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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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Carrier News

Archive for the ‘Carrier News’ Category

RxDC Reporting Deadlines

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Article last updated: February 21, 2024.

Most of your clients likely have upcoming deadlines under 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 5, 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

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.

Get a Quote

 


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.


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Claremont Promotes Nicole Allyn

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With a focus on market expansion and stronger customer relations, Claremont has promoted Nicole Allyn to Director of Sales. Nicole is responsible for leading Claremont’s strategic approach, driving growth, and shaping the company’s sales direction. Nicole joined our team in 2020 as a Regional Sales Manager.

A collaborative and team-focused manager who leads by example, Nicole excels at building strong partnerships with her team, brokers, and carrier partners. She is skilled at developing sales strategies and providing top-notch service and solutions to clients. Nicole derives great satisfaction in helping her team and partners succeed.

Outside of work, Nicole is a devoted mother to her teenage son, Joey. In her free time, she enjoys staying active by lifting weights and pursuing creative outlets like playing guitar and singing. We are thrilled to have Nicole step into this new role and look forward to her continued contributions.

You can reach Nicole at nicole@claremontcompanies.com or 925.296.8818.

 


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MetLife Introduces Expanded Teledentistry For Dental PPO Members

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Starting January 1, 2024, MetLife is expanding access to teledentistry by partnering with industry leader Virtual Dental Care. This collaboration gives MetLife PPO members on-demand 24/7 access, including emergency care, to licensed dentists through a video call.

Whether it’s an urgent issue like dental pain or swelling, or just a quick question, Virtual Dental Care’s extensive network of dentists is available anytime, anywhere. Dentists can even prescribe medications and refer to local in-network providers for follow-up care. 

Help your groups stay competitive in today’s tight labor market by offering the forward-thinking dental benefits of MetLife and Virtual Dental Care. This powerful combination brings leading-edge teledentistry to your clients’ workforce helping them get ahead of dental problems before they escalate. Learn more.

Contact us today for a MetLife quote!

Get a MetLife 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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BASIC Webinar: The ACA Filing Clock Is Ticking. BASIC’s Solution Is Here for You.

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The IRS is increasing enforcement, actively pursuing non-compliant Applicable Large Employers (ALEs) with 50+ full time equivalent employees (FTEs). ALEs are required to furnish Form 1095-C to employees by March 4, 2024, and file Form 1094-C with the IRS by February 28, 2024 (April 1, 2024, if filing electronically).

Attend this webinar for an overview of the ACA requirements and deadlines, and get a demonstration of BASIC’s ACA Elevate filing solution that will handle ACA compliance and help your clients avoid penalties.

This webinar is not eligible for CE credits. Reserve your spot today!

Reserve Your Spot

 

Presenter: Chris Eckert, Vice President of Sales
Chris has been with BASIC for over 18 years, with proven success in helping employers find cost-effective, value-driven solutions for HR Benefits, Compliance, Payroll, and Leave Management. He’s dedicated to providing thorough, professional, and personalized customer service with integrity. Chris consistently goes above and beyond for his clients by finding the BASIC service that satisfies their toughest HR challenges while meeting all their must-haves.

To learn more, check out the BASIC website and contact us at 800.696.4543 or info@claremontcompanies.com for assistance when you’re ready to enroll a group in a BASIC plan.

 

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

 


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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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BRI – Tips and Resources For New Plan Participants

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Taking advantage of pre-tax benefit plans through a Flexible Spending Account (FSA), Health Reimbursement Arrangement (HRA), or Health Savings Account (HSA) allows your clients to stretch their benefits budget. With access to tax-free funds for qualified medical expenses, these accounts provide a strategic way to maximize savings and better manage healthcare costs. To ensure your clients make the most of their new accounts, here are tips to keep in mind, and reminders of valuable resources from BRI.

Accessing Funds

Checking Your Balance

View the BRI infographic for details.

