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2020 Summary of Benefits | Rates | Renewal Center | Underwriting Guidelines | Changes To | Mandates |Wellness

 

2020 Benefit changes

Medical

Access 2020 medical plan documents or compare plans and year-over-year changes on the  Plan Comparison Tool.

Our 2020 plan enhancements feature more convenient and affordable ways for our Trio HMO and Tandem PPO members to access care.

• All Trio HMO and Tandem PPO plans feature $0 Teladoc visits and $0 first visit using Heal (learn more about Heal).
• All Trio HMO and Tandem PPO members can take advantage of Healthy Savings, which provides direct savings when purchasing healthy foods at Albertsons, Safeway, Kroger, Walmart, and Sam’s Club.
•  LifeSpring and Call the Car are available to eligible members, as determined by a Blue Shield case manager. LifeSpring provides meal delivery service and Call the Car provides non-emergency transportation.
• Trio HMO plans can now be offered alongside Local Access+ HMO (Trio HMO has been available to pair with Access+ HMO since 2017).

Visit www.blueshieldca.com/aco for full information on Trio plan benefits, programs, and coverage areas.

Specialty

Encourage your clients to take advantage of 10% savings with our specialty Bundled Savings discount program for groups adding dental or vision coverage to their medical plans.

Dental changes
Six new dental plans are available for groups starting January 2020.

SmileSM Plus Gold 50/1500/ Ortho/ U90/ ADV

SmileSM Plus Gold 50/1500/ No Ortho/ U90/ ADV

SmileSM Plus Gold 50/2500/ Ortho/ U90/ ADV

SmileSM Plus Gold 50/2500/ No Ortho/ U90/ ADV

Ultimate Dental PPO for Small Business 50/2000/ Lifetime Ortho/ U90

Ultimate Dental PPO for Small Business 50/2000/ No Ortho/ U90

These plans include:

•  Options with and without lifetime orthodontic benefits
•  No waiting periods for major services
•  Higher OON reimbursements (UCR90)
•  Annual max ranges from $1,500 to $2,500

Beginning with 1/1/20 groups, we will no longer waive the 12-month waiting period on voluntary dental plans. For groups with prior dental coverage with Blue Shield, the waiting period will be waived at the group level.

Vision changes

The $10 eye exam copay plans that replaced the $15 copay plans in 2019 are available for all renewing and new groups in 2020.
New vision plans will not be introduced in 2020.

Life insurance changes
16 new employee Life Insurance plans provide greater flexibility and options for your small business groups.

The new plans feature:
•  Higher maximum amounts, 2-9 segment
•  Higher maximum amounts, 51-100 segment
•  More benefit amounts options
•  All amounts full guarantee issue

Three new dependent Life Insurance plans that provide:
•  Higher maximum amounts, 10-100 segment
•  All amounts full guarantee issue 50% rule applies

Rates will not increase with any of these increased life insurance plan benefits.

Don't forget:
• Quick Match program is available for groups of 10 or more
• Travel assistance included in life insurance plan benefits
• Composite life rates are based on final census

Specialty Underwriting changes

Specialty underwriting for new groups will align with medical on the requirement that a group employs an eligible common law employee to be eligible for group plans. All new sales effective 1/1/20 require a common law employee, eliminating owner-only businesses. Documentation requirements for specialty business will be the same as for medical and based on the number of enrolling subscribers.

Pharmacy

Rx Spectrum Tiered pharmacy network is now available on On-Exchange (CCSB) and Mirrored plans, joining Tandem PPO and Trio HMO plans.

•  Level A (preferred): CVS, CVS at Target, Costco, and Safeway/Vons
•  Level B (non-preferred):  All other pharmacies in Blue Shield’s national pharmacy network

Check out the full directory of Level A pharmacy locations.

Q1 2020 Rates

Blue Shield small business plan rates are available now through your preferred quoting engine. Complete rate tables for all plans and regions are now available.

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 www.blueshieldca.com/digital.

We're moving renewal kits online

This change not only reduces paper waste but also provides a better customer experience, making materials easier to search, share, and save. Each of our small business groups will now have a unique microsite which contains all the materials previously printed and mailed.

There are three ways to access these sites:

•  Brokers have access to all their renewing groups' sites through Shield Renewals
•  An email will be sent to group administrators with a link, log in and password
•  A one-page letter will be mailed to the group with a unique URL, log in, and password

We want to ensure that each group does receive this important renewal information. If a group's microsite is not accessed within a week, we will send a reminder email. If there is still no action by 10 days, we will mail a full paper packet to the group.

Bonus and rewards

Broker Bonus Calculator
Quickly see your bonus earning potential with the incentive programs offered to small business brokers.

Medical Incentive Program 
We’re making it easier for you to earn more when you sell Blue Shield of California Small Business medical products:
• Earn $50 per enrolled new member for small business Off-Exchange medical plans
• Get an additional $50 when a member enrolls in a Trio HMO or Tandem PPO plan as part of the initial sale or during renewal

Specialty Broker Bonus
Earn more from your small businesses enrolling in dental plans, vision plans, or life plans* with our Small Business Specialty Bonus program:
• $10 for each new member enrolled in a dental plans
• $5 for each new member enrolled in a vision plan or life plan
• Double your bonus for dental, vision, and life enrollments with a Specialty triple-play, and earn $40 per member enrolled in all three.

Direct Elite Rewards
Earn more with each new small business account when you sell direct to Blue Shield:
• $100 per member for new small business medical groups if 75% or more of new business comes direct
• $75 per member for new small business medical groups if 50% to 74% of new small business comes direct
• Direct Elite Rewards program runs from February 2019 through January 2020 effective dates

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

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