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Looking forward to a successful 2016!

Updated July 14, 2016

Average quarterly rate increase – Fourth quarter 2016
Medical plans will experience a fourth quarter rate action. Specialty plan rates are staying flat – no quarterly increase.
Average quarterly rate increase – Fourth quarter 2016
      Northern California
New Business
Southern California
New Business
Small business medical plans1
PPO plans
(non HSA-compatible)
5.0% 5.0%
PPO plans
4.9% 4.9%
HMO plans 2.8% 2.8%
 Small business specialty benefits
Dental plans  0.0%
Vision plans2 0.0%
Life insurance plans2 0.0%
For more details, download our fourth quarter rate sheets»
1. The October 2016 rate actions represent rates applicable to new and renewing business.
2. Underwritten by Blue Shield of California Life & Health Insurance Company.

Plan pairing makes it easier to do business with Blue Shield!

Starting this October Blue Shield Small Business customers will have more options. For the first time Blue Shield Small Business customers may purchase both Trio ACO HMO plans and Access+ HMO® plans. To date, customers have had the option of purchasing one or the other, but not both. To enroll simply complete the Master Group Application for newly applying customers, and the Request for Contract Change form for current customers.
Blue Shield HMO plans
Access+ HMO® plans, Local Access+ HMO® plans and Trio ACO HMO plans have different provider networks. Access+ HMO® plans, which have a full network, and Trio ACO HMO plans, which have a select network, may now be offered together. Local Access+ HMO® plans, however, may not be offered with Access+ HMO® plans or Trio ACO HMO plans. 
Why Blue Shield Trio ACO plans
Blue Shields Trio ACO (Accountable Care Organization) is an innovative care model between hospitals, doctors and Blue Shield that keeps employees healthy AND lowers costs. Using a select network Trio provides Blue Shield members with personalized, proactive care offering greater control at a lower cost. Learn more about Trio ACO»
News and remindersCurrent promotions |  Tools and resources
HealthEquity: Building health Savings
New! Matching HSA-compatible plans with HealthEquity
Your clients can now offer HealthEquity as the health savings account (HSA) administrator for these two plans:

  • Bronze Full PPO Savings 4500/30% OffEx
  • Bronze Full PPO Savings 5500/40% OffEx
HealthEquity is one of the nation’s oldest and largest dedicated health savings custodians. Individuals and families can build health savings while employers cut benefit costs through innovative, integrated healthcare account administration and investment platforms.

Choosing HealthEquity is an exciting option. Blue Shield will share eligibility and claims data with HealthEquity for a seamless process. When your clients select HealthEquity as their HSA administrator, there's no need to search for their own third-party HSA administrator. They can choose HealthEquity administration by checking the box on the Master Group Application (paper form) when newly enrolling, or on the Request for Contract Change form (paper) when renewing coverage. Please remember to send the paper form(s).

Learn more about HealthEquity
HealthEquity webinars demonstrate the key functions of the Health Equity employer portal including the various options for making contributions.
More Choices!

Earlier this year, we expanded our medical plan portfolio with more variety and choice. Available now: three additional HMO plans with varying network choices, and an additional Gold-level PPO medical plan – all available now.

The added HMO medical plans

  • Platinum HMO 0/20 OffEx (Access+, Local Access+ and Trio)
  • Platinum HMO 0/30 OffEx (Access+, Local Access+ and Trio)
  • Gold 750/30 OffEx (Access+, Local Access+ and Trio)

The Platinum HMO 0/20 OffEx and Platinum HMO 0/30 OffEx plans are richer options with no deductibles. The new Gold 750/30 HMO OffEx plan is a good choice for a small business that wants to offer a more robust plan with a moderate deductible. The good news is that each of these 3 plans is offered with a choice of one of our three provider networks: Access+ HMO (broadest network), Local Access+ HMO (narrow network), and Trio ACO HMO (accountable care organization, most narrow network).*

The added PPO plan

  • Gold Full PPO 250/20 OffEx medical plan

The Gold Full PPO 250/20 OffEx plan gives employers another option to choose from our PPO medical plan portfolio. The new Gold Full PPO 250/20 medical plan has a low $20 copay for covered in-network services – a good option for employers looking for a comprehensive yet more affordable PPO plan.

