Product cycle updates and benefit changes

Q3 2022 rates

Our third-quarter 2022 rate action is a statewide average of 2.4% for all plans and rating regions. The cumulative rate action for groups renewing in Q3 2022 is 6%, reflecting the preceding four quarters' rate actions combined.

Complete rates for medical plans, dental plans, and vision plans are available in our rate books here, on Broker Connection. Rate tables for dental plans and vision plans are included in the same file as the medical plans for each region.

Rates for closed Specialty benefits (dental and vision plans) are included in a variety of locations including:

• Rate book – includes Medical and Specialty (all regions: 1-19)
• Rate books 1-11
• Closed Rate Book – includes closed Specialty (all regions: 1-19)

Medical

We’ve included several new plans in our 2022 medical portfolio since the original Cycle Launch – providing your clients more options with greater value. These plans are listed immediately below.

 

Off-exchange PPO plans:

• Bronze PPO 5500/65 and Bronze 6500/70

Our new bronze plans feature competitive pricing with lower medical deductible and pharmacy deductibles. These plans include first-dollar coverage for primary care, specialist, and mental health office visits, which means immediate access to these benefits.

Off-exchange HMO plans:

• Silver HMO 2750/65

This plan provides a great lower cost option with the richness that a Silver plan offers. Benefits includes flat copays for office visits, tier 1, and tier 2 prescription drugs that are not subject to the deductible.

• Bronze 7000/70 Trio HMO

With all professional services available prior to deductibles, integrated Pharmacy deductibles, flat copays, and chiropractic services included, this plan offers richer benefits at a lower cost.

A list of 2021 Small Business medical plans changed names for 2022 can be found here.

Learn more about the 2022 small business medical plans

Trio HMO Network expansion into Santa Barbara and Monterey County!  

Starting in January 2022, the Trio ACO network will expand to include certain parts of Santa Barbara and Monterey.

Santa Barbara County

The following medical group will be added to the Trio ACO network in Santa Barbara (partial county):

• Sansum Medical Clinic

The following hospital partner will be added to the Trio ACO network in Santa Barbara (partial county):

• Santa Barbara Cottage Hospital
• Santa Ynez Valley Cottage Hospital
• Goleta Valley Cottage Hospital

Zipcodes affected:

City	Zip Code
Carpinteria	93013, 93014
Goleta	93116, 93199, 93117, 93118
Oak View	93022
Ojai	93023, 93024
Santa Barbara	93110, 93130, 93160, 93111, 93103, 93190, 93109, 93102, 93120, 93121, 93101, 93140, 93108, 93107, 93106, 93150, 93105
Santa Ynez	93460
Solvang	93463, 93464
Summerland	93067
Ventura	93001

Monterey County

The following medical group will be added to the Trio ACO network in Monterey (partial county):

• Aspire Health plan

With network medical groups consisting of:

• Montage
• Salinas Valley Health System

The following hospital partner will be added to the Trio ACO network in Monterey (partial county):

• Community Hospital of the Monterey Peninsula (CHOMP)
• Salinas Medical Center

Zipcodes affected:

City	Zip Code
Marina	93933
Monterey	93940,93942,93943,93944
Pacific Grove	93950
Pebble Beach	93953
Seaside	93955

Specialty

A few important reminders about our specialty offerings:

• Our dental plans come with a two-year rate guarantee.
• Groups can now select two vision plans to offer members.
• Life insurance includes beneficiary assistance and travel assistance.

Dental plan changes

We’ve developed a simplified portfolio of dental PPO plans to help streamline your sales experience.

The new dental PPO plans are easy to navigate with a clear hierarchy that helps find buy-up and buy-down options and follow medical plan naming convention (bronze, silver, gold, platinum, diamond). The changes, initiatives, and enhancements covered here are effective January 1, 2022. Some of the competitive benefits included are:

• Implants are included in all silver, gold, platinum, and diamond plans.
• Rollover rewards are included in all bronze, silver, and gold plans.

Introducing 22 new DPPO plans with five categories with a naming convention that mirrors the medical plans:

• Bronze/Bronze Voluntary
• Silver
• Gold
• Platinum
• Diamond

Existing 2021 marketed DPPO plans will change to non-marketed status and will be closed for new business. Renewing groups may continue to renew into the same plan or choose one of the new 22 plans available at renewal.

Dental HMO plans will include a third dental cleaning for pregnant women to help maintain good oral hygiene. Dental HMO/PPO/DINO will allow for dental cleaning frequency twice per consecutive 12-month period vs. once every 6-months.

