shield of California has direct access to the national network of the Blue Cross Blue Shield Association of America that is recognized and accepted by doctors, specialists, healthcare systems, and hospitals across the country. If this occurs, please call your dedicated Blue Shield Medicare Concierge and share your doctor’s information. They will reach out directly to your doctor to explain how the new Blue Shield Medicare PPO plan works even outside of California and answer any of their questions. Since you are a current patient, we do not anticipate any further issues, but we are committed to working through any issues that may arise during this transition. 5. How can I keep seeing the same therapist who has known me for years on the Blue Shield Medicare PPO plan? As an existing patient, your visits will be covered as long as your therapist participates in Medicare and bills Blue Shield directly. ACCESS TO PHARMACIES AND PRESCRIPTION DRUGS 6. What if I have special needs and require in-home medications, infusions, or care? Will I be able to get the same medication and in-home care and treatment? Blue Shield has a vast network of Home Infusion providers that send nurses in California and nationwide to assist with in-home medications. Additional Home Health services are also available for the same quality in-home treatment and care as you receive today. 7. How can I confirm if my current pharmacy will accept the new Blue Shield of California MAPD-PPO Plan? There is a Pharmacy Locator tool at blueshieldca.com/sfhss which you can use to locate your local pharmacies. Another way is to call Blue Shield Medicare Concierge and they will gladly confirm whether your current pharmacy is in the network. 8. How can I check if my current prescriptions are covered by the Blue Shield of California MAPD-PPO plan? There is a Formulary Lookup tool to check your prescriptions on your custom SFHSS website at blueshieldca.com/sfhss. Another way is to call your dedicated Blue Shield Medicare Concierge and they will be happy to confirm if your prescription is covered in the formulary. 9. What if Blue Shield will only cover a generic or alternative drug when my doctor prescribed the brand name drug? How can I get the same prescription that my doctor prescribed? Blue Shield can work with your doctor to provide a transitional supply of your current drug within the first 90 days of coverage if it is not on our formulary list of covered drugs. This provides time for your doctor to re-evaluate whether it is best to switch to a covered medication, or request a formulary exception for the same drug. 10. How much will my prescription drugs cost under the new Blue Shield of California MAPD-PPO plan? The new Blue Shield MAPD-PPO plan has been custom designed with the same copayments and rich formulary for your prescriptions as your current UnitedHealthcare Medicare PPO plan so you should not see much difference in your copays for your prescriptions. ADDITIONAL BENEFITS 11. I currently get gym membership covered through UnitedHealthcare. Will I have access to my current gym with Blue Shield of California? A nationwide Silver Sneakers gym membership with one of the largest networks of participating gyms is included in the new Blue Shield MAPD-PPO Plan at no additional cost. You can simply locate your closest Silver Sneakers gym at https://tools.silversneakers.com/locationsearch or give your dedicated Medicare Concierge a call to assist with locating participating gyms. 12. Does Blue Shield of California provide acupuncture and chiropractor benefits? The Blue Shield MAPD-PPO plan covers both routine acupuncture and chiropractor visits and services. |
| Blue Shield of California is an independent member of the Blue Shield Association. |
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