What's new for Small Businesses – Q4 2022

1-100 employees – Effective October 1, 2022

What's new for you

Our Small Business online renewal sites got a face lift
You may have noticed that our renewal sites for small business groups have a new look and feel, making it easier for you and your employees to renew your health coverage! We’ve added a new feature that allows you to download renewal PDF kit, along with a new specialty page.

Medical plan updates

We’ve included several new plans in our 2022 medical portfolio – providing you and your employees more options with greater value.

Off-exchange PPO plans:

  • Bronze PPO 5500/65 and Bronze 6500/70
    Our new bronze plans feature competitive pricing with lower medical and pharmacy deductibles. These plans include first-dollar coverage for primary care, specialist, and mental health office visits, which means members enrolled in these plans get immediate access to these benefits.

Off-exchange HMO plans:

  • Silver HMO 2750/65
    This plan provides a great lower cost option with the richness that a silver plan offers. Benefits includes flat copays for office visits, tier 1, and tier 2 prescription drugs that are not subject to the deductible.
  • Bronze 7000/70 Trio HMO
    With all professional services available prior to deductibles, integrated Pharmacy deductibles, flat copays, and chiropractic services included, this plan offers richer benefits at a lower cost.

A list of small business medical plans that changed names for 2022 can be found here.

You can compare benefits of your current plan selection with these new plan options by using our Plan Comparison Tool. We have added new enhancements to help you find the best plan that fits you and your employees. With these enhancements, you’re able to:

  • Compare multiple plans across multiple years to see changes and updates to our plans.
  • Compare premium rates across all of our available plans for 2022.
  • Use the network comparison tool to see current and future providers in our network.

Complete benefits for all of our small business plans can be found on Employer Connection.

For exact terms and conditions of coverage for all 2022 plan offerings, refer to the Evidence of Coverage and the plan contract, or contact your Blue Shield sales representative.


Learn how Trio and Tandem plans are a good solution for your employees

Trio Plan

Trio HMO is Blue Shield’s answer to addressing healthcare affordability. It’s an innovative plan designed with comprehensive, in-demand benefits.

Learn more with this interactive video

Tandem Plan

Blue Shield has collaborated with select providers to create a PPO plan that leverages our existing accountable care organization (ACO) partnerships throughout the state. Even better, Tandem PPO comes with Concierge, our enhanced member service model, at no additional charge.

Learn more with this interactive video


Programs that will benefit you and your employees

Maven Maternity

Comprehensive pregnancy and postpartum support, to manage the expected and the unexpected. This maternity program includes:

  • Continuous care
  • High-risk management
  • Inclusive care
  • Measurable results
  • Referrals and coordination

For more information, contact your BlueShield sales representative.


LifeReferrals 24/7

We are providing you and your employees a team of experienced professionals who are ready to assist with a wide range of personal, family, and work issues. Employees are guided to the appropriate resource depending on their needs. Services include:

  • Personal counseling
  • Legal/financial
  • Work/life productivity
  • Workplace support services
  • Identity theft assistance

For more information, contact your BlueShield sales representative.


Round out your coverage with dental plans, vision plans, 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.

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 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.

We’ve developed a simplified portfolio of 22 new dental PPO plans. The new plans are easy to navigate, with clear hierarchy that helps find plans based on your employees’ needs. The changes, initiatives, and enhancements covered here are available to you and your employees beginning January 1, 2022. Some of the competitive benefits included are:

  • Implants included in all silver, gold, platinum, and diamond plans
  • Rollover rewards are included in all bronze, silver, and gold plans

Are you currently enrolled in a dental PPO plan? Here’s what you need to know. All groups enrolled in a 2021 dental PPO may continue to renew into their same plan or choose one of the new 22 plans available at renewal.

All dental HMO plans now include a third dental cleaning for pregnant women, to help maintain good oral hygiene. Dental HMO/PPO/DINO plans allow for dental cleaning frequency of twice per consecutive 12-month period vs. once every 6 months.

