County of San Bernardino –

Retirees

Effective January 1, 2020

Aim higher with Blue Shield

• Large networks mean you’ll find doctors you like close to home or work

• Collaboration with doctors and hospitals to

deliver “accountable care” -- you benefit from combined knowledge and expertise

• As a mission-driven nonprofit, we’re reforming the system with an eye on quality and affordability

High performance

• Care programs to improve and maintain your health no matter what your health status

• Customized care programs for members with complex or advanced conditions based on needs and preferences – not “factory medicine”

High touch

• Website / mobile app provide suite of 24/7 resources to simply, conveniently manage your family’s health care

• Teladoc video/phone visits that bring care to you

High technology

• Discounted wellness products and services to encourage healthier lifestyles and make your healthcare dollars go further

High value

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“There are some big differences between plans.Which one’s right for me?”

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Blue Shield plans for retirees

• Shield Signature Plans – non-Medicare

• Shield Signature – High

• Shield Signature – Low

• NEW – TRIO HMO Plan – non-Medicare

• Medicare Integrated Plans

• Blue Shield 65 Plus (HMO) – GMAPD High

• Blue Shield 65 Plus (HMO) – GMAPD Low

• Blue Shield of California Medicare Rx Plan (PDP)

• Medicare Coordination of Benefits PPO Plan

• Shield Spectrum PPO plan – COB

Health plans include:

Pharmacy benefits

NurseHelp 24/7

Teladoc

Health programs

Trio HMO Plan

This chart is intended to provide a high level summary of plan benefits. The Evidence of Coverage and

Plan Contract should be consulted for a complete description of plan benefits and coverage.

Annual deductible None

Calendar-year

copayment maximum

$3,000 per individual

$9,000 per family

Office visits $50/visit

Inpatient hospital $1,000/admission

Outpatient surgery $750/surgery

Ambulance services $250/transport

Emergency services

No direct admission

Direct admission

$250/visit

$1,000/admission

Diagnostic lab/x-ray $0

Retail drug copayments $10/$30/$50/$50

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Blue Shield’s fastest-growing HMO, keeping

members highly satisfied with convenient access

to care among known, local providers

• New in 2020!

• Use Heal doctor-on-demand services via phone, web, or mobile; first visit is $0!

• $0 same day Rx delivery with Heal

• $0 copay for Teladoc

• Choose your own doctor, specialists and pharmacies within the Trio network

• Access Teladoc doctors for phone or video appointments, 24/7/365 with $0 copay

• End-to-end service from Shield Concierge, our dedicated support team to help you make care decisions, manage your plan benefits, and transfer medical records

• Engage in digitally-enabled wellness programs

• Access urgent and emergency care coverage anywhere in the world

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House calls, hotel calls—a doctor when and where you

need one for urgent, primary, and preventive care

“I’m at a conference but in my hotel bed with a bad sore throat. I want to seea doctor.”

• Book a doctor on demand to come to you (home, office, or hotel) via phone, web, or mobile

• More convenient than a visit to the Emergency Room

• Access for all Blue Shield PPO and Trio members in select service areas in California, as well as Georgia, DC and Northern Virginia.

• Cost is typically the same as a visit to your doctor* and vary by plan type. For Trio and Tandem, the first visit is $0, with free, same-day Rx delivery after 1/1/20

• Available 8 a.m. to 8 p.m., 365 days a year

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Imagine this:

* Exception: PSP members must pay the full cost of the visit until their deductible is met

LifeSpring: Free meal delivery for Trio members

Intended to provide eligible Trio members

with convenient and nutritious meals while

recovering from serious illness.

Prepared meals are geared towards

people with special dietary requirements.

Available statewide. A Blue Shield Case

Manager determines member eligibility

and meal service delivery frequency.

Call the Car: Non-Emergency

Transportation for Trio members

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This is a non-emergency transportation

service for eligible Trio members

undergoing recovery from serious illness.

Intended to provide eligible members

with reliable transportation to and from

their medical appointments to help with

their recovery.

A Blue Shield Case Manager determines

member eligibility.

Trio HMO or Shield Signature?

A good choice if you’d like…

POS

A select, integrated provider network that provides you with more coordinated care:

• Teladoc 24/7 phone/video doctor visits

for $0 copay after 1/1/20

• Digitally-enabled wellness programs

• Covered urgent and emergency care

while traveling

• Heal at-home doctor visits; first visit $0

after 1/1/20.

