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Cigna + Oscar Withdraws from
The Small Group Market
New Cigna + Oscar (C+O) small group sales and renewals will not be offered in 2025. At C+O’s request, all plans and rates have been removed from the quote engine. However, you can still quote or renew your C+O groups through December 15, 2024 by contacting us at quotes@claremontcompanies.com or 800.696.4543. Please note: the last day of coverage will be December 14, 2025.
Blue Shield of California continues to deliver comprehensive health benefits tailored to the needs of small businesses and their employees. Here’s a summary of the fourth quarter changes.
Q4-2024 Rates
Rates are now available through PRISM, our free and easy online quoting system.
The Q4-2024 rate action is a statewide average of 1.5%.
October groups are available now through Shield Renewals. Use the Small Group Online Renewal (SGOR) tool for group-level changes.
November groups will be available on July 30.
December groups will be available on August 27.
November and December group-level changes will be available on the new Employer Enrollment Tool (EET) for renewals beginning August 1 and September 1 respectively.
Visit the Renewal Center page on Broker Connection for more information and resources.
The bonus program is in effect from February 1, 2024 through January 31, 2025.
Brokers can earn points for every new Tandem and Virtual Blue PPO membership for renewing groups. • 100 points per new enrolled member in a Tandem PPO or Virtual Blue plan as part of the initial sale. • 50 points per new enrolled medical member on all plans, excluding Tandem and Virtual Blue PPO plans as part of the initial sale. • 10 points per new enrolled member in a small business dental plan. • 5 points per new enrolled member in a small business vision plan. • 5 points per new enrolled member in a small business life insurance plan. • 2x points for each new member enrolling in all three: dental, vision, and life (40 points total).
The current Small Business Incentive Program is good through January 31, 2024. The new program above includes a change in points earned for non-Tandem and Virtual Blue plans.
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.
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.
As part of its commitment to providing comprehensive and affordable healthcare solutions, Blue Shield of California is expanding its large group medical plans for 2025. These enhancements are designed to provide more comprehensive coverage options to employers with 101-299 employees.
The Expanded 2025 Large Group Plan Portfolio Includes:
Virtual Blue PSP portfolio will include five of the most popular plan designs. Several will be HSA-compatible:
Virtual Blue PPO Savings Embedded Deductible 3300
Virtual Blue PPO Savings Embedded Deductible 3300 100%
Virtual Blue PPO Savings Embedded Deductible 4400 100%
Virtual Blue PPO Savings Two-Tier Embedded Deductible 1650/3300/3300
Virtual Blue PPO Savings Two-Tier Embedded Deductible 1800/3300/3600
The most popular Full PPO Savings plans will be available with the pharmacy Value Formulary, providing more client choices:
Full PPO Savings Embedded Deductible 3300 100% with Value Formulary
Full PPO Savings Embedded Deductible 3500 with Value Formulary
Full PPO Savings Embedded Deductible 4000 with Value Formulary
Full PPO Savings Embedded Deductible 4400 100% with Value Formulary
Full PPO Savings Embedded Deductible 6350 100% with Value Formulary
Full PPO Savings Two-Tier Embedded Deductible 1800/3300/3600 with Value Formulary
Full PPO Savings Two-Tier Embedded Deductible 2250/3300/4500 with Value Formulary
Assisted Reproductive Technology riderswith varying dollar maximums and coinsurance levels for fertility coverage flexibility will be offered on these plans:
To meet the 2025 IRS minimum deductibles for HSA-compatible plans, all of the January 1, 2025 PSPs have been updated to comply with the new guidance. The changes include:
Individual deductible increased from $1,600 to $1,650.
Family or individual on a family plan from $3,200 to $3,300.
New HMO Pharmacy Riders
Based on market demand for a lower premium products, Blue Shield will introduce a new Enhanced RX $15/50% pharmacy rider option in 2025. With this rider, Tier 1 will feature a $15 copayment encouraging generic drugs. Tiers 2-4 will apply a 50% coinsurance, up to $250 maximum per prescription. These riders will be available for either the Plus or Value formulary.
Factor Pharmacy Network
As part of Pharmacy Care Reimagined, Blue Shield of California has transformed how members receive specialty medications for rare bleeding disorders like hemophilia. Members with hemophilia now have more network options to receive high-quality and comprehensive care management.
Starting January 1, 2024, Blue Shield:
Expanded their network of specialty pharmacies that provide hemophilia specialty medications for factor and Hemlibra to include Red Chip, CVS Caremark®, and Accredo.
