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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.
If you need assistance, please contact our Quotes team at quotes@claremontcompanies.com or 800.696.4543.
Login To PrismAn Applicable Large Employer (ALE) may be meeting its Large Employer Mandate obligation to offer Minimum Essential Coverage and a Minimum Value plan, but are they certain they are offering coverage to all eligible employees and dependents? If your client has selected an employee-only coverage plan, the employer may be exposing their business to a penalty. While the employer does not need to contribute towards the cost of dependent coverage, they are required to offer coverage to dependent children.
The Society for Human Resource Management (SHRM) states that dependent status under the PPACA is based on the relationship between a child and a participant and that a large employer that fails to offer coverage to employees’ dependents is not meeting the ACA requirements for coverage and therefore subject to an assessable penalty.
Did you know groups with substantially fewer than 50 employees may be an ALE?
If you have ALEs in your book that are on employee-only coverage, we can assist those groups written with Covered California.
To learn more about the Large Employer Mandate and how to identify Applicable Large Employers, download our essential ‘Play or Pay’ guides.
Questions?
Contact the small group experts at 800.696.4543 or info@claremontcompanies.com.