Know What Expenses Are Eligible

Please review the Plan Highlights to confirm what expenses or expense types are permitted under the plan.

Understanding Your Accounts

Maximize Savings

To learn more, check out the BRI FAQs. These tips and resources will ensure your clients are well informed and prepared to make the most out of their pre-tax benefit plans.

Contact us at 800.696.4543 or info@claremontcompanies.com for assistance when you’re ready to enroll a group in a BRI Specialty Account.

 

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


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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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TASC Webinar: 2023 ACA Filing – The Keys to Doing It Right

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If your clients have 50 or more full-time (FTE) employees, they must report health insurance coverage information to the IRS by April 1, 2024. Join this informative webinar to learn everything you need to know about the Affordable Care Act (ACA) reporting requirements and deadlines for 2023.

Led by ACA expert Joe Aitchison, this webinar will cover key filing details and what employers need to do if they receive an IRS penalty notice. You’ll also get helpful tips for both first-time and experienced filers. Whether you’re new to ACA reporting or simply need a quick refresher, this webinar has practical tips to ensure your fully insured and self-funded clients stay compliant.

This Webinar Will Cover:

Details: 

The first 60 minutes will focus on the above topics with the remaining time devoted to Q&A and information about TASC’s ACA Filing Service. This course is approved for 1.0 HRCI and 1.0 SHRM-CP advanced credits (live attendance only). Register to attend now.

Register Now

 

About Joe Aitchison, SPHR, SHRM-SCP, CHRS
Joe provides Business and HR client advisory services and HR out-source services nationally. He is a Human Resource professional with over 25 years of business management and HR consulting experience. He has worked with multi-plant International Tier I Automotive Manufacturing, retail, food processing, health care, legal administration, and professional services.

Mr. Aitchison is recognized as a leader in human resources and has obtained a lifetime certification as a senior professional in human resource management, SHRM – Senior Certified Professional and Healthcare Reform Specialist by the Healthcare Reform Center & Policy Institute. Mr. Aitchison serves on several for-profit and not for profit boards.

Learn more about TASC’s wide range of integrated administration and compliance solutions.

 

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


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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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Gone Fishing! Wishing Ken Ruotolo a Very Happy Retirement

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Claremont COO, Ken Ruotolo, is retiring at the end of the year after more than twelve years of company service. Ken’s been a huge part of the Claremont family since 2011, helping us hit some major goals and inspiring us all with his focus and determination.

“Ken’s contributions to Claremont have been numerous,” said Michael Traynor, Claremont President. “From leading us through ACA implementation, to his commitment to customer service excellence, and his development of strategic business partnerships, Ken has been key in advancing our company mission. We wish him all the best in his upcoming world travels, continued community work, and exploration of California’s best salmon runs.”

“Moving into this next phase is bittersweet,” said Ken. “While I look forward to spending more time on personal and family activities, I will genuinely miss engaging with our clients and partners, and I will especially miss my coworkers. They are some of the most professional, dedicated and nicest people I’ve worked with in 40 years as a business professional. They always put our clients and partners first by bringing thoughtful solutions to both challenges and opportunities. It’s rare that one has the opportunity to be part of such a special team.”

Please email your congratulations and best wishes to Ken at kruotolo@claremontcompanies.com.

 

 


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Humana 2024 Producer Partnership Plan

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Earn more with Humana in 2024 with their Producer Partnership Plan.

Group Benefits (Dental, Vision, Life & Disability)

Leaders Club Program

Humana is sunsetting their traditional Leaders Club Program for 2024, but will be releasing a new Producer Recognition Program in the upcoming months.

For details, download the 2024 Producer Partnership Plan brochure.

Contact us today for a Humana quote and take advantage of the Group Benefits Bonus!

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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In our library, you’ll find carrier forms, applications, enrollment kits, broker bonuses, marketing resources, and more. However, not all carrier forms are available online.

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