The latest update for 2020 Blue Shield of California ASH Plans, directly from ASH
1. The Blue Shield PPO plans to move to ASH January 1, 2020, are as follows:
â¢ Individual and Family Plans (IFP): on-exchange and mirrored. The small business group plans: on-exchange and mirrored
These plans do not include chiropractic benefits as they are part of Covered California plans that had no chiropractic benefits.
â¢ Small business group plans: off-exchange with acupuncture and/or chiropractic
â¢ Mid-large, fully insured plans: with acupuncture and/or chiropractic benefits
â¢ A NEW 2020 plan: Blue Shieldâs new PPO Medicare Advantage Prescription Drug Plan
(GMAPD) â a new PPO product for Blue Shield that becomes effective 1/1/2020. This will
NOT apply to Blue Shieldâs existing Medicare Advantage Individual Prescription Drug Plan
IMAPD) and will NOT apply to Blue Shieldâs existing Medicare Supplement plans.
2. The plans that will remain with Blue Shield and our own provider network are Plans that are
self-funded by employers, as well as FEP PPO, Individual Medicare Advantage PPO plans
and IFP Grandfathered plans.
3. Whether or not you are a Blue Shield network participating provider, in order to provide in-
network services to the plans that ARE moving to ASH, you will need to join the ASH network.
ASH is encouraging providers to do so because it helps members in the affected PPO plans reduce
their out-of-pocket expense.
4. Providers who are not part of the ASH network can provide services under the members out
of network benefits. Member out-of-network benefits (higher cost share) will apply. If you
choose to be a non-participating practitioner (not in ASHâs network) the following will apply:
â¢ ASH will verify medical necessity for out-of-network services for Blue Shield of
California PPO members in the affected plans.
â¢ The claims are sent to ASH and processed as out-of-network.
â¢ Blue Shield of California may request documentation for medical necessity review
at any point in treatment which may begin upon the first visit or anytime thereafter.
â¢ Non-participating providers can render all services within the scope of practice, but
reimbursement will be limited to those covered services that are determined to be
medically necessary through the ASH Group medical necessity verification process.
â¢ Patients will be responsible for any costs not covered by their plan.