Blue Shield of California Promise Health Plan
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Before a beneficiary can enroll with Blue Shield Promise Medi-Cal, they must first enroll in the Medi-Cal program by following the steps below:
Individuals seeking to enroll in the Medi-Cal program must first visit the nearest Department of Social Services (DPSS) / County Welfare Department and apply for benefits. If eligibility is established, the beneficiary is advised to attend an on-site information session administered by Health Care Options - a California Department of Health Services private contractor - to learn about available health care choices.
Health Care Options is responsible for educating Medi-Cal recipients about their benefits and how to enroll in a health plan. Beneficiaries needing further assistance or who have questions can contact Health Care Options at (800) 430-4263 or TDD for the hard of hearing: (800) 430-7077. Beneficiaries may also contact Blue Shield Promise Medi-Cal(800) 605-2556 or their doctor’s office and receive assistance with completing the enrollment form.
Upon receiving beneficiary eligibility information from DPSS, Health Care Options mails each recipient an enrollment packet. The packet contains enrollment materials as well as explains that the beneficiary must choose a health plan, what health plans are available, and that if the enrollment form is not completed and received at Health Care Options in 30 days a health plan will be chosen for them. When Health Care Options chooses a health plan for the beneficiary, it is called default or "automatic assignment."
Beneficiaries are primarily defaulted because they do not receive the enrollment packet, they do not understand the information because it was sent in English and they speak another language, or they submitted an incomplete enrollment form. Some are defaulted due to administrative and processing errors. Beneficiaries that are defaulted are not prevented from later choosing a health plan of their choice.
Enrolling with Blue Shield Promise Medi-Cal largely depends on a beneficiary’s status in the Medi-Cal Managed Care program.
Beneficiaries new to the Medi-Cal Managed Care program who have never completed an HCO form to select a health plan and doctor can:
Beneficiaries already enrolled or defaulted into a health plan can elect to transfer to Blue Shield Promise Medi-Cal at anytime. To ensure prompt response to a transfer request, beneficiaries and those assisting them must follow the appropriate processes. It is important to:
Beneficiaries enrolled with a Commercial Health Plan wishing to transfer to Blue Shield Promise Medi-Cal, must request and complete a Health Care Options (HCO) form.
Beneficiaries already enrolled with one of the health plan partners under the Local Plan (L.A. Care) and who wish to transfer to Blue Shield Promise Medi-Cal must request and complete a Plan Partner Transfer form.