Mastering the essentials of health care

Understanding health care can be challenging. Let’s review some of the basics.

Healthcare 101

What are PPO and HMO plans? Which one is right for my business needs? Check out our Understanding Health Plans video to gain a better understanding of employer-sponsored health coverage.

Finding a doctor

Learn how to use our Find a Doctor tool with video tutorials and FAQs.

Deductibles, copays, and coinsurance

A deductible is the amount a member pays for covered services each calendar year before Blue Shield begins to pay. The predetermined amount (copayment) or percentage of the cost (coinsurance) of service that a member is responsible for paying is based on their plan benefits.

Off-exchange vs. on-exchange

On-exchange plans are plans purchased through a state or federal marketplace – an online platform for shopping and comparing plans. Off-exchange plans are available through an insurance company like Blue Shield.

Mirror plans

The Mirror Package for Small Business lets employers purchase the same plans that Blue Shield is offering through Covered California for Small Business (CCSB). This package includes several HMO and PPO options. These plans are also available for purchase on the Covered California for Small Business (CCSB) online marketplace.

Metal levels

The plan metal levels are standardized for all health carriers as part of the Affordable Care Act. Levels are based on “actuarial value” which indicates the average percentage of health costs that would be covered by the carrier for a member. The levels are Platinum (90%), Gold (80%), Silver (70%), and Bronze (60%).