Provided members access to a federally funded network of Hemophilia Treatment Centers via Red Chip, per the contract pharmacy program. Treatment centers include University of California San Diego, Children’s Hospital of Los Angeles, University of California San Francisco Benioff Children’s Hospital, and Center for Inherited Blood.
Began requiring prior authorization for new factor requests, or for members who change prescribing providers.
Offer your prospects and clients Blue Shield’s diverse range of affordable plans tailored to the needs of large groups (101-299 employees).
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.
As a trusted advisor to small businesses, your clients rely on your guidance to maintain a healthy and productive workforce. Musculoskeletal (MSK) conditions like back pain, arthritis, and muscle strains are becoming increasingly common among employees, resulting in significant costs for employers. According to “The Burden of Musculoskeletal Diseases in the United States,” more than 50% of Americans over the age of 18 suffer from an MSK injury, with nearly 40% of Californians affected. Additionally, 22% of the workforce misses work days due to debilitating MSK pain. With more employees working remotely and potentially having improper home ergonomic setups, MSK risks are exacerbated, making your guidance even more valuable.
To prevent and treat MSK pain, Blue Shield of California is expanding its Wellvolution digital health program to include three new services:
SworkIt – a mobility and exercise app for everyone, with or without musculoskeletal pain. The program offers video-guided workouts to help prevent and recover from injury. The app features stretching, strength, cardio, yoga, barre and Pilates workouts.
Kaia – an evidence-based digital therapy addressing various musculoskeletal conditions, including back, joint and chronic pain. Kaia provides tailored care plans with exercises, mindfulness techniques, educational content, and one-on-one support from Nationally Certified Health Coaches. It also includes Motion Coach™, an industry leading motion analysis technology that guides members through each exercise session with real-time feedback.
Sword Health – a clinically rigorous program designed to predict, prevent and treat pain. Members have a dedicated, licensed physical therapist who creates tailored exercise plans and connects with them two to three times weekly, offering empathy, support and compassion throughout their journey.
By offering programs that address the direct costs of musculoskeletal (MSK) disorders and promote overall employee wellness, you can help your clients reduce healthcare costs, improve productivity, and create a healthier workforce. Dealing with MSK issues early can prevent conditions from escalating and avoid costly treatments in the future.
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.
Blue Shield of California continues to deliver comprehensive health benefits tailored to the needs of small businesses and their employees. Here’s a summary of the third quarter changes.
Q3-2024 Rates
Rates are now available through PRISM, our free and easy online quoting system.
The Q3-2024 rate action is a statewide average of 1.3%.
The bonus program is in effect from February 1, 2024 through January 31, 2025.
Brokers can earn points for every new Tandem and Virtual Blue PPO membership for renewing groups. • 100 points per new enrolled member in a Tandem PPO or Virtual Blue plan as part of the initial sale. • 50 points per new enrolled medical member on all plans, excluding Tandem and Virtual Blue PPO plans as part of the initial sale. • 10 points per new enrolled member in a small business dental plan. • 5 points per new enrolled member in a small business vision plan. • 5 points per new enrolled member in a small business life insurance plan. • 2x points for each new member enrolling in all three: dental, vision, and life (40 points total).
The current Small Business Incentive Program is good through January 31, 2024. The new program above includes a change in points earned for non-Tandem and Virtual Blue plans.
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.
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.
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:
Spending on prescription drugs and health care services.
Prescription drugs that account for most spending.
Drugs that are prescribed most frequently.
Prescription drug rebates from drug manufacturers.
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
Covered CA Small Business groups, whether active or inactive with Blue Shield, are required to fill out this intake form, using the group ID and following web key: #24yr23.
All other groups (Off-Exchange/non-Covered California plans) are required to follow the process below:
Active groups have two options:
1. Complete this form using web key #24yr23.
2. Complete the intake form available on Employer Connection upon logging in.
Inactive groups (terminated on or before December 31, 2023) are required to fill out this intake form, using the group ID and following web key: #24yr23.
The deadline to provide information is Friday, April 19, 2024 at 6:00 PM (PST).
Blue Shield is not accepting paper, PDF, or fax submissions. If you, or the group, previously provided a response through either of these methods, please resubmit this information through the process outlined above.
Other Details:
For group plan sponsors whose benefit structures include multiple groups (subgroups), the intake form must be completed for the group, not the subgroup, under the main ID.
