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Covered California for Small Business –
New Blue Shield Plans

Starting July 1, Covered California for Small Business (CCSB) is offering new Blue Shield plans, providing more options for enrollees. These plans include the Access+ HMO Network with Platinum, Gold, and Silver metal tier options, as well as the Bronze Trio HMO 7000/70. The two most popular Blue Shield High Deductible Health Plans (HDHP), Silver Full PPO Savings 2300/25% and Bronze Full PPO Savings 7000 plans, are also now available.

All of these plans offer benefits such as Wellvolution, Teladoc Mental Health, Nurse Help 24/7, LifeReferrals 24/7, and the Blue Card program for when members are outside of California.

For assistance, please contact our Quotes team at quotes@claremontcompanies.com or 800.696.4543.

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Blue Shield of California

Archive for the ‘Blue Shield of California’ Category

RxDC Reporting Deadlines

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Article last updated: March 19, 2024.

Most of your clients likely have upcoming deadlines under the federal prescription drug benefits reporting (RxDC) requirements. Here’s a summary of the requirements, how carriers are helping, and the deadlines.

General Information

Under Section 204 of the 2021 Consolidated Appropriations Act (CAA), insurance companies and employer-based health plans must submit information regarding prescription drug benefits and health care spending. The information must be submitted to the Centers for Medicare and Medicaid Services (CMS) by June 1st of each year for the prior year’s coverage.

According to the CMS, the information that is required to be submitted by insurance companies and employers are:

CMS Resources

Blue Shield

Blue Shield will collect D1 Premium information from groups between February 5, 2024 and April 19, 2024. Blue Shield will also submit D2 for all groups and D3-D8 for groups with prescription drug benefits under a Blue Shield health benefit plan, and P2 accordingly. If a group does not have prescription drug benefits with Blue Shield, they should coordinate submission of D3-D8 with their pharmacy/prescription drug benefits carrier, and P2 accordingly.

Key Details

Other Details:

Information Requested

UnitedHealthcare

Due to technical issues on their end and updated guidance from CMS about the 2024 submission, below are revised dates:

UnitedHealthcare will complete the CAA Prescription Drug (RxDC) reporting for its fully insured and self-funded/level funded groups, including those with OptumRx as the integrated PBM. However, groups with these will need to complete the Request for Information (RFI) tool for RxDC reporting between February 1, 2024, and March 31, 2024. The March 31, 2024, deadline is firm.

To support its customers with this important filing, UnitedHealthcare will be submitting the P2 (Group Health Plan), D1 (Premium and Life Years) and D2 (Spending by Category) files for all employers who had active coverage during the reference year (2023). However, completion of the submission requires gathering some information not currently maintained in their system.

UnitedHealthcare will also submit the D3-D8 data files for customers with OptumRx as an integrated PBM. UnitedHealthcare has access to all data required to complete the submission of the D3-D8 data files. Customers who use any other PBM, including OptumRx Direct, must work with that PBM to submit the D3-D8 files.

Resources

Kaiser Permanente

Kaiser Permanente is required to submit information on prescription drugs and healthcare spending to CMS. On February 1, 2024 Kaiser Permanente began to send out a survey form from Kaiser-Permanente-RxDC@kp.org to all contract signers to request this information. The form must be completed by March 15, 2024.

Information Requested

Kaiser Permanente plans to submit all applicable reports and required responses for all employer groups to CMS by the June 1, 2024 deadline.

Sutter Health Plus

Employer groups must submit information to Sutter Health Plus regarding the average monthly premiums paid on behalf of enrollees and the amount paid by enrollees each year.

For calendar year 2023 reporting, employers or brokers are to submit the required information through the online Premium Reporting Form.

Submissions are due no later than March 1, 2024.

Cigna + Oscar

Cigna is reporting on behalf of Cigna + Oscar groups, so no action is required by employer groups or brokers.

Covered California for Small Business

Covered California for Small Business (CCSB) serves as an administrator of their participating Health Plan Issuers and is not an insurance company nor an employer-based health plan. Therefore, CCSB is not subject to RxDC data collection requirements on behalf of their employer groups. Claremont recommends that the employer follow the reporting guidelines for the enrolled carrier(s).

