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Blue Shield Q1-2020 Plan Updates

Blue Shield Q1-2020 Plan Updates

Blue Shield Q1-2020 Plan Updates, Carrier News,

Below are the 2020 plan updates for medical and specialty options, dates and updates for January renewals, and resources for enrolling both new and renewing business. Additional information can be found on Blue Shield’s Broker Connection.

Use the Plan Comparison Tool to quickly and easily select multiple plans and compare the benefits side by side, or select a single plan and see how benefits have changed from 2019 to 2020.

Rates for Q1-2020

  • The rate action statewide average is +0.9% and will vary by plan, from -6.4% to +2.7% for PPO plans and from -6.7% to +3.0% for HMO plans. 
  • The rate action is consistent across all 19 regions, except for San Diego (Region 19) which will see a slightly lower rate action for Tandem PPO plans.

January 2020 Renewals

  • January group renewals will be available to brokers through Shield Renewals early next week. Employers will be notified of their renewal materials October 25–29.
  • Group level changes can be made using Small Group Online Renewal (SGOR) beginning October 16.
  • Reminder — groups will receive an email notification and a one-page mailed letter directing them to their renewal microsite for complete renewal information. Full renewal printed packets will only be mailed to groups if these sites are not visited within the allotted time.
  • Groups are also notified by email of the online availability of their health plan documents – SBCs and EOCs – which can also be accessed by brokers through the Shield Renewals site.
  • Visit the Renewal Center for broker resources and more information.

Please note: due to regulatory approval delays, the group renewal kits and the Small Group Online Renewal (SGOR) tool do not include information on the new plan options.

Open Enrollment Resources

Medical Coverage 2020 Updates

New medical plans for small business groups beginning with January 1, 2020, effective dates:

  • Platinum PPO 0/0 – no deductible, 0$ primary care physician visits, and $0 tier 1 pharmacy drugs.
  • Gold HMO 1000/35.
  • Silver Savings 2500/35%.
  • Tandem PPO options to match all Full PPO and Tandem PPO network plans.

Trio HMO and Tandem PPO plan enhancements:

  • All plans feature $0 Teladoc visits and $0 first home visit using Heal.
  • All members can take advantage of Healthy Savings, which provides direct savings when purchasing healthy foods at Albertsons, Safeway, Kroger, Walmart, and Sam’s Club.
  • LifeSpring and Call the Car are available to eligible members, as determined by a Blue Shield case manager. LifeSpring provides meal delivery service and Call the Car provides non-emergency transportation.
  • Trio HMO plans can now be offered alongside Local Access+ HMO (Trio HMO has been available to pair with Access+ HMO since 2017).
  • Full information on plan benefits, programs, and coverage areas is available here.

Visit Blue Shield’s Product Cycle update on Broker Connection to learn more.

Plan Updates

  • American Specialty Health Group, Inc. (ASH) will provide service administration for members enrolled in PPO plans whose coverage includes chiropractic/acupuncture benefits.
    • Chiropractic annual visits increased from 12 to 20 for most plans.
  • Rx Spectrum: tiered pharmacy network for On-Exchange (CCSB) and Mirrored plans, as well as Tandem (2018) and Trio (2019) plans:
    • Level A (preferred): CVS, CVS at Target, Costco, and Safeway/Vons.
    • Level B (non-preferred): all other pharmacies in Blue Shield’s national pharmacy network.

Specialty Coverage 2020 Updates

The Blue Shield member portal will offer greater integration with dental and/or vision plan benefits. Members can view their benefits, find dental and vision providers, view account balance, payment information, and manage claims. The site also features a dental treatment cost estimator, the ability to view and print ID cards, and other resources.

Specialty underwriting will align with medical on the requirement that a group employs an eligible common-law employee to be eligible for group plans. All new sales effective January 1, 2020, will require a common-law employee, eliminating owner-only businesses. Documentation requirements for specialty business will be the same as for medical and based on the number of enrolling subscribers.

Six new dental plans are available beginning with January 2020 effective dates, they include:

  • Options with and without lifetime ortho benefits.
  • No waiting periods for major services.
  • Higher out-of-network (OON) reimbursements (UCR90).
  • Annual maximum ranges from $1,500 to $2,500.

Beginning with January 1, 2020 groups, the 12-month waiting period will no longer be waived on voluntary dental plans. For groups with prior Blue Shield dental coverage, the waiting period will be waived at the group level. Learn more.

16 new employee life insurance plans feature:

  • Higher maximum amounts, 2-9 segment.
  • Higher maximum amounts, 51-100 segment.
  • More benefit amounts options.
  • All amounts full guarantee issue.

Three new dependent life insurance plans provide:

  • Higher maximum amounts, 10-100 segment.
  • All amounts full guarantee issue 50% rule applies.

Rates will not increase with any of these increased life insurance plan benefits. Learn more.

Underwriting Updates and Reminders

In lieu of payroll documents, Blue Shield will accept simple attestation forms and W-4 forms for start-ups and spin-offs. Other standard documentation is still required. Get the new attestation forms and details here

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

  • Payroll will be required for eligible employees who are not listed on the group medical bill and a W-4 may be required for new hires.
  • Start-ups, groups with both union and non-union 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 guidelines will be extended through the end of 2020, requiring only 25% employee participation with a minimum of five enrolled employees for medical plans. Download the flyer.

Part of the employer contribution rule will be eliminated. Previously, groups had to choose either a percentage or a dollar amount but could not mix them. Groups can now contribute a percentage for an employee and a dollar amount for dependents, or vice versa.

Since Q4 2018, Blue Shield accepts IFP waivers as a valid refusal of coverage.

Blue Shield Broker Resources

Additional Resources

Visit Blue Shield’s Broker Connection to learn more.

Contact your Claremont team at 800.696.4543 or



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