A broader HMO network thatoffers more choice of doctors.

• Choose your own doctor (Level 1), self-

refer to physicians (Level 2) for office

visits only

• Teladoc 24/7 phone/video doctor visits

for low copay

• Digitally-enabled wellness programs

• Covered urgent and emergency care

while traveling

1LifeReferrals 24/7 available to groups with 101+ employees.

Shield Signature Trio HMO

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Trio HMO Plan or Shield Signature Low Option

Trio HMO Shield Signature – Low Option

Annual deductible None Annual deductible None

Calendar-year

copayment maximum

$3,000 per individual

$9,000 per family

Calendar-year

copayment maximum

$3,000 per individual

$9,000 per family

Office visits $50 Office visits $50 Level 1 / $80 Level 2

Inpatient hospital $1,000/admission Inpatient hospital $1,000/admission

Outpatient surgery $750/surgery Outpatient services $750/surgery

Ambulance services $250/transport Ambulance services $300/transport

Emergency services

No direct admission

Direct admission

$250/visit

$1,000/admission

Emergency services

No direct admission

Direct admission

$250/visit

$1,000/admission

Diagnostic lab/x-ray $0 Diagnostic lab/x-ray $0

Retail drug copayments $10/$30/$50 Retail drug copayments $10/$30/$50

This chart is intended to provide a high level summary of plan benefits. The Evidence of Coverage

and Plan Contract should be consulted for a complete description of plan benefits and coverage. 11

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“How can I get the most out of my healthcare dollars?”

Programs designed to help you live

better with illness, recover from acute

conditions, and have a more seamless

healthcare experience

Shield Support Program

Nurse support, home visits, self-management

tools and workshops to help members with:

• Behavioral health

• Cancer

• Chronic Conditions, e.g. Coronary Artery Disease, Heart Failure, Diabetes, COPD, Asthma

• Catastrophic injury

• Musculoskeletal conditions & pain management

• Stroke

• LGBTQ health needs

• Transplant process

• Plus: ER utilization, post-discharge from hospital, opioid use, high cost and direct referrals

Support to manage your health

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Contact Teladoc: 1-800-Teladoc

“I feel like I have the flu, but I don’t want to wait in the ER on a Friday night.”

Log in to your Teladoc account or call Teladoc, 24/7/365, to request a phone or online video consult-ation for primary care services.

Step 1

Contact Teladoc

Step 2

Talk with a doctor

Step 3

Resolve the issue

Step 4

Settle up

Step 5

Smile<10 MinutesAverageWait Time

A board-certified doctor reviews your Electronic Health Record (EHR) and consults with you, just like an in-person visit.

The doctor recommends a treatment for your medical issue. If a prescription is needed, it’s sent electronically to the pharmacy of your choice.

Your medical issue gets resolved, and you save time and money!

• $0 copay for HMO and PPO plans (lower cost than an office visit).

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Imagine this:

Online and in-person programs for both general wellbeing and disease reversal

Proven and backed by doctors’ methods for results

Largest collection of scientifically-backed apps

A personal digital health coach, taking guesswork out of your health strategy

A new way to achieve your health goals

Included with your health plan at no additional cost

Take charge of your

health with Wellvolution

You choose

areas of focus

We help with digital tools,

personalized weekly task

plans, and helpful information

when you need it

Go it alone or join a

support community –

online or in person

Trust in a hand-picked

network of tools that are

scientifically proven to

bring results

Create new plans as your goals

change to keep Wellvolution

giving you important

information and help

Connect to your phones

and/or other fitness-trackers

you already own -- no new

equipment needed

01 02

03 04

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Your health journey

now has a plan

Visit wellvolution.com to get started on your personal proven path.

Wellness discount programs

Save on alternative healthcare services from

participating practitioners.

25% or more off usual and customary fees for:

• Acupuncture

• Massage therapy

• Chiropractic services

Discounts also available for health and wellness

products like vitamins and supplements.

Alternative care

Lose those extra pounds and keep them off with

nationally recognized lifestyle change programs.

•Enroll in weight management programs at no

additional charge through our Wellvolution®

Diabetes Prevention Program.