CCSB Resources – CCSB’s Small Business Service Center is available to help with questions at 855.777.6782.

CaliforniaChoice

CaliforniaChoice serves as an administrator of their participating Health Plan Issuers and is not an insurance company nor an employer-based health plan. Therefore, CaliforniaChoice is not subject to RxDC data collection requirements on behalf of their employer groups. Claremont recommends that the employer follow the reporting guidelines for the enrolled carrier(s).

Summary

The carriers are taking action to support your clients with the federal reporting requirements. In order to do so, they require information from each employer group. Look out for emails directly from the carriers, and follow their instructions. If you or your clients have questions, we can help direct you to the right contacts at the carriers.

Contact us today for assistance.

 

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.


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Blue Shield of California – MES to EyeMed Transition FAQs

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Effective January 1, 2024, and announced last year, Blue Shield of California transitioned its vision plan administration from MES to EyeMed following EyeMed’s 2020 acquisition of MES. This change was seamless for members, who were automatically moved to EyeMed’s network regardless of renewal date.

With EyeMed, members have the same vision benefits and access to an extensive network of independent eyecare professionals, popular retail chains like LensCrafters and Target Optical, plus online options. Check out the Blue Shield FAQs and Blue Shield Access Vision Network flyer for details on accessing EyeMed’s exceptional vision care and products.

Contact us today for a Blue Shield vision quote.

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Resources

COVID-19 Resources

Contact us today for a Blue Shield quote.

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Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.


Get The Latest News with Text Messaging!

Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.

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Blue Shield of California Q2-2024 Updates

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Blue Shield of California remains committed to providing your small group clients with comprehensive benefits that prioritize the well-being of employees. Here’s a summary of the changes for the second quarter of 2024.

Q2-2024 Rates

Q2-2024 Renewals

Medical Plans

Dental Plans

Vision Plans

Small Business Incentive Program

Renewal Rewards Program

Brokers can earn points for every new Tandem and Virtual Blue PPO membership.

Bundled Saving Program

The 10% specialty discount is a perpetual program that is applied when a dental and/or vision plan is added to a new or existing small business medical group.

Contact us today for a Blue Shield quote.

Get a Quote

 


Resources

COVID-19 Resources

Contact us today for a Blue Shield quote.

Get a Quote

 

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.


Get The Latest News with Text Messaging!

Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.

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Blue Shield of California Q1-2024 Updates

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Blue Shield of California remains committed to providing your small group clients with comprehensive benefits that prioritize the well-being of employees. Here’s a summary of the changes for the first quarter of 2024.

Q1-2024 Rates

Q1-2024 Renewals

Medical Plans

Dental Plans

Vision Plans

Small Business Incentive Program

Renewal Rewards Program

Brokers can earn points for every new Tandem and Virtual Blue PPO membership.

Bundled Saving Program

The 10% specialty discount is a perpetual program that is applied when a dental and/or vision plan is added to a new or existing small business medical group.

Relaxed Participation Promotion

The Relaxed Participation Promotion has been extended through December 31, 2024.

Enhanced Plan Comparison Tool

More information and plan summaries can be found in Blue Shield’s Q1-2024 Medical Sales Guide and Specialty Sales Guide.

Contact us today for a Blue Shield quote.

Get a Quote

 


Resources

COVID-19 Resources

Contact us today for a Blue Shield quote.

Get a Quote

 

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.


Get The Latest News with Text Messaging!

Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.

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Blue Shield 2024 Broker Roadshow

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Join Blue Shield’s Small Business leadership team for their annual Broker Roadshow on September 18th at 10:30 am PT. Learn what’s new for Q1-2024, and hear about market trends, new innovations, enhancements to the broker experience, and more. This is an opportunity to gain strategic insights and connect directly with Blue Shield.

Date and Time: Monday, September 18, 2023, 10:30 am PT

Register Now

Can’t make it live? Register now and get access to the recording for 30 days after the event.

 


Resources

COVID-19 Resources

Contact us today for a Blue Shield quote.

Get a Quote

 

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.