Check out our latest What’s New for Q4-2016 (PDF, 2.1KB) and the Packages for Small Business Brochure for Q4-2016 (PDF, 1.8MB) for more details.

Specialty product update

It's a great time to add specialty plans to your presentation to small business clients who don't already offer Blue Shield dental, vision, and life insurance products.

  • Dental PPO* and INO* rates are decreasing by 10%, effective January 1, 2016.
  • The Ultimate, Preferred, and Enhanced Vision plans* will see a rate reduction of 20%.1
The 2016 new group rating model enhancements for groups of 10 to 50 eligible employees will provide more competitive composite life insurance rates. For more details, download our fourth quarter rate sheets.
*Underwritten by Blue Shield of California Life & Health Insurance Company.
 1. 20% rate reduction applies to the Ultimate, Preferred and Enhanced Vision plans currently marketed.

Previous Tier 4 policy:
Members had a coinsurance for Tier 4 drugs and it didn’t have a maximum cost share
  • For HMO plans, members had a 20% coinsurance (no maximum cost share)
  • For PPO plans, members had a 30% coinsurance (no maximum cost share)

What Changing:
Blue Shield is implementing a maximum cost share for Tier 4 drugs to limit the out of pocket costs for our members:
  • Platinum, Gold & Silver Plans: now have a $250 maximum cost share for a 30-day supply
  • Bronze: have a $500 maximum cost share for a 30-day supply

Member benefits:
  • Reduces out of pocket costs
  • For 51-100 groups: transitioning to the Small Business market, implementation of maximum cost share for Tier 4 drugs is more in-line with Large Group coverage, making the transition to Small business less disruptive.

Transition of groups with 51-100 employees to the small group market plans

While many clients with 51-100 employees chose to keep their large group coverage an additional year by renewing early in 2015, many others have chosen to retain their current renewal date and will move to a small group plan when they renew their coverage in 2016. We’ve kept the process of enrolling into small business plans as simple as possible.

To assist in the transition, we've made small group plan recommendations based on your client(s) current coverage. About 60 days before their coverage effective date, we will e-mail your clients packets with the information they need to transition to a small business plan. For your convenience you can view the same packet on Shield Renewals.

Packets include rates, plan comparison fliers and a Master Group Application (MGA), along with the subscriber and member census to review and compare benefits and rates. The 2016 Plan Package brochure is also included in their packet.

If the recommendation is right for your clients, they simply need to submit a signed MGA and we will automatically enroll their currently enrolled employees into that coverage. If your clients want to select other coverage, they just need to use the Subscriber Change Request form to make changes and submit it with the MGA.

For more information, visit, our dedicated page for small businesses with 51-100 employees.

Pediatric dental benefits are included and now embedded with medical plans

As of January 1, 2016, pediatric dental benefits, are included within our small business medical plans. PPO, HSA and HMO medical plans provide the same PPO dental coverage for pediatric dental benefits, but only PPO and HSA medical plans will offer coverage for pediatric dental benefits received from non-network providers, at non-network provider benefit levels. There is no coverage for non-network pediatric dental benefits in our HMO medical plans, except for emergencies. Dental and vision care are required essential health benefits (EHBs) under the Patient Protection and Affordable Care Act of 2010 (ACA) for children up to age 19.

Download the pediatric dental and vision FAQ (PDF, 92KB)
News and reminders

Small Business customers may opt to change their renewal month

When your customers chose the early renewal option to keep their 2013 plans, their renewal month shifted to the 4th quarter to coincide with their plan year. Many customers have asked to change back to their original renewal month/plan year, or another month altogether. So, we are offering them the option to do so in 2016. It's about flexibility.

Download the Change Renewal Month Form (PDF, 89KB) which has all the details and restrictions.
Updated commission schedule for Blue Shield of California small business (1-100) Off-Exchange business

Blue Shield’s commission schedule remains competitive with other carriers. Our commitment to you extends to specialty benefits plans as well, with a 10% flat commission for sales of dental plans, vision plans and life insurance to groups of 1-100!