Only one individual (broker, group administrator, or delegate) may submit responses for a single group ID.
A single broker or delegate may, however, submit a response for multiple groups.
Information Requested
Basic group information such as group name and group ID.
Healthcare premium percentage paid by the employer for Small Business Groups and Large Groups that have prescription drug benefits with Blue Sheild or,
Total healthcare premium paid by employer and employee, for Large Groups that have pharmacy/prescription drug benefits with another carrier besides Blue Shield.
Total Premium Equivalent Amount (for self-funded ASO only, when applicable) – Total cost of providing and maintaining coverage, including claims costs, administrative costs, self-funded ASO and other TPA fees, and stop-loss premiums.
Due to technical issues on their end and updated guidance from CMS about the 2024 submission, below are revised dates:
The opening of the Request for Information (RFI) tool is Wednesday, February 14, 2024.
The deadline for employers/brokers to complete submissions (or to contact UHC to request data) is Wednesday, April 10, 2024.
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.
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
Average monthly premium that is paid by employee/member.
Average monthly premium that is paid by the employer/group.
Employer/group Form 5500 Plan Number (if applicable).
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).
Blue Shield of California 800.559.5905
Blue Shield of California issued a Broker Alert detailing instructions for the submission of group data via an intake form. The deadline for the submission of this form is Friday, April 5, 2024 at 6:00 PM PST.
Kaiser Permanente 800.464.4000
Kaiser Permanente is compiling and submitting the required data on behalf of their employer groups.
Sharp Health Plan 800.359.2002
Sharp Health Plan will be contacting their employer groups directly to obtain the required information. In addition, they will be sending a broker and employer alert informing all brokers and CCSB employers of the RxDC reporting requirement.
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).
Anthem – Anthem will file on behalf of their fully insured and ASO clients for the benefits they administer and maintain. This includes ASO groups who opt-in to the D1 reporting. In order to submit all required information and ensure reporting accuracy, Anthem will request some information from clients via email that will link to an online form.
Cigna + Oscar – Cigna is reporting on behalf of groups. No action required by employer or broker.
HealthNet – HealthNet is reporting on behalf of groups. No action required by employer or broker.
Kaiser – see above.
Sharp Health Plan – no details released yet.
Sutter Health Plus – see above.
UnitedHealthcare – see above.
Western Health – the carrier will reach out to the employer group for any additional.
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.
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.
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.
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.
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
Rates are now available through PRISM, our free and easy online quoting system.
The Q2-2024 rate action is a statewide average of 2%.
April 2024 renewals should be available on Thursday, January 11, 2024.
Visit the Renewal Center page on Broker Connection for more information.
Medical Plans
Reminder: 2 new Virtual BlueSM plans are available:
– Virtual Blue Platinum Tandem PPO 250/20
– Virtual Blue Silver Tandem PPO 2700/75
Virtual Blue plans are now offered on all 4 metal tiers.
There are minimal portfolio and plan design changes for 2024.
The 2024 medical plan names have been mapped to the 2023 plan names with information including the plan name change due to updated copay, coinsurance or deductible amounts for 2024.
2024 Medical Plans at a Glance provides a list of all 2024 plans with descriptions, value-add, and select benefit cost shares.
Reminder: EyeMed is the new vision network provider, replacing MES Vision. EyeMed and MES have been working together to ensure a smooth transition.
Portfolio vision changes include:
• Optometric out-of-network (OON) visits now match ophthalmologic cost share.
• Eyeglass frame OON allowance has increased.
• All vision plans include both Standard and Progressive lenses (no-line bifocals) benefits.
• Contact lens benefit updates:
– Electives – reduce OON allowance to match OON frame allowance.
– Non-elective (medically necessary) – same cost share for hard and soft contacts.
The bonus program is in effect from February 1, 2024 through January 31, 2025.
Brokers can earn points for every new Tandem and Virtual Blue PPO membership for renewing groups. • 100 points per new enrolled member in a Tandem PPO or Virtual Blue plan as part of the initial sale. • 50 points per new enrolled medical member on all plans, excluding Tandem and Virtual Blue PPO plans as part of the initial sale. • 10 points per new enrolled member in a small business dental plan. • 5 points per new enrolled member in a small business vision plan. • 5 points per new enrolled member in a small business life insurance plan. • 2x points for each new member enrolling in all three: dental, vision, and life (40 points total).
