What's new for small businesses – Q1 2021

1-100 employees – Effective January 1, 2021

What's new for you

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 new Platinum PPO features a combined in-network and out-of-network deductible, $10 primary doctor and specialist visits, and $10 pharmacy drugs (Tier 1), making it the richest coverage offered by our plan options.
  • Gold PPO Savings 1750/15%
    We’ve also added a new Gold PPO Savings plan to our HSA-eligible plan options. With the lowest calendar-year medical deductible and out-of-pocket maximum of any of our other HSA-eligible plan options, this is our richest PPO savings plan. 

Both of these new off-exchange PPO plans are offered on the Full PPO and Tandem PPO networks.

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

Trio HMO and Tandem PPO – Great choice, plus new features

Our 2021 plan enhancements feature more convenient and affordable ways for our Trio HMO and Tandem PPO members to access care as well as exclusive programs and features.

  • Virtual doctor and telehealth appointments*.
  • Access to online self-assessment tools through the myStrength app, designed to help employees with stress, anxiety, depression, insomnia, and more. Visit myStrength.com to learn more.
  • $0 first visit for doctor house calls with Heal™. Learn more about Heal.
  • Discounts on groceries with Healthy Savings®. Find out more by visiting blueshieldca.com/healthysavings.
  • Online wellness platform to manage your workforce’s health with Wellvolution®. Learn more about Wellvolution.
  • A dedicated team of healthcare experts with Shield Concierge. Learn more about Shield Concierge by visiting blueshieldca.com/shieldconcierge
  • Emergency care available worldwide with BlueCard® and Blue Shield Global Care.

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

*Primary care and mental health consultations provided remotely via virtual doctor and telehealth appointments through Teladoc.
Heal is a trademark of Get Heal, Inc.
Wellvolution is a registered trademark of Blue Shield of California. Wellvolution and all associated digital and in-person health programs, services, and offerings are managed by Solera, Inc., a health company committed to changing lives by guiding people to better health in their communities. 
Healthy Savings is an independent entity that administers services on behalf of Blue Shield of California.


Plans that changed deductibles and/or copays are outlined in the table below.

2020 small business plan Maps to 2021 small business plan
Off-exchange PPO plans
Gold Full PPO 0/20 OffEx Gold Full PPO 0/25 OffEx
Gold Tandem PPO 0/20 OffEx Gold Tandem PPO 0/25 OffEx
Silver Full PPO 1800/55 OffEx Silver Full PPO 1950/50 OffEx
Silver Tandem PPO 1800/55 OffEx Silver Tandem PPO 1950/50 OffEx
Silver Full PPO 2300/45 OffEx Silver Full PPO 2400/55 OffEx
Silver Tandem PPO 2300/45 OffEx Silver Tandem PPO 2400/55 OffEx
Bronze Full PPO 5000/70 OffEx Bronze Full PPO 6250/70 OffEx
Bronze Tandem PPO 5000/70 OffEx Bronze Tandem PPO 6250/70 OffEx
Bronze Full PPO 6500/50 OffEx Bronze Full PPO 7500/50 OffEx
Bronze Tandem PPO 6500/50 OffEx Bronze Tandem PPO 7500/50 OffEx
Off-exchange PPO HSA plans
Silver Full PPO Savings 2000/25% OffEx Silver Full PPO Savings 2100/25% OffEx
Silver Tandem PPO Savings 2000/25% Silver Tandem PPO Savings 2100/25% OffEx
Silver Full PPO Savings 2500/35% OffEx Silver Full PPO Savings 2600/35% OffEx
Silver Tandem PPO Savings 2500/35% OffEx Silver Tandem PPO Savings 2600/35% OffEx
Bronze Full PPO Savings 5300/40% OffEx Bronze Full PPO Savings 5700/40% OffEx
Bronze Tandem PPO Savings 5300/40% OffEx Bronze Tandem PPO Savings 5700/40% OffEx
Bronze Full PPO Savings 6900 OffEx Bronze Full PPO Savings 7000 OffEx
Bronze Tandem PPO Savings 6900 OffEx Bronze Tandem PPO Savings 7000 OffEx
Mirror HMO plans
Blue Shield Trio Platinum 90 HMO 0/15 + Child Dental Blue Shield Trio Platinum 90 HMO 0/20 + Child Dental
Blue Shield Trio Gold 80 HMO 250/25 + Child Dental Blue Shield Trio Gold 80 HMO 250/35 + Child Dental
Blue Shield Trio Silver 70 HMO 2250/50 + Child Dental Blue Shield Trio Silver 70 HMO 2250/55 + Child Dental
Mirror PPO plans
Blue Shield Gold 80 PPO 250/25 + Child Dental Blue Shield Gold 80 PPO 350/25 + Child Dental

