Product cycle updates and benefit changes

Small Business (1-100)

Compliance with SB 729's fertility services requirements

We are working in good faith to implement the various requirements of SB 729 for fully-insured small and large employer groups.  

We have engaged our clinical and legal teams to ensure we provide fertility services consistent with the bill’s requirements and intend to comply by July 1, 2025. 

Coverage details are currently being reviewed by the Department of Managed Health Care (DMHC).  

Once the DMHC approves our implementation approach, plan documents such as EOCs and SOBs will be updated and distributed accordingly for all fully-insured small and large employer groups that elect to offer fertility service in accordance with SB 729.   

We will continue to provide additional information as it becomes available. Please see these FAQs for more information. 

Medical plan updates

See below list for impacted PPO plans with cost share and name changes. There are no name changes within our HMO portfolio. You can view the full list of 2025 plan name changes here.

For a full list of 2025 plan changes and updates you can visit the ‘Changes To’ page on broker connection. To view exact terms and conditions of coverage for all 2025 plan offerings, refer to the Evidence of Coverage for the plan, or contact your Blue Shield account manager. You can also use the Plan comparison tool to see plan updates across multiple years and compare plan benefits within the same plan family.

Making it easier to offer HMO to your groups

Effective January 1, 2025, you can now offer all 3 HMO (Access+, Local Access+, Trio) networks alongside each other, applicable to both new sales and renewals allowing for more simplification and growth.
 

Trio HMO now offering coordinated in-person and virtual care

A virtual provider option is now available in all counties that offer Trio HMO through Accolade Care offering primary, specialist, and behavioral care. Please note that referrals are required for specialty care.

Improved and equitable access to healthcare.

Providing improved accessibility to at-home care with DispatchHealth

Through DispatchHealth we are offering employers and their employees convenient and prompt at-home medical support post-hospitalization. Now available at $0 for all PPO members. A referral is needed by a case manager or a provider.
 

Our commitment to equitable access to health care

Effective January 1, 2025, we will be expanding our travel reimbursements program for eligible covered services, which currently includes abortion services, to also cover gender-affirming care. This program is designed to support members living in states that ban or restrict these services, providing them with access to necessary care.

Specialty Plans (Dental, Vision, Life)* update

Prepare for 2025 Dental PPO plan withdrawals

As part of our product transformation and portfolio simplification efforts, three DPPO plans will be withdrawn from our Specialty portfolio beginning January 1, 2025. See mapping grid for list of withdrawn plans and corresponding recommended available plans. You can also use the Plan Comparison Tool to compare benefits between a withdrawn plan and new available plan by using the compare year over year function. Plans being withdrawn:

• Smile℠ Deluxe 50/1500/Ortho/MAC
• Smile℠ Deluxe Gold 50/1500/Ortho/U85/NR
• Ultimate Dental Plus PPO for Small Business 50/2000/Ortho/MAC/NR

We will be providing written communication to your employer groups enrolled in any of these withdrawing plans 60 days prior to their anniversary. Please contact your blue shield account manager for more information.

Easily offer added specialty products with these enhanced programs

Bundled Savings discount program where 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. 

Pharmacy updates

New 2025 pharmacy care model resources now available

You can now learn more about Blue Shield’s first-of-its-kind pharmacy solution by visiting this new pharmacy care mode resource page (authentication required). This page includes details about Blue Shield’s Pharmacy care model, Amazon Pharmacy for home delivery, new I.D cards and many more helpful information for you and your groups.
 

Updates to Member Pays Difference Penalty (MPD)

When the MPD penalty applies, your group’s employees will pay the difference in cost plus the applicable tier cost share of the brand drug. The MPD penalty will be expanded to brand drugs that have an available preferred biosimilar drug. An exception process continues to be available when the brand drug is medically necessary.
 

Changes to weight loss drug exclusions

Beginning January 1, 2025, upon group renewal the weight loss drug benefit exclusion will be reinstated to align with the market. Weight loss drugs will be excluded from coverage except when medically necessary. For exact plan coverage details please refer to the plan’s Evidence of Coverage.
 

Sell more, earn more with our various rewards programs

The small business incentive program will reward you for newly enrolled members and offer added bonuses when enrolling a new member in all three specialty products: dental, vision, and life. We are continuing to reward direct-selling brokers with our Direct Elite Rewards program. Each point you earn is equal to $1 available to both independent and individual brokers within an agency that has opted into a program. Learn more about enrolling in Producer Rewards here (authentication required).

Resources for a trusted advisor

• Q1 2025 Broker Roadshow recording
• Q3 2025 Forms and applications
• 2025 Medical Plan cheat sheet
• Plan comparison tool

For additional support and information your Blue Shield support team is available to you throughout the year. Contact Broker Services: (800) 599-5905 or email at producer.services@blueshieldca.com.

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