Product cycle updates and benefit changes
Small business (1-100)
Broker resources
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2021 Summary of Benefits | Rates | Renewal Center | Underwriting Guidelines | Changes To | Mandates | Wellness |
Q3 2021 rates
We have a statewide average rate action of 1.2% for our third quarter of 2021 for all plans and rating regions. The cumulative rate action for groups renewing in Q3 2021 is 1%, 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 now included in the rate book(s) and are not posted as separate files. As a reminder, closed plan rate tables are not included in group renewal kits.
Medical
We’ve added another new plan design to our 2021 medical portfolio: introducing the Silver PPO 2225/50 plan, our first plan that provides $0 medical care to members with chronic conditions.*
Silver PPO 2225/50
- Our Silver PPO 2225/50 plan includes Value-Based Benefits (VBB), which provide $0 office visits and lab tests for members with diabetes, asthma, COPD, and CAD. Tier 1 and Tier 2 drugs are available with no deductible and, good news, any eligible member can enroll in this plan (an eligible condition diagnosis is not required). The plan is available statewide on both the Full PPO and Tandem PPO networks, offering your clients rich coverage at a low price for their employees that need it most. You can compare the benefits of current plan selections to these new plan options by using our Plan Comparison Tool.
- Learn more about Value-Based Benefits here.
* Value-Based Program services are provided at $0 cost-share when seeing a participating provider for treatment of diabetes, asthma, chronic obstructive pulmonary disease (COPD), or coronary artery disease (CAD).
Enhancements to our Bronze PPO plans
As California adopted new expanded Bronze AV legislation, we’ve redesigned all of our non-HSA (Health Savings Account) Bronze PPO plans, which now offer enhanced first dollar coverage prior to the deductible.
In addition, all of our plans below come standard with $0 Teladoc medical and mental health consults.
Bronze PPO 6850/65 OffEx
- 5 non-preventive office visits with copay prior to meeting the deductible
- Separate pharmacy deductible that is waived for Tier 1 drugs
Bronze PPO 6250/70 OffEx
- 1 non-preventive office visit with copay prior to meeting the deductible
- Plan deductible is waived for Tier 1 drugs
Bronze PPO 7500/50 OffEx
- 1 non-preventive office visit with copay prior to meeting the deductible.
All of these plans are offered on the Full and Tandem PPO networks. See the Summary of Benefits for each plan for more information.
You can compare the benefits of your current plan selection to these new plan options by using our Plan Comparison Tool.
Updates to Teladoc
In response to the coronavirus pandemic, we made telemedicine visits through Teladoc available to our members at no cost through the end of 2020. Beginning next year, $0 copays for Teladoc general medical visits will be standard throughout our 2021 small business portfolio plans. This is for all plans including PPO/HMO, Trio, and Tandem, On/Off Exchange. Also included are PPO Savings (HDHP) plans, with copays being $0 a visit and not subject to the deductible.
We're also adding Teladoc mental health* with a $0 copay for all plans including PPO/HMO, Trio and Tandem, On/Off Exchange. For PPO Savings (HDHP) plans, the copay will be $0 a visit and not subject to the deductible. Teladoc mental health provides confidential support for many conditions, with licensed clinicians and clinical social workers. Scheduled appointments are available for ages 13 and up starting in 2021 and can be done online or via mobile app seven days a week from 7 a.m. to 9 p.m. in the members' time zone.
$0 copay and addition of mental health benefits are upon renewal in 2021 and for new groups enrolling in 2021.
* Teladoc changed 'Behavior Health' to 'Mental Health' (August 2020).
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
- There are no dental plan updates for Q3.
Vision plan changes
- There are no vision plan updates for Q3.
Life insurance changes
Basic Life and AD&D insurance, underwritten by Blue Shield of California Life & Health Insurance Company (Blue Shield Life), is an affordable way for your clients to way to provide their employees and their families with added security during uncertain economic times.
The following enhancements have been made to Small Business multiple of salary plans.
- 12 existing multiple of salary (1X and 2X) plans with benefit maximums between $125,000 and $300,000 will be available for groups with as few as 10 eligible lives:
- 1X Annual Salary to $125,000 maximum
- 1X Annual Salary to $150,000 maximum
- 1X Annual Salary to $175,000 maximum
- 1X Annual Salary to $200,000 maximum
- 1X Annual Salary to $250,000 maximum
- 1X Annual Salary to $300,000 maximum
- 2X Annual Salary to $125,000 maximum
- 2X Annual Salary to $150,000 maximum
- 2X Annual Salary to $175,000 maximum
- 2X Annual Salary to $200,000 maximum
- 2X Annual Salary to $250,000 maximum
- 2X Annual Salary to $300,000 maximum
- 6 new multiple of salary (2X) plans have been added with higher benefit maximum amounts.