•Save on Weight Watchers with special rates on

three- and 12-month subscriptions. Monthly pass is

also available for unlimited local meetings each

month, plus free eTools.

Weight management programs

Enroll in one of the most flexible gym membership

programs to stay committed to your health goals.

•Work out at any facility within our wide network

of more than 10,000 national fitness locations.

•Work out as often as you need while tracking

progress to your goals online.

•If you are a Medicare-eligible member, you

have access to gyms and fitness classes with

coverage provided by our SilverSneakers® fitness

program.

Fitness and exercise

Save on eye services at participating providers

whether or not you have vision care benefits.

Discount Provider Network – Save 20% on eye

exams, frames and lenses, contacts, and more.

MESVision Optics – Competitive prices on

contacts, glasses and eye care accessories.

QualSight LASIK – Save on LASIK surgery at more than 45 surgery centers in California.

NVISION Laser Eye Centers – Get a 15% discount

for laser services.

Vision discounts

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Overview

The ‘Fitness your way’ program provides eligible members

access to 10,000+ participating fitness centers nationwide

for $25 per month with a one-time $25 enrollment fee.

• Eligible Blue Shield California members enroll via the ‘Fitness your way’ website or by phone

• Members download a membership card on the website to use at a fitness center immediately

• Enrolled members pay Tivity Health through a recurring

payment every month

• Members can visit multiple locations – no need to select only one fitness location

• The offer is available to Blue Shield members and covered dependents age 18 or older

Blue Shield of California

Fitness your way by Tivity Health

SilverSneakers® Fitness Program(Blue Shield 65 Plus HMO members only)

SilverSneakers provides a basic membership to any participating

Fitness center location across the country. Program includes:

• Access to conditioning classes, exercise equipment, pool, sauna and

other available amenities

• Signature SilverSneakers Fitness Program classes, designed specifically

for older adults and taught by certified instructors

• Fun social activities and events, including health education seminars

• Access to an exclusive member online community at

www.silversneakers.com/member.

• SilverSneakers® Steps is a personalized fitness program for members

who don’t have convenient access to a SilverSneakers location within

15 miles of their home.

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Discount vision programSave 20% at participating providers on:

• Routine eye exams

• Frames, lenses, tints & coatings

• Extra pair of glasses

• Hard contact lenses

Vision and hearing discount programs

QualSight LASIK

20% discount on

traditional and custom

LASIK surgery.

Nvision Laser Eye Centers

15% discount on

LASIK procedures.

EPIC Hearing Service

30-60% off MSRP on major brand

hearing aids and related

professional services.

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Coverage right down to your identity

AllClear ID identity protection available for all eligible*

Blue Shield members—at no extra charge!

*Blue Shield Federal Employees Program, Medicaid, Medicare Advantage HMO, and Medicare Prescription Drug Plan members are not eligible.

• ID theft monitoring services

• Credit monitoring services, with lost wallet protection

and fraud resolution

• Identity repair services

100% success in resolving financial

identity theft cases in the U.S.

Access services by calling (855) 904-5733, Monday to Saturday, 6 a.m. to 6 p.m. PST, or visiting blueshieldca.allclearid.com

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Registering on blueshieldca.com is easy

• Have your member ID number and email address handy.

• Create a username and password, select security Qs and As.

• Search for network doctors, hospitals and other facilities

• Get information about medical and pharmacy benefits

• Print copies of your Blue Shield ID card

• Learn about Blue Shield programs and services

• Get secure access to medical and pharmacy benefits, claims and more

• Email Member Services with questions such as claims issues, benefits, providers, etc

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Redesigned, rebuilt app for easy use

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We’re here to help

• Member Services

• Shield Signature, TRIO, Shield Spectrum PPO plans

(855) 829-3566

7:00 a.m. to 7:00 p.m., Monday through Friday

• Blue Shield 65 Plus HMO

(800) 776-4466 [TTY: (800) 794-1099]

7:00 a.m. to 8:00 p.m., seven days a week from October 1 through February 14. However, after February 14, calls will be handled by our automated phone system on weekends and holidays

• Blue Shield of California Medicare Rx Plan PDP

(888) 7766-4466 [TTY: (888) 238-6482]

7:00 a.m. to 8:00 p.m., seven days a week from October 1 through February 14. However, after February 14, calls will be handled by our automated phone system on weekends and holidays

Thank youWe look forward to caring for you