Eligibility and benefits

Search for and verify eligibility and benefits for Blue Shield of California, Blue Shield of California Promise Health Plan, Federal Employee Program and other Blue plan members with online resources and tools.

 

Eligibility tools

Verify and learn more about eligibility of Blue Shield of California, Blue Shield Promise, Federal Employee Program and other Blue plan members. Download rosters of patients who have selected you as their personal physician or belong to your IPA/medical group.

Verify eligibility

Verify member eligibility by subscriber ID or name.

Member rosters

Download a list of members who have chosen you as their Personal Physician or medical group.

 

Benefit summaries

Get information about the variety of benefits available to our members.

If you have questions or would like more information, call Provider Information and Enrollment:

Summary of Benefits and Coverage

Access Evidence of Coverage (EOC) and Summary of Benefits (SOB) documents for IFP, Small Business and Mid/Large Group plans.

Medicare Advantage plan documents

Access Evidence of Coverage (EOC) and Summary of Benefits (SOB) documents for Medicare Advantage plans.

Blue Shield Promise Medi-Cal benefits

Access Evidence of Coverage (EOC) documents in multiple languages for Los Angeles and San Diego counties.

 

Preventive services, benefits policy and health guidelines

Learn about policy for preventive services, benefits, and health guidelines to ensure benefits are correctly configured and applied with the right billing codes..

Find preventive health guidelines for healthy children, adolescents and adults, including immunizations, screenings, patient-doctor discussion topics, and injury prevention.  Review other codes associated with select benefits mandated by state, federal or regulatory agencies.

Benefits policy

Review and download benefits policies, including codes associated with select mandated benefits.

Preventive health guidelines

Review guidelines for healthy children, adolescents and adults.

 

Additional resources

Access these additional resources to help you find and manage member eligibility and benefits

Benefits and member ID cards

Find benefit details for Blue Shield IPAs, medical groups and their contracted providers.

Eligibility and benefits contacts

Find benefit details for Blue Shield IPAs, medical groups and their contracted providers.

Primary Care Reimagined Support

Access program information, resources, and support materials.

Advanced Primary Care support

Use our educational resources to help ensure your success with Blue Shield's Advanced Primary Care program.

Value-based reporting

View member attribution and patient data about visits, risk scores and provider incentive opportunities.

Specialty Care Reimagined resources

View episodes of care reports and support materials.

Accountable Care Alliance reporting 

View ACO financial, quality, member experience, and utilization reporting.

Primary Care FFS+ support

Access program information, resources, and support materials.

FFS+ value-based reporting

Find benefit details for Blue Shield IPAs, medical groups and their contracted providers.

Hospital Value Model (HVM) Support

Access program information, resources and support materials.

Specialty Care Reimagined Support

Access program information, resources and support materials .

Specialty Care Reimagined reporting

View monitoring reports with detailed information on financial and quality performance and potentially opportunities.

Advanced Primary Care value-based reporting

View member attribution and patient data about visits, risk scores, and provider incentive opportunities.