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The Virtual Blue plans give members (small and large groups) the choice of virtual or in-person care. Virtual care includes $0 unlimited visits to primary care, behavioral health and specialty care through a new partnership with AccoladeCare. In-person care is available through the Tandem PPO network in California and via BlueCard when outside of the state.
The two Virtual Blue small group plans available in PRISM are the Virtual Blue Gold Tandem PPO 1500/45 and Virtual Blue Bronze Tandem PPO 7500/75. These can be identified by ‘Virtual Blue’ in the plan name.
When using the PRISM filter options for Narrow or Broad networks, select ‘All’ networks instead of ‘Broad’ only networks to generate plans for Blue Shield’s Virtual Blue, Trio HMO, and Tandem PPO plans.
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On October 11, 2022, the Internal Revenue Service (IRS) announced updated rules designed to fix the Affordable Care Act (ACA) “Family Glitch.” The change impacts family health coverage options for hundreds of thousands of lower-income Californians currently enrolled in group family coverage. The updated rules come into effect for 2023 coverage. As you conduct open enrollment meetings with your clients, you will likely get questions from employees, so you’ll want to familiarize yourself with the updated rules.
The updated rules change how premium tax credit (subsidy) eligibility is calculated for families on the ACA individual marketplaces (Covered California for California residents). Currently, if a family member has employer coverage, subsidy eligibility for the other family members is calculated based on the affordability of the employee coverage, not the affordability of the family coverage. This is often a big difference, because employer premium contribution is often less for family coverage compared to employee coverage. The updated rules change that calculation. Now, for 2023 coverage onwards, if a family member has employer coverage, the Covered California subsidy eligibility calculation for the other family members is based on the affordability of the family coverage. It is expected that many family members currently enrolled in family coverage in group plans will now be eligible for Covered California individual coverage subsidies, which creates an additional factor in their decision on whether to enroll in the group plan.
The updated rules do not affect employer liability under the ACA large employer mandate.
Employers with non-calendar year plans, including health reimbursement arrangements (HRAs), and Section 125 cafeteria plans, will want to review how the updated rules impact family member ability to disenroll mid-plan year.
For more information, check out the resources below.
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