Blue Shield of CA - Please Comment


1000 Post Club
Katy, TX
Hello Everyone...

I am looking for some general comments on BLUE SHIELD (not Blue Cross) of California.

Here is what I am looking for...

1. PRICING - Are they competative compared to BLUE CROSS, and other major California competitors?

2. UNDERWRITING - Do they APS most cases? Rate ups? Declines? Are they easy to do business with?

3. POLICY PROVISIONS- Anything to be concerned with the policy terms, conditions, or coverages?

These questions are specific to IFP only.

Thanks in advance, I look forward to comments on Blue Shield of California, your experiences, and how they stack up to the competition.
Last edited:

Pricing-Co-pay plans are usually higher then Blue Cross and Health Net. They do have a good product line but they are probably my third carrier I look to write business with. I write a lot of HSA's and they are usually priced much higher then others.

Underwriting-They have improve this a bit of late are usually longer then Blue Cross and in the past liked to APS a lot. They tend to rate up more then Blue Cross. They have been better of late so may be worth a case in certain situations.

Policy Provisions-Nothing wrong with the plans the plans are designed just like Blue Cross's for the most part just a different name and priced higher.

In order of how I write business to date:

Blue Cross
Farm Bureau Health Net
Health Net
Blue Shield
Thanks for your comments. What would you say the average underwriting turn around is on a clean app these days?

Also on commission do they pay based on total final premium or base rate only? (I assume base rate?).
Turn around time on clean app I have seen 24 hours to 72 hours.

Commission Structure

Level 1 20 percent
Level 2 Rate up 25% pays you 16 percent of total premium
Level 3 Rate up 50% pays you 10.67 percent of total premium

Usually equals out to the orginal base premium sometimes costs you pennies or a few dollars.
OK thanks sounds similar to Aetna, and a lot of CA IFP carriers.

Is the online application and agent services acceptable enough to do business? Can you check status, and billing easily?
Their online services are generally good and acceptable.

I like their provider finder function - it's really easy to use.
Blue Shield of CA is my #1 choice most of the time because I find that they have the best service. I myself have the Spectrum 4000 HSA, however I recommend the 2400 to younger people.

Not the cheapest plans but of all the carriers I've written I've never had a service issue with Blue Shield. I had one client who didn't pay her premium on time so they denied the claim. But when she got her check to them they were happy to re-submit it and paid it in 24 hours. I didn't even have to call and make a stink about it.

I find Shield also has the best and most responsive agent support. Try calling Blue Cross this week. You will be on old for 20 minutes. Why? They know the problem.... their rate increases are causing a huge volume and they are totally understaffed to handle it. The local rep even sent me the following internal communication:

Hi Al,

Here is some info on sales support - we are well aware this is a peak time.
March 1 rate increase ind and March 1 senior rate increase cause m,ore agent and member calls.


Hello RSM’s!

Two things to update you on…

1) We are EXTREMELY busy in the Sales Support and Membership Call Centers. Due to the high call volume, we ask that for any non-urgent issues, please ask your agents to use the shared email box [email protected] vs. a phone call. Another good option for your agents is to use the Agent Service Section of the Agents website.

Also, Please note that the RSM support team will be assisting with general Sales Support calls during their peak times, so please be patient if they aren’t able to answer the phone at their regular speed. Please be confident that they are still working hard on your issues.

Forget the 'shared email box." It's a black hole. No one ever answers. Same with the "leave a message and we'll call you back." Never happens.

I don't think you can go wrong writing either of the Blues in CA. But you asked about Shield and my experience has always been positive with them. Cross is my #1 for young people as I like the Lumenos set up. But they are too pricey for older folks wanting an HSA.

I've heard that some cases are taking 3 or 4 weeks to UW, but clean cases are breezing through in a couple of days. I wrote a 25 year old female smoker who was rated up with Shield, but she got approved in 4 hours! (Lumenos was too high for her... just out of law school and $$60K in debt and working at a small family law firm at NOT big dollars... and no group plan... which I'm trying to change!)

The big issue with Shield is that their UW is so very tight. If you have a pimple on your tush, you are not getting tier 1... and will probably be APSd and then declined!

Aetna is on my $#@! list (another thread here about that) and HealthNet is a nightmare to deal with. Color me blue.

Blue Cross blows BS out of the water! Better online application, quicker to APS, lenient underwriting, portfolio is more extensive, part of the Anthem online "agent services".

Blue Shield seems to do everything slower. And their underwriting is as tight as it has ever been.
Thanks again for comments...

What about let's say...

-controlled blood pressure for 3 years, 2 meds, halfway good BMI?


-ashtma with inhaler, no smoking, good BMI?

and finally...

-anxiety (zoloft let's say), no smoking, good BMI?

Would ANY or ALL of those 3 common scenarios trigger APS and / or rate ups?