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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.

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

Blue Shield of CA – Q1-2025 Updates

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Blue Shield of California continues to deliver comprehensive health benefits tailored to the needs of small businesses and their employees – offering healthcare that is accessible, affordable, high quality, and universal. Here’s a summary of the changes for 2025.

Q1-2025 Rates

Q1-2025 Renewals

Medical Plans

Other Highlights

New Small Business Incentive Program

Specialty Bundled Savings Program

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

Relaxed Participation

The Relaxed Participation promotion has been extended through December 31, 2025.

Contact us today for a Blue Shield 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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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 CA – 2025 Small Business Broker Roadshow Recording

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Blue Shield 2025 Small Business Broker Roadshow

Miss the Q1-2025 Blue Shield Small Business Broker Roadshow? Watch it on demand for valuable insights and updates to help you during the upcoming open enrollment period.

Highlights Include:

View The Recording

Contact us today for a Blue Shield 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 CA – Stanford Medicine is Now In-Network

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Starting September 1, 2024, all Stanford Medicine providers and hospitals are in-network for Blue Shield Commercial HMO and PPO members. This includes Stanford Hospital, Lucile Packard Children’s Hospital, Tri-Valley Hospital, Stanford Medicine Partners, and Packard Children’s Health Alliance.

However, Stanford Hospital and Stanford Medicine Partners are out-of-network for Blue Shield’s Individual and Family Plan (IFP) PPO and Trio HMO networks. Lucile Packard Children’s Hospital, Packard Children’s Health Alliance, and Tri-Valley Hospital are in-network for these plans.

 


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 CA – Updates to Small Business Dental Plans

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As part of Blue Shield’s ongoing product transformation and portfolio streamlining initiatives, three DPPO plans will be discontinued from their specialty portfolio, effective January 1, 2025.  Blue Shield will email each broker a list of affected clients.

Dental PPO Plans Unavailable as of January 1, 2025:

Groups enrolled in one of the three plans being discontinued will be automatically transitioned to a recommended plan during their 2025 renewal. For a list of withdrawn plans and corresponding recommended plans based on group size (1-50 and 51-100), please refer to the dental plan map. To confirm benefits, review the Summary of Benefits for each plan. You can also compare available dental plans by visiting blueshieldca.com/employerplans. Moving clients to a new dental plan early will help ensure a smoother renewal process for 2025.

 


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 CA – 2025 Small Business Broker Roadshow

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Join Blue Shield’s Small Business leadership team for their annual Broker Roadshow on September 25th at 1:30 pm PT. Learn what’s new for Q1-2025, and get a look inside the steps they’re taking to improve the member and broker experience through their digital ecosystem.

Date and Time: Wednesday, September 25, 2024, 1:30 pm PT

Register Now

Can’t make it live? Register now and get access to the recording.

 


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 – Q4-2024 Plan and Rate Updates

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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

Q4-2024 Renewals

Small Business Incentive Program

Bundled Savings 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

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

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 – Large Group 2025 Plan Updates

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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:

The most popular Full PPO Savings plans will be available with the pharmacy Value Formulary, providing more client choices:

Assisted Reproductive Technology riders with varying dollar maximums and coinsurance levels for fertility coverage flexibility will be offered on these plans:

IRS Minimum Deductible for HSA Compatible 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:

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:

Offer your prospects and clients Blue Shield’s diverse range of affordable plans tailored to the needs of large groups (101-299 employees).

Contact us today for a Blue Shield large group 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 – Three New MSK Health Programs

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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:

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.

To help keep small business employees healthy and productive, 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.

Sign Up for Text Messaging

 

 

Blue Shield of California Q3-2024 Rates

Posted by

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

Q3-2024 Renewals

Small Business Incentive Program

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

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

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.

Sign Up for Text Messaging

 

 

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.


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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