Blue Shield 2022 Large Group Updates
Jun 28, 2021, 5 Minute Read
To meet the evolving needs of employers, Blue Shield of California is broadening its plans to provide more options at lower costs, including medical and behavioral health Teladoc benefits at no charge. They are also updating their Specialty portfolio and pharmacy programs.
Plus, your clients can enjoy rate guarantees and discounts of up to 3% when they add dental, vision, and life coverage with the Benefits Solutions Discount.
Medical Plan Portfolio Expansion for 2022
- PPO Savings Embedded Deductible 6350 100%
- Available on the Full PPO or Tandem PPO network (plans are not customizable).
- Plans feature higher deductibles keeping premiums reasonable.
- Out-of-pocket maximum is equal to the deductible when visiting participating providers. The member contributes until the deductible is met and then Blue Shield covers the remaining costs.
- EPO 25-1500 80
- EPO 25-2500 80
- Available on the Full PPO or Tandem PPO network (plans are customizable).
- Plans feature lower premiums than existing EPO offerings, with higher deductible thresholds and more benefits subject to the deductible.
- Active Choice Classic & Active Choice Plus
The plans below are available now and effective for 2021 (plans are not customizable).
- Active Choice Plus 1000 80/60
- Active Choice Plus 1000 20 80/60
- Active Choice Plus 300 80/60
- Active Choice Plus 300 20 80/60
- Active Choice Classic 850 80/60
- Active Choice Classic 600 80/50
- Active Choice Classic 850 70/50 with 1000 Deductible
Visit Blue Shield of CA to learn about all the available plans.
Existing Plan Updates for 2022
- Maximizing PPO Savings Coverage
Peak flow meter and glucometer benefits will be available to members prior to meeting their deductible in accordance with IRS Notice 2019-45.
- Portfolio plan cost shares:
- For standard PPO savings plans, glucometer and peak flow meter cost shares equal DME.
- For PPO Savings plans with $0 HDHP preventive drugs, glucometers and peak flow meters are available at no charge.
- Custom plan fully insured cost-share options:
- For custom PPO Savings plans without $0 HDHP preventive drugs, glucometers and peak flow meters can be either no charge or have a cost-share matching durable medical equipment (DME).
- For custom PPO Savings plans with $0 HDHP Preventive Drugs, glucometer and peak flow meter must be no charge.
- ASO cost-share options:
- ASO plans may set glucometer and peak flow meter to no charge, equal to DME or not covered regardless of HDHP Preventive Drug cost share.
- Active Choice Benefits Clarified
Both medical and behavioral health Teladoc benefits will be moved to Category 2 to clarify that those services are available at no charge. Active Choice plans are also reintroducing first dollar allowance rollover and access to family first dollar credit for members on a family plan, with language updates to clarify these plan features. Check out Blue Shield’s Mid/Large group plan documents.
- Physician Visit Cost Shares
Physician office visit and physician home visit cost shares are now equal for the three portfolio plans:
- EPO Admit 10-250 (Full PPO/Tandem PPO)
- Added Advantage POS 300-100/90/70
- Added Advantage POS 500-100/80/60
To compare year over year plan changes, visit Blue Shield of CA.
Specialty Benefits Updates for 2022
With more emphasis on health and wellbeing as we emerge from COVID-19, there’s never been a better time to bundle dental, vision, and life benefits with Blue Shield medical plans. Your clients can enjoy a streamlined sales process, rate guarantees, discounts of up to 3% with the Benefits Solutions Discount, and some of the largest networks of dental and vision providers. Learn more about Blue Shield’s dental and vision plan options.
Dental Plan Updates
- Core Specialty Duo Dental/Vision
This plan is being withdrawn from the market.
- Dental HMO: Orthodontic in Progress Takeover
Available for new groups moving from a prior carrier’s DHMO plan to a new Blue Shield DHMO plan, and available for eligible members receiving “active orthodontic treatment” that will not be finished until after the Blue Shield DHMO plan takes effect.
- Dental PPO/HMO/DINO: Dental Cleaning Frequency Change
Dental cleaning frequency is covered twice per consecutive 12-month period, updated from once every 6-months.
- Dental HMO: Enhanced Dental Cleaning for Pregnant Women
Allows a third cleaning for pregnant women.
- Dental PPO – Allow Prior Carrier Deductible Credit
For an individual with dental PPO coverage with a prior dental carrier, any deductible amount paid for dental benefits during the same calendar year will be applied to the new Blue Shield dental PPO plan.
- Dental PPO – Allow Prior Carrier Calendar Year Maximum Credit
For groups who transition mid-year to a Blue Shield plan, Blue Shield can provide credit for the deductible already paid but they will also reduce their current annual maximum amount for any claims dollars that were paid out as well under the prior plan. This change will be applied with prior carrier deductible credit noted above.
Vision Plan Updates
- Elective Contact Lens Allowance to Match Frame Allowance
This change will increase the elective contact lens benefit allowances to match the frame allowances for some plans that did not already align with this benefit.
- Add Standard Progressive Lenses on Vision Plans Without Premium Progressive Lenses
- Applies to marketed and non-marketed (closed) portfolio vision plans with a frame allowance of $120 or lower.
- Includes vision materials only plan with a $120 frame allowance.
- Applies to new and renewing groups in 2022.
- Custom Vision Bracketed Filing
Increase frame allowance option from $300 to $500.
Summary of Benefits (SOBs) documents will be used as both pre-and post-sale materials for 2022.
Pharmacy Updates for 2022
All changes will be effective upon group renewal.
Copay Card Accumulator Program
When a member uses a non-financial needs-based manufacturer copay card at CVS Specialty Pharmacy, only the member’s true out-of-pocket costs will apply to their deductible and/or out-of-pocket maximum. Impacted members using copay cards at CVS Specialty Pharmacy will be notified via mail approximately 60 days in advance of their plan renewal.
90-Day Supplies at Retail Pharmacies
- Up to a 90-day supply of maintenance medications at retail pharmacies in Blue Shield’s Rx90 Retail network.
- Rx90 Retail network includes 99.7% of all pharmacies in Blue Shield’s broad national retail pharmacy network.
- Convenient alternative to Mail Service Pharmacy.
Coverage for infertility-related drugs
- The infertility rider will now have coverage for self-administered infertility drugs through the outpatient pharmacy benefit via a prior authorization process.
- Members can pick-up drugs from the pharmacy at the applicable formulary tier cost share (instead of navigating the current reimbursement process).
- Groups who offer the infertility rider should integrate their pharmacy benefit under Blue Shield to ensure a seamless experience when filling these types of drugs.
Benefits Solutions Discount
Employers (101-1,000 eligible employees) can save up to 3% on medical premiums when they add dental, vision, and life insurance plans to their Blue Shield medical coverage. The more they add, the more they save:
- Save 2% when adding dental plans.
- Save 0.5% when adding vision plans.
- Save 0.5% when adding life insurance.
Download the flyer for details.
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Contact your Claremont team at 800.696.4543 or info@claremontcompanies.com.
