Blue Shield Medical

Need to confirm your current doctor’s affiliation with Blue Shield? Find a network specialist or hospital? An urgent care center? Chances are your current providers are in the Blue Shield network.

• California employees have access to Blue Shield’s “Full PPO and Full PPO Savings” network.
• Outside of California, employees use providers in the BlueCard network, which links local Blue plans across the United States and abroad.

Get help in finding a provider or confirming that your provider—including your regular doctor, specialists, hospital, and local urgent care center—is part of the Blue Shield network:

• Visit the Blue Shield website (created especially for Okta employees) to connect with a virtual assistant that can help you.
• Choose Find a Doctor and a chat box will appear. Your virtual assistant will ask for your ZIP code and address. Answer any additional questions and your virtual assistant will provide you with a list of providers based on your answers.

To find a provider:

• Go to BlueCard’s website.
• Make your selection based on the type of doctor or facility you're looking for. 
• Log in or continue as a guest. Enter your Zip code.
• Follow the prompts based on your location.
• When you are asked to find your plan by prefix, enter OTX.

For more information, follow the steps outlined in this guide or call Blue Shield at 855-599-2650 if you need help.

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The Blue Shield HDHP + HSA plan is one of Okta’s best-value medical plans for most employees.

It has two parts: a high deductible, HSA-compatible medical plan and a tax-advantaged health savings account.

This plan may be right for you if:

1. You want a low per-paycheck deduction—even if it means you have to meet a higher deductible.
2. You rarely need to see a doctor; an annual checkup is usually it for the year.
3. You feel comfortable paying for a large health expense that costs almost as much as your deductible.
4. You want the opportunity to accumulate savings and to invest and take part in the plan’s triple tax advantage for future healthcare expenses.
5. You plan to use network providers for your care, but like having the option to go out of the network.

Here’s how it works:

Paycheck costs

• Amounts deducted from your paycheck are lower than other options.
• Employee-only coverage is 100% paid for by Okta.

Health savings account

• In 2022, Okta will maintain its annual HSA contributions for employees: up to $780 (for employee-only coverage) and up to $1,518 (if you cover one or more family members).
• You can contribute your own money to your HSA, too.
• Use your HSA funds to pay for healthcare expenses—including your annual deductible.

Doctors and other healthcare providers

• Go to any provider, but you pay less when you use Blue Shield or BlueCard network providers. (These are doctors, hospitals, therapists, and other healthcare providers who have contracted with Blue Shield to furnish services and supplies for a negotiated charge.)

Cost sharing between you and the plan

• You pay $0 for in-network preventive care and prescription drugs that qualify as preventive care.
• For all other care, you must meet the annual deductible before the plan cost sharing begins.
• The in-network annual deductible is $2,800 for an individual and $5,600 for families.
• Once you hit the annual deductible, the plan pays 100% of eligible in-network medical expenses.

For prescription drugs, you pay these copays after you satisfy the annual deductible:

In-network retail pharmacy

• $10 for tier 1 generic
• $25 for tier 2 formulary
• $40 for tier 3 non-formulary
• 30% up to $200 for tier 4 specialty formulary

Mail service

• $20 for tier 1 generic
• $50 for tier 2 formulary
• $80 for tier 3 non-formulary
• 30% up to $400 for tier 4 specialty formulary

See the prescription drug formulary list.

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With the PPO plan, you may go to any provider, but you pay less when you use Blue Shield or BlueCard network providers.

This plan may be right for you if:

1. You and your family are frequent users of medical care.
2. You want a lower cost when you receive care—even if it means you pay more per paycheck.
3. You mostly use network providers, but you would like to have access to out-of-network providers in certain circumstances. 

Here’s how it works:

Paycheck costs

• The PPO plan has a higher monthly paycheck contribution because it offers the most choice of providers with a lower deductible.

Doctors and other healthcare providers

• Go to any provider, but you pay less when you use Blue Shield or BlueCard network providers.

Cost sharing between you and the plan

• You pay $0 for eligible preventive care and prescription drugs that qualify as preventive care.
• For all other care, you must meet the annual deductible before the plan pays benefits.
• In-network annual deductible:
  • $500 for an individual and $1,500 for families 
• Out-of-network deductible:
  • $1,500 for an individual and $4,500 for families
• Once you reach the annual deductible, you pay copays for some eligible in-network services and coinsurance for others.

In-network copays for frequently used services

• $150 for emergency room visits (waived if you’re admitted to the hospital from the emergency room)
• 10% coinsurance for inpatient hospital stays

You pay these copays for prescription drugs:

In-network retail pharmacy

• $10 for tier 1 generic
• $20 for tier 2 formulary
• $40 for tier 3 non-formulary
• 30% up to $200 for tier 4 specialty formulary

Mail service

• $20 for tier 1 generic
• $40 for tier 2 formulary
• $80 for tier 3 non-formulary
• 30% up to $400 for tier 4 specialty formulary

See the prescription drug formulary list.

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With the EPO plan, you must use in-network providers – if you go out-of-network, the plan will not cover your services. The EPO plan uses the same network of providers as our current Blue Shield/BlueCard plans, which gives you access to a wide range of providers throughout the U.S.

This plan may be right for you if:

1. You only use providers in the Blue Shield/BlueCard network.
2. You prefer to pay a fixed cost at the time you need care.
3. You’re not required to meet a deductible.

Here’s how it works:

Paycheck costs

• This plan has a higher monthly paycheck cost because you pay less when you use healthcare services.

Doctors and other healthcare providers

• You must use Blue Shield or BlueCard network providers.

Cost sharing between you and the plan

• You pay $0 for eligible preventive care and prescription drugs that qualify as preventive care.
• There is no deductible.
• You pay copays for eligible in-network services.
• There is no coverage for services received from out-of-network providers.

In-network copays/coinsurance for frequently used services

• $15 for doctor office visits and specialist office visits
• $100 for emergency room visits (waived if you’re admitted to the hospital from the emergency room)
• $250 copay per admission for inpatient hospital stays

For prescription drugs, you pay these copays:

In-network retail pharmacy

• $10 for tier 1 generic
• $20 for tier 2 formulary
• $40 for tier 3 non-formulary
• 30% up to $200 for tier 4 specialty formulary

Mail service

• $10 for tier 1 generic
• $40 for tier 2 formulary
• $80 for tier 3 non-formulary
• 30% up to $400 for tier 4 specialty formulary

See the prescription drug formulary list.

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Blue Shield offers virtual visits—also known as telemedicine—so you can use your phone, tablet, or computer to immediately connect with a medical professional.

Teladoc

• Get 24/7 access to board-certified doctors, available by video and by phone at 800-Teladoc (835-2362)
• Also, go to Blue Shield’s Teladoc site for details.

NurseHelp

• Talk with a registered nurse, 24/7, 877-304-0504.
• Also, go to Blue Shield’s NurseHelp site for more information.

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