New Summary of Dental Benefits and Coverage (SDBCs)

The Dental Plan Transparency Effect (Senate Bill No. 1008) requires standardized benefits and coverage disclosure matrix be displayed for dental plan benefits like how Summary of Benefits and Coverage (SBCs) display information for medical plan benefits. These disclosures are referred to as Summary of Dental Benefits and Coverage.

Beginning in mid-November, SBDCs will be displayed on the Blue Shields Policy Page for plans effective January 2022. Beginning January 1, 2022, pre-enrollment and post-enrollment microsites for Small Business will include SDBCs.

For more information, please refer to the Mandates Page of Broker Connection.

Vision plan changes

We are introducing a few benefits enhancements to help members maintain good vision health.

1. Standard progressive lenses are included on plans with a frame allowance of $120 or less.
2. Elective contact lens allowance will match frame allowance for all vision plans with a frame allowance of $150.

Life insurance changes

• There are no life insurance updates for Q1.

Important pharmacy update: copay card programs

Certain specialty drugs have copay card programs offered by drug manufacturers to help members lower their out-of-pocket costs. These programs are voluntary and may also be referred to as copay coupons, copay assistance, or copay savings programs.

The terms and conditions of copay card programs are set by the manufacturer, and members enroll in these programs directly with the manufacturer. When a member uses a copay card, the drug manufacturer pays part or all of the member’s copay or coinsurance, thus lowering the amount the member pays out of pocket.

While copay card programs are not offered with all specialty drugs, many of the drugs used to treat multiple sclerosis, rheumatoid arthritis, anemia, and other chronic conditions have copay card programs available.

Currently, the portion of the member’s copay or coinsurance paid for by the manufacturer’s copay card is applied toward the member’s deductible, and out-of-pocket maximum.

What’s changing

Starting January 1, 2022, for Individual and Family Plans (IFP) and upon group renewal after January 1, 2022, for Small Business and Large Group, only the amount members actually pay for their prescriptions (i.e., true out-of-pocket costs after using a copay card) will be applied toward their deductible and out-of-pocket maximum when using a copay card at CVS Specialty® Pharmacy. The portion of the member’s copay or coinsurance paid for by the manufacturer’s copay card will no longer be applied toward the member’s deductible nor out-of-pocket maximum.

What’s not changing

Members can continue to use copay cards to lower their out-of-pocket costs at CVS Specialty® Pharmacy. This change does not affect copay card programs provided by foundations or financial needs-based copay assistance.

Example: A member’s copay for specialty medication is $250. The member uses a copay card to lower the out-of-pocket cost to $5. Only $5 will apply to the member’s annual deductible and out-of-pocket maximums.

Go green. Go digital.

We continue to enhance and promote our digital tools for brokers that are designed to make your jobs easier while also reducing paper waste. You can learn about these resources by visiting blueshieldca.com/digital.

July, August, and September renewals

Groups renewing in July, August, and September will be available to brokers through Shield Renewals on Friday, April 8* while group-level changes can be made using Small Group Online Renewal (SGOR) beginning Wednesday, April 13.*

As a reminder, group renewal information is available as a microsite for each group, and these can be accessed through Shield Renewals. No download is required; you can open the site, find the information you need, and send the link or selected components to your clients.

Groups will receive an email notification and a mailed one-page letter. The letter will direct them to their renewal microsite for complete renewal information. Full renewal printed packets will only be mailed to groups if these sites are not visited on or before the dates outlined below.

Full renewal printed packets will only be mailed to groups if these sites are not visited on or before the dates outlined below:

	Employer notifications sent	Access site by
July renewals	April 25, 2022	February 15, 2022
August renewals	May 23, 2022	March 19, 2022
September renewals	June 24, 2022	April 8, 2022

Groups are also notified by email of the online availability of their health plan documents — Summary of Benefits and Coverage (SBC) and Evidence of Coverage (EOC) — which can also be accessed by brokers through the Shield Renewals site.

Visit the Renewal Center for all your Blue Shield small business renewal needs. If you have questions regarding SGOR, a training guide is available on Broker Connection for guidance.

* Dates subject to change

New and improved digital tools!

New plan comparison tool function

Brokers can now compare plans across all available years in the Plan Comparison tool. Previously, users could only compare plans from the same year or could only compare the same plan for year over year comparisons. Now, users can select and compare any plan from a past year, current year, and future year (three years of plan information).

We’ve made shopping for the right plan easier by a ‘year-over-year’ and ‘plan to any plan’ comparison function. Users can now see when plans are no longer available and when new plans are introduced, providing users with additional information to make the right choice.

Based on your feedback, we’ve also added a download spreadsheet option to the Plan Comparison Tool to provide more ways to view plans based on your, or your client’s, needs.

