Blue Shield of California PPO
Blue Shield of California PPO allows you to choose any healthcare provider. When you obtain care from in-network providers, the plan pays higher benefits, your out-of-pocket expenses are less, and claims are submitted for you by your doctor. If you obtain care from an out-of-network provider, the plan pays lower benefits and you may be required to pay for services directly and submit your own claims. PPO's don't assign a Primary Care Physician, so you have more responsibility for coordinating your own care.
Visit Blue Shield of California's SFHSS website here.
Find in-network providers within California here.
Information regarding out-of-network flexibility here.
Find providers outside of California using the national network of Blue Cross Blue Shield providers here and enter the prefix SFG.
Find the Value in Your Benefits
Discover more about the other options available to you by reviewing the Summary of Benefits in the plan documents. Below are some examples:
Preventive Immunizations
$0 share of cost from OON provider
Teladoc
15% coinsurance (OON not covered) (Not available with OOA)
Acupuncture Services
Up to $1,000 maximum per member, per calendar year
Chiropractic Services
Up to $1,000 maximum per member, per calendar year
Medical Nutrition Therapy, Not Related to Diabetes
Up to 4 visits per member, per calendar year
Home Health Care Services
Up to 120 visits per member, per calendar year (15% coinsurance INN/50% coinsurance OON)
Skilled Nursing Facility (SNF)
Up to 120 visits per member, per calendar year (15% coinsurance INN/50% coinsurance OON)
Hearing Aids and Equipment
Up to $2,500 per ear, per member, per 36-month period
Outpatient Rx Plan Design
90 days at retail, with one copay per 30 days (excluding Tier 4)
Retail
Tier 1: $10 — OON covered 50% plus $10 per prescription
Tier 2: $25 — OON covered 50% plus $25 per prescription
Tier 3: $50 — OON covered 50% plus $50 per prescription
Tier 4: $50 — OON covered 50% plus $50 per prescription
Mail Service
Tier 1: $20 — OON not covered
Tier 2: $50 — OON not covered
Tier 3: $100 — OON not covered
Tier 4: $100 — OON not covered
PPO Purchased Ancillary Services
Teladoc General Medical (Not Available with OOA)
Teladoc’s U.S. board-certified doctors can resolve many medical issues, 24/7/365, via phone or online video consultations. Teladoc is a high-value service for busy employees who may not always have time to make a medical office visit with their primary care physician or who may want to save on out-of-pocket costs by having a phone or video consultation. Cost shown is for the program only and does not include the cost of member consultations.
LifeReferrals 24/7 (Not Available with OOA)
The program offers members personal consultations with a master’s-level professional anytime, day or night, seven days a week. With complete confidentiality, members can turn to this referral service for personal, family, and work issues such as marriage, relationships, career, grief, legal, and financial concerns. This program helps employers increase employee satisfaction and productivity by helping employees better manage the stressful demands of home, health, and career.
Prenatal Program
Comprehensive pregnancy, postpartum, newborn, and return-to-work support for new and expecting parents. Early intervention and specialized support are available for all members, including those who show warning signs of high-risk pregnancies or postpartum depression. The program is available throughout 9 months of pregnancy and 3 months postpartum. It also includes support for members who have experienced a miscarriage or pregnancy loss and specialized resources for partners.
Wellvolution
Wellvolution is a lifestyle medicine platform that addresses whole health across the care continuum. It provides a personalized, structured lifestyle change experience utilizing highly rated apps, evidence-based therapies, and member-centric design.
Wellvolution allows members to create a personalized, proven path to better health by answering a few questions about their health needs and goals and then selecting the best tool from the options provided in their recommendation.
The platform can help individuals with everything from improving nutrition and getting better sleep to preventing diabetes and reversing a chronic condition. Wellvolution hosts the largest curated lifestyle medicine network in the country, including almost 70 individual solutions using more than 35 provider partners.
Eligible members will be directed to www.wellvolution.com to access the platform and enroll in a program.
2026 Plan Documents
Other Benefits
- To access mental health services: (866) 336-0711
Contact Information
- Telephone: (888) 499-5532