- Four plans with benefit maximum amounts between $350,000 and $500,000 will be available for groups with as few as 10 eligible lives:
- 2X Annual Salary to $350,000 maximum (10-100 lives)
- 2X Annual Salary to $400,000 maximum (10-100 lives)
- 2X Annual Salary to $450,000 maximum (10-100 lives)
- 2X Annual Salary to $500,000 maximum (10-100 lives)
- Two plans with benefit maximum amounts of $550,000 and $600,000 will be available for groups with 51+ eligible lives:
- 2X Annual Salary to $550,000 maximum (51-100 lives)
- 2X Annual Salary to $600,000 maximum (51-100 lives)
- Four plans with benefit maximum amounts between $350,000 and $500,000 will be available for groups with as few as 10 eligible lives:
All new groups receive a two-year rate guarantee on their life insurance coverage.
Our life insurance Quick Match ProgramSM provides streamlined underwriting by matching rates from any other plan, for new or existing groups with 10–100 eligible employees. Click here to learn more.
* Underwritten by Blue Shield of California Life & Health Insurance Company.
† Please refer to the plan contract and the Evidence of Coverage for a detailed description of covered benefits, limitations, and exclusions.
Change to CVS Health for Pharmacy Claims Processing
The other update is that Blue Shield has signed an agreement with CVS Health to become our pharmacy claims processing vendor and will handle all related services effective January 1, 2021. This change does not impact benefits, formulary, or the pharmacy network. We expect a seamless transition to the new claims processing platform with minimal member disruption.
To enable claim processing by CVS Health, ID card information will need to be updated to allow pharmacies to submit claims to CVS Health. As a result of this vendor change, all members will receive new ID cards so they can begin to use their new ID card on January 1.
If a member has selected an electronic delivery preference, then they will access their updated digital ID card on blueshieldca.com. Members will receive an email notification when their new ID card is available.
Everyone else will receive printed ID cards. The printed ID cards will arrive prior to January 1 and will include a buck slip indicating why the member is receiving a new card and include instructions to continue to use their existing card until December 31, 2020, and present their new ID card to their pharmacy beginning January 1, 2021.
We created a resource page with additional information including frequently asked questions and samples of member communications to help support you with these upcoming changes.
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
July through September group renewals will be available to brokers through Shield Renewals on Thursday, April 8,* while group-level changes can be made using Small Group Online Renewal (SGOR) beginning Friday, April 23.*
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 one-page mailed 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.
- July renewals: Employer notifications sent April 26 | Access site by May 18
- August renewals: Employer notifications sent May 25 | Access site by June 15
- September renewal: Employer notifications sent June 25 | Access site by July 16
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 now on Broker Connection for guidance.
*Dates subject to change
A digital-first approach to printed medical ID cards
Beginning in October 2020, members who have opted into electronic delivery of communications will no longer receive printed medical ID cards. These members will be directed to access a digital ID card at blueshieldca.com. We are honoring the member's preference to go digital by expanding that preference to include ID cards.
Members will have access to their currently active ID card, which will automatically update with the most up to date plan information at any time, such as after renewal.
If a member would still like a printed ID card, they can access a copy of the PDF on blueshieldca.com, request a printed copy from the website, or call Customer Care to receive a printed copy.
Members who did not opt into electronic delivery or if they are new members will be mailed a printed ID card prior to their plan effective date as we normally do.
We have done provider outreach training, education, and communication to ensure providers understand this digital option for ID cards. In addition, we are working closely with our provider services, provider relations, and customer care.
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.
Bonus and rewards
Relaxed participation requirements for small business extended to December 31, 2021
We’ve extended our relaxed participation requirements through the end of 2021 – now until December 31, 2021, 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 waiving our participation requirements for Trio-only membership for groups of 1 to 100 eligible employees. Simply select “Trio plans only” on the Master Group Application and a new group can enroll with Blue Shield with just a single member.
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.
Direct Elite Rewards
Our Direct Elite Rewards program continues to benefit direct-selling small business brokers in 2021, with elevated bonuses for new Blue Shield of California small business medical member sales. The rewards program is available to all small group brokers who sell direct, with effective dates from February 2021 through January 2022.
- $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.
Download the full program details 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 ProgramSM
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.