Supporting open enrollment events virtually

Even before COVID-19 reset norms to shift from in-person to online group meetings, attending all open enrollment events for your small business clients was unlikely, if even at all possible. This is why we developed digital pre-enrollment kits and gave brokers direct access to create digital pre-enrollment kits for their clients earlier this year. If you missed this roll-out, now is a good time to catch up and prepare for the busy fourth quarter. Instructional videos and other resources are available, along with access to the tool, when you select "Order Materials" from the Resources drop-down tab on Broker Connection (login required).

Within a few minutes, you can provide an enrollment microsite for any of your clients, complete with plan information, program fliers, enrollment forms, and more.

New small business microsite look and feel

Our renewal microsite has a new look and feel, making it easier for your group to renew! We’ve added a new ‘download renewal PDF kit’ function, a new specialty page, as well as enhancing the site’s look and feel.

Make life easier this quarter and submit your new business enrollments on the Employer Enrollment Tool

In addition to streamlining your new business enrollments, you will benefit from using the enrollment tool with:

• Increase your Direct Elite Rewards bonus when you submit through the enrollment tool in Q3
• Streamlined, digital applications give you visibility to the status of all your Q3 submissions.
• Automated reviews get member ID numbers to your inbox in an average of 30 minutes.
  • Don’t be disheartened if your application needs review! Manually review applications through the tool average two hours from start to ID numbers.

Additional enrollment functionality is coming to the tool in early 2022, so seize this opportunity to become an Employer Enrollment Tool expert now!

Bonus and rewards

Your producer rewards are waiting

The energy and commitment of our small business brokers drives our success. We see it. We feel it. And we want to reward you for it. That’s why Blue Shield of California has created Producer Rewards, a points-based bonus program that rewards you for the outstanding work you do. This program automatically ties rewards to each new sale made effective on or after June 1, so you could have points already waiting for you!*

When you sign up for Producer Rewards, your bonuses will be awarded directly to you. You'll continue to receive the full value of the bonuses you earn, as each point is equal to one dollar. Points can be redeemed for gift cards in the dollar amount or used to purchase merchandise. Beginning October, you’ll be able to see all the points you’ve earned to date and get monthly updates on your points balance.

For more information about the points you can earn for each new member sale, read more here.

Visit blueshieldca.com/ProducerRewards to get started or contact your Blue Shield sales representative to learn more. We look forward to your continued partnership!

* Broker agencies must enroll in the program before individual producers within that agency can enroll and begin earning points.

Small Group Incentive Program

This program lets you earn 50 points for each new employee and dependent enrolled in a medical plan, plus double bonus points for each new employee and dependent enrollment in a Trio or Tandem plan. That’s not all – there are additional bonus points awarded for employee and dependent enrollment in dental, vision, and life plans. Plus, for each member enrolled in all three specialty plans you’ll earn double points. Each point is equivalent to one dollar and is hosted through Producer Rewards.

Download the full program details here.

Direct Elite Rewards

This program continues to benefit direct-selling small business brokers, with cash bonuses of $100 per member for selling new business direct and enrolling members through the Employer Enrollment Tool.

Download the full program details here.

Broker Bonus Calculator

One sale, two reward systems to award your efforts. To help you track all your earnings, we have improved the broker calculator tool. This interactive tool will provide you with an estimate of your total earnings both in points and cash bonus.

Estimate your earnings here.

Bundled Savings discount program

We’ve increased the savings for groups when they add a dental and/or vision plan to their existing medical plan:

• Groups will now receive a 10% discount on their dental or vision premium when added to their medical plan.

Download the full program details here.

Quick Match Program^SM

Matching for small business life insurance plans has been enhanced. We can now match a current group's combined Basic Life/AD&D renewal rates at $0.08 per $1,000, for amounts between $15,000 and $200,000.

• Changes applied for groups with December 1, 2018, or later effective dates.

Download the full program details here.

Relaxed participation requirements for small businesses extended to December 31, 2022

We’ve extended our relaxed participation requirements through the end of 2022 – now until December 31, 2022, groups can take advantage of the following:

• We’re relaxing underwriting participation requirements for groups with five or more enrolled employees to just 25% for our medical, dental, vision‡, and life‡ insurance plans
• We’re relaxing underwriting participation requirements for groups with five or more enrolled employees to just 25% for our medical, dental, vision^‡, and life^‡ insurance plans^#

This promotion allows your client to purchase a medical plan and/or specialty benefits from Blue Shield alongside another carrier with more lenient underwriting participation rules.

Download the full program details here.

^‡ Underwritten by Blue Shield of California Life & Health Insurance Company.

^# If Trio and Tandem plans are written together, 25% of the total number of eligible employees and no fewer than five must be enrolled.