What's new for Small Businesses – Q4 2023

1-100 employees – Effective October 1, 2023

Medical plan updates

Introducing Virtual BlueSM! A new, virtual-first plan made for you and your employees.

Today, employees expect more. Virtual Blue delivers with anytime, anywhere virtual care, $0 virtual visits, and in-person care when they want it—driving value for businesses of all sizes. Learn more.

 

Off-exchange PPO plan updates:

  • New PPO plans:
    • Virtual BlueSM Gold PPO 1500/45
    • Virtual BlueSM Bronze PPO 7500/75
  • Impacted plans with cost share changes:
    • Silver PPO 2000/60
    • Silver PPO 2350/65
    • Silver PPO 2550/70
    • Bronze PPO 5500/65
    • Bronze PPO 6500/70
    • Bronze PPO 6850/55
    • Bronze PPO 7500/65
    • Gold PPO Savings 1750/15% HDHP Prev RX
    • Silver PPO Savings 2300/25%
    • Silver PPO Savings 2600/35% HDHP Prev RX
    • Blue Shield Silver 70 PPO 2500/55

Off-exchange HMO plan updates:

  • Network expansion for Bronze HMO 7000/70
    The Bronze HMO 7000/70 is now available on Access+ and local Access+. This plan has rich benefits at a low cost. All professional services are available prior to deductibles. It includes integrated pharmacy deductibles, flat copays, and chiropractic services.
  • Impacted plans with cost share changes:
    • Platinum HMO 0/20
    • Gold HMO 0/30
    • Silver HMO 2750/70
    • Bronze Trio HMO 7000/70
    • Blue Shield Trio Silver 70 HMO 2500/55

Mirror PPO plan updates:

  • New Mirror PPO plans:
    • Mirror Silver 2300/25%
    • Mirror Bronze PPO Savings 7000

Mirror HMO plan updates:

  • New Mirror HMO plan:
    • Mirror Bronze HMO 7000/70 – available on the Trio HMO network only
  • Network expansion to Access+ HMO:
    • Mirror Platinum 90 HMO 0/20
    • Mirror Gold 80 HMO 250/35
    • Mirror Silver 70 HMO 2500/55

The Mirror Package for Small Business offers your employees the opportunity to purchase the same plans that Blue Shield is offering through Covered California for Small Business (CCSB).

A list of small business medical plans that changed names for 2023 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 2023.
  • 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 2023 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 Blue Shield sales representative.

LifeReferrals 24/7SM

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 with life insurance coverage* are guided to the appropriate resource depending on their needs. Services include:

  • Beneficiary Assistance (Grief Counseling)
  • Support groups
  • Personal counseling
  • Legal assistance
  • Financial coaching
  • Identity theft assistance

For more information, contact your Blue Shield 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. Learn more.
  • All specialty plans can be purchased with or without a Blue Shield medical package.

Dental, vision*, and life*, simplified

Employees today want a total health package, including dental, vision, and life. And you need affordable coverage with easy administration. Blue Shield simplifies it all.

  • More access to care with large networks
  • More ways to bundle and save
  • One-stop shopping makes it easy

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.

Introducing 2023 new Dental PPO plans

These 8 new DPPO plans will provide your employees with more options and increased offerings. We now expanded our “Marketed” DPPO portfolio plan from 22 to a total of 30 DPPO portfolio plans.

The newly designed plans include:

  • Offering $1500 calendar year maximum option under Bronze DPPO.
    • Existing Bronze DPPO plans include $1000 calendar year maximum.
  • Offering MAC out-of-network reimbursement option under Gold DPPO.
    • Existing Gold DPPO plans include U90 out-of-network reimbursement.

New plans:

  • Bronze DPPO/1500/MAC
  • Bronze DPPO/MAC/Child Only Ortho
  • Bronze Voluntary DPPO/ $1500/MAC
  • Bronze Voluntary DPPO/$1500/MAC/Child Only Ortho
  • Gold DPPO/$1500/MAC
  • Gold DPPO/$1500/MAC/Adult+Child Ortho
  • Gold DPPO/$2000/MAC
  • Gold DPPO/$2000/MAC/Adult+Child Ortho

New rate reductions for a new portfolio of dental plans

  • Starting 10/1/22 many of our dental plans are offered at up to a 17% lower rates. And you can lock in that rate for 2 years.
  • Get a 10% discount on any dental and/or vision coverage premiums, when they are added to your current medical coverage. Learn more.
  • All plans come with a 2-year rate guarantee.
  • All specialty plans can be purchased with or without a Blue Shield medical package.

Dental plans will be withdrawn in 2023

Five DPPO plans and five DINO plans (listed here) will be withdrawn from our Specialty portfolio beginning January 1, 2023, as part of our product transformation and portfolio simplification efforts. We want to make your move to a new plan as easy as possible, so we will be recommending similar coverage for you. Prior to your anniversary date, your group’s renewal information will be available including recommended plan and rates. You will also have the opportunity to choose any of our other available plan options.

Vision* highlights

  • Updates to simplify the Vision SOB
    • Move the Cost Shares next to each Contact Lens benefit below:
      • Non-Elective (Medically Necessary) – hard
      • Non-Elective (Medically Necessary) – soft
    • Remove list of Eye Conditions along with cost shares since cost shares will now be next to each Contact Lens benefit
    • Additional update to the Vision Custom SOB:
      • Add Eye Exam Only plan to increase cost share ranges
      • Provides wider range of copays

Life* highlights

  • All benefit amounts for Small Group Life are full guaranteed issue and do not require any medical underwriting. The guaranteed issue amount equals the maximum benefit amount.
  • Beneficiary Assistance & Travel Assistance are included with life coverage to Small Group employees and their families
    • Flat amount or multiples of salary benefits
    • Age banded for groups of 2-9 lives (up to 50K, guaranteed issue)
  • Composite rates for groups of 10-100 lives
  • Basic Life and AD&D Quick Match program available for groups between 10 and 100 eligible employees.
  • Life is not bound by ACA, can be classed out by management and non-management
  • GI for groups of 2-9 up to $50,000
  • Dependent Life for groups of 2-9 up to $5000 and for groups of 10+ up to $20,000

Important pharmacy updates

New Continuous Glucose Monitors benefit

Provide your employees with easier access to Continuous Glucose Monitors as we expand coverage to retails pharmacies. Effective 1/1/23, CGMs will be accessible at retails pharmacies through the Blue Shield pharmacy benefit, prior authorization is required. Learn more.

Weight loss drug exclusion removal

Previously only member with morbid obesity could access weight loss drugs. This change will allow for more accessibility. Medical necessity requirements will continue to apply and all drugs for weight loss require prior authorization.

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.