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Broker Guide
Individual and Family Plans

Premium Payment Policy
The Subscriber is responsible for payment of dues to Blue Shield of California. Blue Shield of California does not accept direct or indirect payments of dues from any person or entity other than the Subscriber, his or her family members or a legal guardian, or an “Acceptable Third Party Payor.” Acceptable Third Party Payors are:
 
  • Ryan White HIV/AIDS programs under Title XXVI of the Public Health Services Act
  • Indian tribes, tribal organizations or urban Indian organizations
  • A lawful local, State, or Federal government program, including a grantee directed by a government program to make payments on its behalf.
  • Bona fide charitable organizations and organizations related to the Subscriber (i.e., church or employer) when the following is also true: payment is guaranteed for the plan year, assistance is provided based on defined financial status criteria and health status is not considered, the organization is unaffiliated with a healthcare provider, and the organization has no financial interest in the payment of a health plan claim. Financially interested institutions/organizations include institutions/organizations that receive the majority of their funding from entities with a pecuniary interest in the payment of health insurance claims, or institutions/organizations that are subject to direct or indirect control of entities with a pecuniary interest in the payment of health insurance claims.
Upon discovery that dues Subscription Charges were paid directly or indirectly by a person or entity other than those listed above or the Subscriber, Blue Shield of California has the right to reject the payment and inform the Subscriber that the payment was not accepted and that the Subscription Charges remain due.  Please note that processing any payment does not waive Blue Shield of California’s right to reject that payment and future payments under this policy.
Help your customers through the 2016 tax season
Because we care about you and your customers, we've made it easy for you to help your customers access need-to-know tax information and resources for their individual and family plans at blueshieldca.com/taxinfo.
Understanding the SEP environment
The special enrollment period (SEP) is upon us and the focus will be on SEP enrollments for 2016 by keeping you informed of the enrollment process. Please join one of our monthly webinars to learn more about our: checklist of qualifying events, broker tools, overview of our 2016 IFP plans, Q&A session, and more! No RSVP is required. 
IFP product updates effective January 1, 2016
For 2016, we are retiring our EPO plans and EPO Network so we can offer PPO plans and our larger Exclusive PPO Network in every county throughout the state, including Alpine, Monterey, Sutter and Yuba counties. We will be introducing three new medical plans and a new lower-cost vision plan, the Ultimate Vision 15/25/120. Learn more» 
Member educational series
Those who purchase a health plan for the first time often need help understanding how to use it. Share these informational fliers with your current and future Blue Shield clients to help them get the most from their health plan and assist them in their efforts to reduce their costs. 
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