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Blue Shield 2019 Small Business Updates

Blue Shield 2019 Small Business Updates

Blue Shield 2019 Small Business Updates, Carrier News,

Dental Plan Updates

Offer your clients more options and lower costs with Blue Shield’s high-quality dental benefits and earn a broker bonus. What’s more, dental coverage is available with or without Blue Shield medical coverage.

Advantages — 25 Options and Lower Costs

  • 11 new PPO plans with lifetime maximum ortho benefits that match the annual maximum amount, and non-network reimbursement on most UCR plans in the 80th percentile.
  • 13 new PPO plans with the same benefit design as the current plans offered with the Dental Smile Rollover RewardsSM program. Plans with Rollover Rewards will be closed to new business but continue to be available for groups already offering them. These 13 new plans will be available at a lower rate than the comparable plans with Rollover Rewards.
  • One new dental HMO plan for a complete suite of DHMO options.
  • 10% savings on premiums for medical groups that add dental and/or vision plans. Get the Bundled Savings Program details.
  • Simplified administration — one bill, one renewal, and the online Employer Connection portal.
  • 2-year rate guarantee for budget planning.
  • Wellness program discounts.
  • Over 45,000 dental providers — one of the largest in California.

Benefit summaries, broker sales resources, and additional information are available on the Small Business Dental page.

Broker Bonus Programs and Commissions

  • Small Business Specialty Bonus Program 
    Enroll members in a dental, vision, and/or life plan and earn $10 per net new member in 2019. Learn more.
  • Direct Elite Rewards
    Earn $75 to $100 per member for new small business medical member sales that come directly to Blue Shield. Effective dates from February 2019 through January 2020. Get the details.
  • Commission Schedules
    As of October 2018, Blue Shield’s off-exchange mirror plans commissions match Covered California for Small Business levels, and align with the rest of their off-exchange commission schedules at 5%. Read the announcement.

Rewards and commission schedules are available on Blue Shield’s Broker Connection.

Q2-2019 Rate Actions

  • PPO rates increase 1.5% in Q2, for a 3.5% annualized increase.
  • HMO rates increase 1.6% in Q2, for a 0.4% annualized increase.
  • Statewide average annualized rate action in Q2 for all plans is a 2.7% increase.
  • View the rate tables.

Small Business Renewals

2019 renewal kits for groups with April through June effective dates are available for download, and group-level changes can be made using the Small Group Online Renewal (SGOR) tool. Renewal packets will be mailed to groups beginning January 28. Visit Blue Shield’s Renewal Center.

2019 Plan Information

Quickly and easily select plans from the same year and compare the benefits side by side, or select a single plan and see what benefits have changed from 2018 to 2019 with Blue Shield’s new Plan Comparison Tool.

Use the updated forms and applications for 2019, including the Enrollment Spreadsheet, available on Broker Connection.


  • Silver PPO 2000 now has separate medical and pharmacy deductibles.
  • Trio HMO plans now include the Spectrum preferred (Level A) pharmacy network, which includes CVS, Target, Costco, and Vons/Safeway. Members can still utilize the full Blue Shield pharmacy network but may pay higher cost shares for prescriptions. Check out the Pharmacy Directory.
  • Vision plans with $15 copays are now available with $10 copays for 2019. “Enhanced” vision plans have been renamed “Basic” for 2019, but the benefits remain the same.
  • All small business off-exchange plans have creditable prescription drug coverage for Medicare except the following:
    – Bronze Full PPO 6500/50% OffEx
    – Bronze Tandem PPO 6500/50% OffEx
    – Bronze Full PPO Savings 5300/40% OffEx
    – Bronze Full PPO Savings 6650 OffEx
    – Blue Shield Bronze 60 PPO 6300/75 + Child Dental (Mirror)
    Learn more about creditable coverage for small group plans.


  • DE 9C
    The DE 9C requirement will be waived for groups with 5 or more enrolling employees when submitted with the completed and signed “Eligibility/Participation Attestation” and the most recent group medical bill.

    • Payroll will be required for eligible employees that are not listed on the group medical bill and a W-4 may be required for new hires.
    • Start-up groups, groups with both union and nonunion employees, and groups terminating a PEO arrangement are not eligible to have the DE 9C requirement waived.
    • Underwriting reserves the right to request the wage and tax information (DE 9C, payroll) whenever necessary to determine eligibility.
  • Relaxed Participation Requirements Extended
    The 25% participation requirement for groups of five or more enrolling continues in 2019. Groups with just one enrollee will be accepted with Trio plans only. Get the details.
  • New Groups’ Application Status Available Online
    You can now check your new groups’ application status online on Broker Connection. Select “New Group Submission Status” from the Small Business (1-100) drop-down menu.

Download the Blue Shield Small Group Underwriting Guidelines.

Specialty Drug Short Cycle Expansion Program

Effective January 1, 2019, Blue Shield will extend the Short Cycle Program for select specialty drugs for all commercial plan members from 30 days to 90 days. Currently, members receive two partial day supplies (14 or 16 days) of select specialty drugs before receiving a full 30-day supply of their prescription. For details, download the Specialty Drug Short Cycle Program Expansion RxNews Flash.


Visit Blue Shield’s Broker Connection to learn more.

Contact your Claremont team at 800.696.4543 or



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