What's new for small businesses – Q4 2025

1-100 employees – Effective October 1, 2025

Compliance with SB 729’s assisted reproductive technology (ART) benefits

Effective July 1, 2025, ART riders will be updated to comply with the requirements of SB 729, ensuring parity between medical and ART benefit cost shares. These changes are mandatory and provide valuable enhancements for you and your employees. 

Mandatory changes include:

• ART cost shares will now match group’s medical plan (e.g., coinsurance and deductibles). 
• ART coinsurance will apply toward the out-of-pocket maximum. 
• The definition of infertility has been expanded to support same-sex couples and those 35+ with improved access to care. 
• For PPO/PSP plans, new ART riders will match existing coinsurance levels, deductible applicability, and out of network coverage of the medical plan it is paired with. PPO and PSP plans will include out of network ART coverage. 
• For HMO plans, Blue Shield will apply coinsurance coverage equivalent to the metal level of the product (90% Platinum, 80% Gold, 70% Silver, 60% Bronze). No deductibles apply and there is no out-of-network coverage. 

To learn more view the ART mapping grid showing the corresponding ART rider to your groups medical plan, and download the updated rider from the Small Business Summary of Benefits page. 

Billing and payments reminders

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. 

For more information regarding making payments you can refer to the Billing and Payment guide. 

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.

Medical plan updates

Minimal changes to plans for 2025 include improved deductibles and out-of-pocket maximums. You can visit the ‘Changes to your plan benefits’ section of your renewal materials for more details. 

Impacted plans with cost share and name changes:

You can compare benefits by using our plan comparison tool where you can:

• Compare multiple plans across multiple years to see changes and updates to our plans.
• Compare cost shares across all of our available plans for 2025.
• Use the network comparison tool to see current and future providers in our network.

For 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 sales representative.

Access to care anywhere in California, via Accolade Care now available with Trio HMO plans

Transform your employee’s health journey with Trio, offering a combination of 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.¹  

Dental, vision and life²

Dental plan updates

Dental plan withdrawal effective January 1, 2025

Three dental PPO plans are to be withdrawn from our specialty portfolio beginning January 1, 2025, as part of our product transformation and portfolio simplification efforts. You can refer to the plan mapping grid (PDF, 61 KB) to see your new plan and available options. 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

Vision plan updates

Insight discount with EyeMed³ Doctors for 2025

Use your discount with these three easy steps:

1. Locate an eye doctor – Select from a broad network of independent eye doctors. Visit Blueshieldca.com to find a provider near you. 
2. Schedule an appointment – Call ahead or stop by one of the many eye doctors that offer walk-in appointments.
3. Use your discount – When you arrive, let the eye doctor know you have a discount plan through Blue Shield of California. 

Please note your discount cannot be combined with any other discounts, coupons or promotional offers. Learn more about our vision discount. 

Life plan reminders

Get more out of your Blue Shield life insurance with these services:

• Beneficiary assistance services offers your employees care and support for family members who have suffered a recent loss of a loved one. 
• Travel assistance services offers your employees and their families a broad range of worldwide travel and medical assistance services.

For exact terms and conditions of coverage refer to the Evidence of Coverage and the Plan Contract and to the Summary of Benefits for a comprehensive summary of plan benefits. You can access these plan documents here. 
 

¹ A referral from your virtual PCP is required for any in-person or specialty care.
² Underwritten by Blue Shield of California Life & Health Insurance Company.
³ EyeMed is independent of Blue Shield of California and is contracted by Blue Shield to provide vision services.

Pharmacy updates

Price Check my Rx 

Members now have a better way to manage their medication costs online. The Price Check My Rx tool creates a personalized experience with real-time information from the member’s formulary and benefits usage. Members can use the tool once logged into their Blue Shield account.

Prescription Savings Program

The SMS text-based Prescription Savings Program (PDF, 169 KB) offers discounts on member out-of-pocket costs for select medications and is designed to improve prescription drug affordability and medication adherence.

Member Pays Difference (MPD) 

When the MPD penalty applies, your employee 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.