Medical

Home > Health and Wellbeing > Medical

The medical plans offered by PCOC are designed to help protect you and your covered dependents against financial loss by paying for a substantial portion of eligible expenses incurred for medically necessary care and treatment. The medical plans are insured by Blue Shield of California.

  • If you enroll for coverage within your initial eligibility period, your coverage will be effective on the first of the month coinciding with or next following 30 days of full-time employment.
  • If you do not enroll for coverage within your initial eligibility period, you may enroll for coverage during the next annual open enrollment period or within 31 days of a qualifying event (as outlined in Making Changes During the Year).

Opt-Out Credit

If you waive the PCOC medical plan and provide proof of other coverage, you will be eligible to receive an opt-out credit of $50 per pay period. Even if you elect dental and/or vision coverage, you will receive the full opt-out credit. Contact Human Resources for more information.

Your Cost

Your cost is generally deducted from your pay on a pretax basis. Contributions for domestic partners are generally deducted on an after-tax basis, unless otherwise permitted by state or federal law. Refer to Employee Contributions for the applicable cost.

Find the Doctor of Your Choice

Find a list of in-network personal physicians, specialists, mental health providers, hospitals, pediatric dentists, pediatric vision care providers, and pharmacies using these tips.

  1. How you start depends on the type of plan:
  2. Select the type of provider you need (e.g., doctor, facility, mental health, etc.).
  3. Enter your preferred location.
  4. Select whether you want to search by provider specialty or provider name.
  5. Relevant results will be displayed. You can then filter and sort by other criteria, such as language or nearest to you.

If you are enrolling in an HMO plan

When you enroll in an HMO plan, you and your dependents must choose a personal care physician (PCP) within 15 miles or a 30-minute drive from where you live or work. You can either search for your PCP using Blue Shield’s Find a Doctor tool found at www.blueshieldca.com/networkhmo, or call member services at (888) 319-5999 to request a directory. If you do not select a PCP when you enroll, Blue Shield will assign you one. You can then change your PCP at any time by calling member services. PCPs provide routine checkups, immunizations, urgent care, and refer you to specialists.

If you are enrolling in a PPO plan

As a PPO plan member, you can choose your own doctor and do not need a referral to see a specialist. Choosing a provider in the Full PPO Provider Network can save you money and ensure that you receive the highest level of benefits available to you. When you visit doctors outside the Full PPO Provider Network, you may be responsible for higher copayments plus any charges in excess of Blue Shield’s allowed amount for the services.

Teladoc 24/7/365 Phone and Online Video Consultations

Teladoc provides you with access to board-certified doctors and pediatricians who are always available to resolve many of your medical issues via phone or online video consultations. Teladoc doctors diagnose and treat many of your non-emergency medical problems and write necessary prescriptions for you to pick up at your local pharmacy. Teladoc costs significantly less than urgent care and emergency room visits (no copay for members). For more information, visit www.blueshieldca.com/teladoc or call (800) Teladoc (835-2362).

Pediatric Dental and Vision Care

Coverage for pediatric benefits is automatically provided upon enrollment into a PCOC medical plan. These benefits provide important coverage for members through the end of the month in which they turn 19 years old, including preventive care, fillings, x-rays, prescriptions for lenses and more extensive services like medically necessary orthodontia. For more information, contact Blue Shield of California at the number on your ID card.

Wellvolution℠

This is a health program provided to PCOC medical plan members at no extra cost. You can create a profile and pick from many program options personalized for you to help achieve your health goals and make healthier choices. These programs include options to:

  • Lose weight.
  • Lower stress and manage anxiety.
  • Prevent or manage diabetes.
  • Quit smoking.

Visit www.wellvolution.com today to take steps toward improving your health!

NurseHelp 24/7℠

The medical plans include NurseHelp 24/7, which provides licensed health care professionals available to assist you by phone 24 hours a day, seven days a week. You can call NurseHelp 24/7 for immediate answers to any of your health questions, including concerns about:

  • Symptoms you are experiencing, including whether you need emergency care
  • Minor illnesses and injuries
  • Chronic conditions
  • Medical tests and medications
  • Preventive care

If your physician’s office is closed, just call NurseHelp 24/7 at (877) 304-0504 or go to www.blueshieldca.com/nursehelp to chat online.

Identity Protection Services

If you enroll in a PCOC medical plan, you are eligible for free identity protection services such as identity repair assistance, identity theft insurance and credit monitoring for you and your covered family members.

To access these services, call (866) 274-3891 or visit www.experianidworks.com/blueshieldca. When creating your account, provide the activation code BCBSCALI24. For over-the-phone setup, you will need engagement number B100349.

CVS Caremark Mail Service Pharmacy

CVS Caremark Mail Service Pharmacy offers you the convenience of receiving up to a 90-day supply of covered maintenance drugs. These drugs can be delivered to your home or office, with no charge for shipping, and they are available at two times the retail copay (which means extra savings for you). The medical plans offered by PCOC use the Standard Drug Formulary (available at www.blueshieldca.com/pharmacy, click on Small group plans and refer to the Standard Drug Formulary).

You must register with CVS Caremark Mail Service Pharmacy to receive medications through mail service. Register with CVS Caremark Mail Service over the phone, online or by mail. Then, your physician can simply submit any new prescriptions to CVS Caremark Mail Service Pharmacy electronically, by phone, by fax, or by mail.

If you have any questions or require more information about pharmacy benefits, contact Blue Shield member services at (866) 346-7200 or visit www.blueshieldca.com/bewell.

The following tables summarize the key features of the 2024 medical plans available to you and your eligible dependents.

PCOC Platinum Medical Plans

PCOC Gold Medical Plans

Blue Shield of California Website

www.blueshieldca.com
www.blueshieldca.com/mobile

First time visitors: You will need to establish a user ID and password.
Then, information is available 24/7.

Wellness Discount Programs

Access additional discounts at www.blueshieldca.com/wellnessdiscounts to take care of your health.