The updated 2016 Commission Schedule and Producer Agreement can now be downloaded.
Medical plans only
Blue Shield of California Off-Exchange Package for Small Business 1-100 Eligible Employees
Contract year Percentage
First year 5%
Renewal years 5%
New guidelines for start-ups that have five (5) or more employees enrolling

Blue Shield now considers start-up groups (new businesses) that have been in business for less than four weeks if at least five (5) or more employees are enrolling and the business has been operating for at least one pay period. Evidence of time in business and eligibility must be supported by payroll records. The payroll records for the most recent pay period for the employees are required. Remember, a start-up group must meet all small group requirements. The Underwriting Guidelines is being modified-see "New Guidelines".

Note: if less than five (5) employees are enrolling, please refer to the start-up rules published in the Underwriting Guidelines.
Don't forget to update your email information in Employer Connection Plus

Employer Connection Plus is Blue Shield’s web-based plan administration tool that enables employer groups (and their designated brokers) to securely manage their employees’ Blue Shield medical and specialty plan benefits online.

Once registered, you can securely log in 24/7 to:
  • Conduct open enrollment, enroll new hires and order member ID cards
  • View medical plan benefit details, such as deductible and copayment information
  • Add or terminate medical plan coverage for your employees and their dependents
  • Update member information
  • View eligibility details
  • Pay your bill online and much more

It's easy to get started! Go to and click on register now.

Employer Connection Plus was designed to give you greater control over your Blue Shield health plan benefits and save you time so that you can concentrate on your business.
Bringing it all together – current promotions

Relaxed participation requirements for small business apply to groups of 1-100 with January 1, 2016 or later effective dates!

Blue Shield of California relaxed participation guidelines for groups of 1-100 employees through September 30, 2016.

Our relaxed participation guidelines require only 25% participation with a minimum of five enrolled employees for our Off-SHOP plans.

For specialty products, we are reducing the participation requirements to 25% and require that Blue Shield must be the sole carrier for dental, vision and life insurance plans. Download the special promotional flier (PDF, 49KB) to show your customers the requirements.*
*Blue Shield reserves the right to modify the rexaled participation requirements for Small Business at any time.
Dental Smile Rollover Rewards Program for Dental PPO plans
Now your clients have another way to save while maintaining their dental health through the Dental Smile Rollover Rewards program. If your clients already have a dental PPO* or dental INO* plan with Blue Shield, they are set, as it automatically becomes a part of their dental PPO plan coverage in 2016. If your clients don't have Blue Shield dental coverage, this program is a great way to get them interested. 

Typically, employees visit their dentist at least once a year and if, at the end of the year, their paid dental claims are below the claim threshold, they'll receive their rewards. And if they see a dentist in their PPO network, versus a non-network dentist, they'll receive an additional boost to their rewards amount.

The reward amount is based on the dental plan's calendar-year maximum and the program's annual claim threshold for the plan. Any rewards that employees earn will rollover in the form of calendar-year maximum funds and raise their calendar-year maximum for the next benefit year.

Download the Dental Smile Reward Program flier (PDF, 55KB) for more information.
*Underwritten by Blue Shield of California Life & Health Insurance Company.
Tools and Resources

Members have a new home online

Members who log in to have improved navigation and easier access to benefits information, available in more languages.

Key enhancements members will experience after logging in to include:

  • Member Overview
    Members now have more insight into their healthcare coverage. Based on the member's plan type, the new design provides a quick and comprehensive view of important health plan information, such as: common copay amounts, annual deductible, and copay maximums.

  • View Claims
    Our redesigned claims experience gives members more flexibility to better understand their healthcare expenses. Both PPO and HMO members can view detailed medical claims information, with contribution breakdowns that may include amounts billed, allowed, and saved – plus, enhanced filters to customize their view of the information.
Updated educational resources

  • Q4 2016 plan package brochure»
    2016 Packages for Small Business – Off Exchange and Mirror plan packages.

  • What's new for Q4 2016» 
    Your customers received this go-to guide for 2016 updates in their renewal kits.

  • Why Blue Shield
    A great one-pager all about the reasons your clients will benefit with a health plan from Blue Shield.
    English  |  Spanish
Health and wellness resources

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Broker Resources
What's new for Q4 2016 brochure
Q4 2016 plan package brochure
Benefit summaries
Renewal center
Underwriting guidelines
Sales resources and collateral
Pediatric dental and vision coverage
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