For exact terms and conditions of coverage for all 2021 plan offerings, refer to the Evidence of Coverage and the plan contract or contact your Blue Shield sales representative.

Digital-first approach

Beginning October 2020, members who have opted in to 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/login

If members 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 in to electronic delivery or who 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 staff members.

Change to CVS Health for pharmacy claims processing

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 affect benefits, formulary, or the pharmacy network. We expect a seamless transition to the new claims processing platform with minimal member disruption.

As part of these changes, we’ll be updating member ID cards to allow pharmacies to submit claims to CVS Health. 

We’ll be mailing new printed ID cards to members before January 1 and will include a buckslip indicating why they’re receiving a new card. Members can continue to use their existing card until December 31, 2020.

Members who have selected an electronic delivery preference will be able to access their updated digital ID card on blueshieldca.com/login. We will send an email notification to members when their digital ID card has been updated.

We’ve 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 and Teladoc Mental Health

Members can get support from mental health professionals and licensed doctors no matter where they are with Teladoc. Teladoc medical doctors are available 24/7/365 by phone or video and can treat many medical conditions including cold and flu symptoms, allergies, respiratory infections, sinus problems, and more.

HMO, PPO, Trio HMO, Tandem PPO, and high-deductible health plans (HDHP) 
General medical per visit – $0

Members can also speak to licensed therapists, psychiatrists, and mental health professionals who can help manage addiction, depression, stress or anxiety, domestic abuse, grief, and more.* Mental health appointments are available from 7 a.m. to 9 p.m. local time, seven days a week..

HMO, PPO, Trio HMO, Tandem PPO, and high-deductible health (HDHP) plans 
Mental health per visit – $0

* To see if you are eligible to use this service, see your Evidence of Coverage or Certificate of Insurance for a complete description of benefit details, exclusions, limitations, and conditions of coverage. Or call the Customer Care number on your Blue Shield member ID card.

Round out your coverage with dental, vision, and life insurance* plans

This is a great time to help your employees stay happier, healthier, and more productive by offering them specialty coverage. All Blue Shield specialty plans give you the convenience of fully integrated billing and administration.

  • Get a 10% discount on any dental and/or vision coverage premiums when they are added to your current medical coverage
  • All specialty plans can be purchased with or without a Blue Shield medical package

Blue Shield members will enjoy a seamless experience when accessing their dental and/or vision plan benefits on the member portal. When logged in, members can view their benefits, find dental and vision providers, view their account balance and payment information, and manage claims. The site also features a dental treatment cost estimator, the ability to view and print ID cards, and other resources.

Dental highlights

Dental coverage is the benefit most requested by employees after medical coverage. With access to some of the largest dental provider networks in the country, our dental plans can help add value to your benefits package and help your employees better manage their oral and overall health. Offering access to preventive oral care can help keep employees happier and more productive at work, too.

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 highlights

Vision coverage is an essential part of a comprehensive benefits package that can help you maintain a healthy workforce and increase employee productivity, which helps your bottom line.

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 additional $39.00 copayment for this benefit

Life highlights

Basic life and AD&D insurance, underwritten by Blue Shield of California Life & Health Insurance Company (Blue Shield Life), is an affordable way to provide employees and their families with added security during uncertain economic times. To provide greater flexibility and more options, we’ve added two 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 ProgramSM provides streamlined underwriting by matching rates from any other plan, for new or existing groups with 10-100 eligible employees. 

*   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.