Get The Latest News with Text Messaging!

Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.

Sign Up for Text Messaging

 

 

 

Blue Shield of California Announces Major Pharmacy Benefits Revamp

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Blue Shield of California has announced a major revamp in its approach to pharmacy benefits. By 2025, Blue Shield will significantly reduce its ties with CVS Health’s PBM services. Instead, it will partner with Amazon Pharmacy, Mark Cuban’s Cost Plus Drug Company, and other firms to bring about potential massive savings and enhanced services for its customers. Here’s a high-level summary of the news, what it means for you, and some links to additional resources.

High-Level Summary

  1. Blue Shield is projecting approximately $500 million in annual savings on drug costs by making this move.
  2. Amazon Pharmacy will introduce fast and free at-home drug delivery and 24/7 pharmacist access.
  3. Mark Cuban’s Cost Plus Drug Company will provide a simple, transparent, and more affordable pricing model, reducing surprise drug costs at the pharmacy pick-up counter.
  4. CVS will retain its role in managing Blue Shield’s specialty pharmacy services.

What This Means For You

  1. No immediate Impact. This change will come into effect in 2025, so your Blue Shield clients and their employees will not be affected just now.
  2. Stay informed. The announcement is big news in the industry. Many of your clients and their employees will hear about it. Familiarize yourself and stay current on this development so that you can answer any questions from your clients.
  3. Be the go-to advisor for your clients and prospects. The cost and availability of prescription drugs is a consistent pain point for your clients. With this change, Blue Shield is tackling the problem head on. Use this as a discussion point in your sales conversations about pharmacy benefits.

We will continue to keep you updated on this development. Contact us with any questions at 800.696.4543 or info@claremontcompanies.com.

Additional Resources

Blue Shield of California

Blue Shield’s New Partners

 

Contact us today for a Blue Shield quote.

Get a Quote


Reminders

Small Business Incentive Program

Renewal Rewards Program
Blue Shield increased the points earned for every new membership in Tandem PPO and Virtual Blue PPO plans. You can earn:

Bundled Saving Program
The 10% specialty discount is a perpetual program that is applied when a dental and/or vision plan is added to a new or existing small business medical group.

Relaxed Participation Promotion
The Relaxed Participation Promotion was extended through December 31, 2023.

More information and plan summaries can be found in Blue Shield’s Q4-2023 Medical Sales Guide and Specialty Sales Guide.

Contact us today for a Blue Shield quote.

Get a Quote


Resources

COVID-19 Resources

 

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.


Get The Latest News with Text Messaging!

Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.

Sign Up for Text Messaging

 

 

 

 

Blue Shield of California – Instant Digital ID Cards

Posted by

You can now conveniently access and download digital member ID cards directly through Broker Connection. 

To Access Digital ID Cards:

Blue Shield of CA Digital ID Cards

The ID cards are provided as downloadable PDFs for immediate use. This self-service feature is one of many convenient online tools now available on Broker Connection.

Contact us today for a Blue Shield quote.

Get a Quote


Reminders

Small Business Incentive Program

Renewal Rewards Program
Blue Shield increased the points earned for every new membership in Tandem PPO and Virtual Blue PPO plans. You can earn:

Bundled Saving Program
The 10% specialty discount is a perpetual program that is applied when a dental and/or vision plan is added to a new or existing small business medical group.

Relaxed Participation Promotion
The Relaxed Participation Promotion was extended through December 31, 2023.

More information and plan summaries can be found in Blue Shield’s Q4-2023 Medical Sales Guide and Specialty Sales Guide.

Contact us today for a Blue Shield quote.

Get a Quote


Resources

COVID-19 Resources

 

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.


Get The Latest News with Text Messaging!

Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.

Sign Up for Text Messaging

 

 

 

 

Blue Shield of California Resources During a Crisis

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With the serious fires affecting Canada and the potentially heavy fire season in California, Blue Shield of CA wants to remind you of the resources and support available to impacted members during times of crisis. Their priority is to ensure that you and your clients have the necessary assistance and care during these challenging situations.

In the event of state emergencies and evacuations, Blue Shield of CA will be communicating vital information with employers and members residing in the affected areas.