The current Small Business Incentive Program is good through January 31, 2024. The new program above includes a change in points earned for non-Tandem and Virtual Blue plans.
Brokers can earn points for every new Tandem and Virtual Blue PPO membership.
100 points per new enrolled member in a Tandem PPO or plan. February 2023 – January 2024 effective dates.
100 points per new enrolled member in a Virtual Blue plan. March 2023 – January 2024 effective dates.
Specialty plans. February 2023 – January 2024 effective dates. • 10 points per new enrolled dental member. • 5 points per new enrolled vision member. • 5 points per new enrolled life member.
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.
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.
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
Rates are now available through PRISM, our free and easy online quoting system.
The Q1-2024 rate action is a statewide average of 3%.
January 2024 renewals are now available. February and March 2024 renewals will be available on November 9th.
Visit the Renewal Center page on Broker Connection for more information.
Medical Plans
2 new Virtual BlueSM plans are available:
– Virtual Blue Platinum Tandem PPO 250/20
– Virtual Blue Silver Tandem PPO 2700/75
Virtual Blue plans are now offered on all 4 metal tiers.
There are minimal portfolio and plan design changes for 2024.
EyeMed is the new vision network provider, replacing MES Vision. EyeMed and MES have been working together to ensure a smooth transition.
Portfolio vision changes include:
• Optometric out-of-network (OON) visits now match ophthalmologic cost share.
• Eyeglass frame OON allowance has increased.
• All vision plans include both Standard and Progressive lenses (no-line bifocals) benefits.
• Contact lens benefit updates:
– Electives – reduce OON allowance to match OON frame allowance.
– Non-elective (medically necessary) – same cost share for hard and soft contacts.
The bonus program is in effect from February 1, 2024 through January 31, 2025.
Brokers can earn points for every new Tandem and Virtual Blue PPO membership for renewing groups. • 100 points per new enrolled member in a Tandem PPO or Virtual Blue plan as part of the initial sale. • 50 points per new enrolled medical member on all plans, excluding Tandem and Virtual Blue PPO plans as part of the initial sale. • 10 points per new enrolled member in a small business dental plan. • 5 points per new enrolled member in a small business vision plan. • 5 points per new enrolled member in a small business life insurance plan. • 2x points for each new member enrolling in all three: dental, vision, and life (40 points total).
The current Small Business Incentive Program is good through January 31, 2024. The new program above includes a change in points earned for non-Tandem and Virtual Blue plans.
Brokers can earn points for every new Tandem and Virtual Blue PPO membership.
100 points per new enrolled member in a Tandem PPO or plan. February 2023 – January 2024 effective dates.
100 points per new enrolled member in a Virtual Blue plan. March 2023 – January 2024 effective dates.
Specialty plans. February 2023 – January 2024 effective dates. • 10 points per new enrolled dental member. • 5 points per new enrolled vision member. • 5 points per new enrolled life member.
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.
Download market-ready slides for presentations (PPTX compatible) in addition to PDFs.
Compare up to six plans at a time, instead of four plans.
Compare year-over-year for dental plans and include the withdrawn plans. There’s an option to auto-select a mapped dental plan or a new plan for the withdrawn dental plans.
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.
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
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.
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
Blue Shield is projecting approximately $500 million in annual savings on drug costs by making this move.
Amazon Pharmacy will introduce fast and free at-home drug delivery and 24/7 pharmacist access.
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.
CVS will retain its role in managing Blue Shield’s specialty pharmacy services.
What This Means For You
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.
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.
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.
Reminder: Incentive Program now includes an Autopay incentive – earn 25 points for setting up a group on autopay during the initial enrollment. Claremont will assist you in putting this in place.
The current bonus program is in effect from February 1, 2023 through January 31, 2024.
Renewal Rewards Program Blue Shield increased the points earned for every new membership in Tandem PPO and Virtual Blue PPO plans. You can earn:
100 points per new enrolled member in a Tandem PPO plan. February 2023 – January 2024 effective dates.
100 points per new enrolled member in a Virtual Blue plan. March 2023 – January 2024 effective dates.
Specialty plans. February 2023 – January 2024 effective dates. – 10 points per new enrolled dental member. – 5 points per new enrolled vision member. – 5 points per new enrolled life member.
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.
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.
In our library, you’ll find carrier forms, applications, enrollment kits, broker bonuses, marketing resources, and more (video tutorial). However, not all carrier forms are available online.