Product cycle updates and benefit changes

Small business (1-100)

Broker resources

Medical

We’ve added two new plan designs to our 2021 medical portfolio – which means more choice for you and your employees.

Off-exchange PPO plans

Platinum PPO 250/10
Our Platinum PPO 250/10 is offered on both Tandem and Full PPO networks. It has low out of pocket maximum with a combined in- and out-of-network deductible, and features copays for specialists matching primary care office visits. This is the richest plan offered in our small business portfolio.

Gold PPO Savings 1750/15%
Our Gold PPO Savings 1750/15% is the richest of our high-deductible eligible health plans, providing value and flexibility. It's offered on both Tandem and Full PPO networks, and also features a lower out of pocket maximum.

You can compare the benefits of your current plan selection to these new plan options by using our Plan Comparison Tool.

Specialty

We've made a few updates for our 2021 dental plan, vision plan, and life insurance offerings.

Dental changes

Effective January 1, 2021, the following Ultimate Dental PPO plans will include the word “Ortho” or “No Ortho” as part of the legal name.

New legal plan name for open plans:

Ultimate Dental Plus PPO for Small Business 50/2000/Ortho/MAC/NR
Ultimate Dental PPO for Small Business 50/2000/No Ortho/MAC/NR

New legal plan name for closed plans:

Ultimate Dental Plus PPO for Small Business 50/Ortho/2000/MAC
Ultimate Dental PPO for Small Business 50/No Ortho/2000/MAC

Vision changes

Vision coverage is an essential part of a comprehensive benefits package that can help employers maintain a healthy workforce and increase employee productivity.

Added retinal imaging exam benefit
A retinal imaging exam benefit is now available as an option to the comprehensive eye exam. This procedure takes a digital image of the back of the eye to help an optometrist or ophthalmologist find certain diseases and check the health of the eyes without dilation.

Available with in-network providers only.
Applies to all vision plans with eye exam benefit.
Member will pay an additional $39.00 copayment for this benefit.

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 employers way to provide their employees and their families with added security during uncertain economic times. To provide greater flexibility and more options, we’ve added 2 new employee life insurance plans for the 2-9 segment.

Basic Life and AD&D Insurance -$15,000
Basic Life and AD&D Insurance -$20,000
Basic Life and AD&D Insurance -$25,000
Basic Life and AD&D Insurance -$30,000
Basic Life and AD&D Insurance -$35,000
Basic Life and AD&D Insurance -$40,000 NEW
Basic Life and AD&D Insurance -$45,000 NEW
Basic Life and AD&D Insurance -$50,000

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

All new groups receive a two-year rate guarantee on their life insurance coverage.
Our life insurance Quick Match Program^SM 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.

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.

Our vision network is the largest in the state, and our dental networks are also among the broadest available in the market. Combining benefits under Blue Shield makes it easy for members, with one integrated online member experience. Bundled savings lowers premium costs by 10% for dental and vision plans when offered with medical, as well as easier administration with consolidated billing.

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.

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 $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).

Q1 2021 rates

We have a rate pass for the first quarter of 2021 for all plans and rating regions. The cumulative rate action for groups renewing in Q1 2021 is -0.3%, reflecting the preceding four quarters' rate actions combined.

Complete rate tables 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.

Rate tables for closed dental plans are posted on this page as well, as a separate file from the regional rate books; closed plan rate tables are not included in group renewal kits.

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.

Q1 Renewals will be available soon
We know January renewals seem a long way away with the bulk of Q4 still in the works. However, to plug into your calendar for reference, all Q1 group renewals will be available for download on October 16, and group level changes possible October 21.

As a reminder, even though we release multiple months' renewals to brokers at the same time, renewal notifications to employers are staggered based upon their renewal month.

January groups: October 23
February groups: November 20
March groups: December 18

Because we release renewals to brokers early, and there could have been changes made to the group after the renewals were released it does mean that employers may receive renewal packets/information that do not reflect these changes.

Member level changes are always available on Employer Connection Plus one month prior to a group's renewal period. Help prepare your groups for open enrollment with customized group microsites, in lieu of printed enrollment packets. You can develop and deliver these microsites in minutes, and the tool is available 24/7. Get started here (Broker Connection login required).

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

Medical Incentive Broker Bonus Program

You can now earn $50 per new member, and $50 more for each member - new or renewing - who enrolls in a Trio HMO or Tandem PPO plan! You can also earn $25 per member when you enroll using our new Employer Enrollment Tool.

There's no restriction on combining all these incentives with our Direct Elite Rewards Program, described below.

Direct Elite Rewards

Our Direct Elite Rewards program continues to benefit direct-selling small business brokers in 2020, 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 2020 through January 2021.

$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.

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.