To help ensure members in affected areas continue to have uninterrupted access to care, Blue Shield is offering:

Additional Information

California Emergency Alerts

In times like these, it is crucial that we work together and support one another. Blue Shield of California is here to assist you and your clients during these challenging times, and they remain dedicated to providing the care and resources needed.

Contact us today for a Blue Shield quote.

Get a Quote


 

Small Business Incentive Program

Renewal Rewards Program
Blue Shield increased the points earned for every new membership in Tandem PPO and Virtual Blue PPO plans. You can earn:

Bundled Saving Program
The 10% specialty discount is a perpetual program that is applied when a dental and/or vision plan is added to a new or existing small business medical group.

Relaxed Participation Promotion
The Relaxed Participation Promotion was extended through December 31, 2023.

More information and plan summaries can be found in Blue Shield’s Q4-2023 Medical Sales Guide and Specialty Sales Guide.

Contact us today for a Blue Shield quote.

Get a Quote


Resources

COVID-19 Resources

 

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.


Get The Latest News with Text Messaging!

Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.

Sign Up for Text Messaging

 

 

 

 

Blue Shield of California Q4-2023 Updates

Posted by

Blue Shield of California continues to offer your small group clients comprehensive, connected coverage that puts employees first. Here’s a summary of the updates to prepare for Q4.

Q4-2023 Rates

Q4 Renewals

Medical and Dental Plans
There are no changes to Blue Shield’s medical and dental plan portfolios from last quarter. For details or for a listing of medical plans offered for 2023, please refer to the 2023 Medical Plans at a Glance. To learn more about specialty plans for 2023, please refer to the Q4 Specialty Sales Guide.

2024 Vision Network Change
EyeMed will be the new vision network provider, replacing MES Vision for groups and members in 2024. Details about the transition will be forthcoming.

Small Business Incentive Program

Renewal Rewards Program
Blue Shield increased the points earned for every new membership in Tandem PPO and Virtual Blue PPO plans. You can earn:

Bundled Saving Program
The 10% specialty discount is a perpetual program that is applied when a dental and/or vision plan is added to a new or existing small business medical group.

Relaxed Participation Promotion
The Relaxed Participation Promotion was extended through December 31, 2023.

More information and plan summaries can be found in Blue Shield’s Q4-2023 Medical Sales Guide and Specialty Sales Guide.

Contact us today for a Blue Shield quote.

Get a Quote


Resources

COVID-19 Resources

 

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.


Get The Latest News with Text Messaging!

Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.

Sign Up for Text Messaging

 

 

 

 

Blue Shield – New Broker Rewards Programs, Q3-2023 Rates Now Available for Quoting

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Small Business Incentive Program

With Blue Shield’s Small Business Incentive Program, earning points for qualified sales has never been easier (February 1, 2023 to January 1, 2024 effective dates). You can redeem your points for rewards from hundreds of great options, such as gift cards, electronics, products for your home, and more. Or convert your points to cash with a Visa gift card. Best of all, there are no complicated tiers or calculations required!

You Can Earn

With the Producer Rewards points-based bonus program, each point is equal to one dollar. Plus it’s easy to keep track of your point status and what you’ve earned.

Learn more about the Small Business Incentive Program and Producer Rewards Program. Enroll in the Blue Shield Producer Rewards Program today.

Groups written through Claremont are eligible for this program.


Renewal Rewards Program

As an additional incentive, earn points redeemable for rewards for renewing groups with new members into Blue Shield’s Tandem PPO, Virtual Blue, or specialty plans. What’s more, all point distributions are in addition to standard commissions.

How to Qualify

You Can Earn

Download the Renewal Rewards Program flyer to learn more.

Groups written through Claremont are eligible for this program.


Q3-2023 Rates

Contact us today for a Blue Shield quote and start earning rewards!

Get a Quote


Resources

COVID-19 Resources

 

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.


Get The Latest News with Text Messaging!

Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.

Sign Up for Text Messaging

 

 

 

 

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If you don’t find what you are looking for, contact our team for help at 800.696.4543 or materials@claremontcompanies.com.