Vision highlights

We have introduced some vision benefit changes to help members get the most value out of their vision plans. Now, standard progressive lenses will be included on plans without premium progressive lenses. This change will be available:

  • On vision plans with a frame allowance of $120 or lower.
  • On vision materials only plan with a $120 frame allowance.
  • For new groups in 2022, and renewing groups in 2022.

Additionally, elective contact lens allowance will match to the frame allowance, available:

  • On vision plans with a contact lens benefit.
  • On vision plans with a frame allowance of $150.
  • For new groups in 2022, and renewing groups in 2022.

Blue Shield’s Vision Plus plans cover both elective contact lenses and eyeglasses within the same benefit period. These plans will cover up to $150 for a frame allowance and $150 for elective contact lenses along with a standard contact lens fitting and evaluation.

Below are the six Vision Plus plans that include the enhanced benefit:

  • Basic Vision Plus 0/0/150/150
  • Basic Vision Plus 10/25/150/150
  • Preferred Vision Plus 0/0/150/150
  • Preferred Vision Plus 10/25/150/150
  • Ultimate Vision Plus 0/0/150/150
  • Ultimate Vision Plus 10/25/150/150

Standard progressive lenses (no-line bifocals) will be available on all plans with a $120 Frame Allowance at the same materials copay.


Important pharmacy update: copay card program

Certain specialty drugs have copay card programs offered by drug manufacturers to help members lower their out-of-pocket costs. These programs are voluntary and may also be referred to as copay coupons, copay assistance, or copay savings programs.

The terms and conditions of copay card programs are set by the manufacturer, and members enroll in these programs directly with the manufacturer. When a member uses a copay card, the drug manufacturer pays part or all of the member’s copay or coinsurance, thus lowering the amount the member pays out-of-pocket.

While copay card programs are not offered with all specialty drugs, many of the drugs used to treat multiple sclerosis, rheumatoid arthritis, anemia, and other chronic conditions have copay card programs available.

Currently, the portion of the member’s copay or coinsurance paid for by the manufacturer’s copay card is applied toward the member’s deductible, and out-of-pocket maximum.

What’s changing

Starting January 1, 2022 for Small Business, only the amount members actually pay for their prescriptions (i.e., true out-of-pocket costs after using a copay card) will be applied toward their deductible and out-of-pocket maximum when using a copay card at CVS Specialty® Pharmacy. The portion of the member’s copay or coinsurance paid for by the manufacturer’s copay card will no longer be applied toward the member’s deductible nor out-of-pocket maximum.

Example: A member’s copay for specialty medication is $250. The member uses a copay card to lower the out-of-pocket cost to $5. Only $5 will apply to the member’s annual deductible and out-of-pocket maximums.

What’s not changing

Members can continue to use copay cards to lower their out-of-pocket costs at CVS Specialty® Pharmacy. This change does not affect copay card programs provided by foundations or financial needs-based copay assistance.


Autopay makes billing easy

Signing up for automatic payments is a great way to save time and effort when it comes to monthly billing. We’ve made it easy for you to sign up for autopay through Employer Connection. As long as there’s  zero balance with no payment due, all you need to do is follow these steps to sign up:

  1. After log-in to the portal, hover over the BILLING tab at the top left of the home screen.
  2. In the drop-down menu. select BILLING OPTIONS.
  3. Enter your account information (checking or saving), and click the ADD ACCOUNT button.
  4. Go back to the BILLING tab and from the drop-down menu, and select AUTOPAYMENTS.
  5. Start a new autopayment.
  6. Select your group number from the drop down, then select your payment account from the second drop down. Hit the SAVE button.

Please note: currently, Blue Shield of California does not have a paperless billing option. Therefore, groups enrolled in autopay will still receive a paper statement every month.

For assistance, please contact Group Administrative Services by calling (800) 325-5166.


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