Cigna + Oscar Q1-2023 Plan and Rate Updates

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Blue Shield - New Virtual Blue Plans

The Virtual Blue plans give members (small and large groups) the choice of virtual or in-person care. Virtual care includes $0 unlimited visits to primary care, behavioral health and specialty care through a new partnership with AccoladeCare. In-person care is available through the Tandem PPO network in California and via BlueCard when outside of the state.

The two Virtual Blue small group plans available in PRISM are the Virtual Blue Gold Tandem PPO 1500/45 and Virtual Blue Bronze Tandem PPO 7500/75. These can be identified by ‘Virtual Blue’ in the plan name.

When using the PRISM filter options for Narrow or Broad networks, select ‘All’ networks instead of ‘Broad’ only networks to generate plans for Blue Shield’s Virtual Blue, Trio HMO, and Tandem PPO plans.

If you need assistance, please contact our Quotes team at quotes@claremontcompanies.com or 800.696.4543.

Oct 17, 2022, 4 Minute Read

Below are the Cigna + Oscar (C+O) Q1-2023 plan and rate changes. To learn more about the first quarter updates, join the C+O October 20th webinar.

C+O 2022 California Top Rating Regions

Northern CA

San Francisco
Santa Clara
Alameda

Southern CA

Los Angeles (largest membership in CA)
San Diego (second largest membership in CA)
Santa Barbara
Orange County

C+O 2022 California Top Selling Plans

Bronze $6,000
Gold $0
Platinum $0/$10
Gold $250
Bronze $5,750 HSA

Approximately two-thirds of the membership are enrolled on an Open Access Plus Network offering.

Network Updates

LocalPlus® Updates

National Network Enhancements

Effective July 1, 2022 for new and existing business (effective April 1, 2022 with CaliforniaChoice).
LocalPlus can now be offered to out of area members as long as they reside in a LocalPlus service area.
Provides lower cost options for out-of-state members.
Provides more competitive option for renewals.

Expanding PPO Products with LocalPlus – Effective January 1, 2023

LocalPlus and Open Access Plus networks will be available as a PPO product within Cigna + Oscar direct.
CaliforniaChoice offers LocalPlus and Open Access Plus networks as an EPO product only.

Underwriting

51% eligible in California.
– One enrolling employee living in California service area.
No DE9C down to 3 enrolled.
4 plans allowed.
– Any 4 plans, any tier, and any network combination.
Most flexible for startups/virgin groups.
– If 3+ enrolled, no tax documents needed.
– <3 employees, 2 weeks of payroll.

Slicing Requirements

C+O can be paired alongside any other carrier and any other plan type.
60% overall participation, but only 3+ needed to enroll with C+O.

Rates

3.6% average increase from Q4 to Q1.
The premium difference when offering LocalPlus vs Open Access Plus networks averages approximately 10-12% savings (depending on the plan and region). Employer groups can offer both networks to employees.

Double-Digit Savings Across The State

C+O Savings

2023 California Small Group Plans

2023 Product Portfolio Enhancements

Two new Bronze plans added: Bronze $3,000 and Bronze $7,250.

Flexible Plans That Fit Everyone’s Needs

All plans offer employees the freedom to choose between the LocalPlus and Open Access Plus networks.
Groups can offer up to four plans with no restrictions.
20 plans across all metal tiers, including 2 HSA plans.
View the Cigna + Oscar 2023 Plan Grid.

Industry Leading Mobile App and Member Portal

View and download digital ID cards.
Message or call Care Guides.
Request a phone or secure message Virtual Urgent Care consultation (telemedicine).
Download EOB’s.
Lab results.
Step rewards.

Member ID Card Enhancements

C+O Enhanced ID Cards

Member Cost Savings Tools

Virtual Urgent Care

24/7 nationwide unlimited telemedicine benefit.
$0 copay for all non-HSA plans.
HSA members will have a cost share for telemedicine that’s applied to deductible and $0 copay post deductible.

Prescription Convenience and Cost-Savings

$0 ACA preventive RX’s.
Non HSA $3 RX list.
HSA expanded preventive care RX list.
Mail order RX benefits: 2.5x copay for 3 month supply.

Care Routing and Provider Search Tool

Filter by symptoms, specialty area, and availability.
Compare compatibility and ratings.
See appointment availability.
1-on-1 support for members provided by C+O’s dedicated Care Team.

Step Rewards Program

Earn up to $100/year by downloading the C+O mobile app and syncing steps.

Prior Carrier Deductible and Maximum Out-of-Pocket Credits

C+O is the only carrier that will credit both deductible and max out-of-pocket amounts for the current calendar year.

Eligibility and Submission Criteria

Groups must be enrolled with a calendar year deductible accumulator.
Deductible credit requests must be submitted within 30 days of the groups’ effective date to be eligible for credits.
C+O can accept Our Prior Carrier Deductible Form plus copies of member EOB’s OR spreadsheet reporting from the prior carrier.
Claims incurred prior to applying for credits will not be processed.

Provider Education, Claims Submissions, and HIPAA

Download the Provider FAQs to learn more.

Dedicated Care Team and HIPAA

Member satisfaction is twice the industry average.
C+O members are supported by a Care Team of Care Guides and nurses who can help answer questions and save members money by finding the most affordable, highest quality care in their area.

2023 Bonus Program

This Q4, earn a bonus for writing multiple groups with December 1, 2022, December 15, 2022, and January 1, 2023 effective dates.

Tier 1: Earn $250 when you sell 1 group with 4 or more enrolled employees.
Tier 2: Earn $500 when you sell 3 groups with 4 or more enrolled employees.
Tier 3: Earn $1,000 when you sell 5 groups with 4 or more enrolled employees.
Maximum payout: $1,750 for hitting all three tiers.

Download the Cigna + Oscar Bonus Program flyer for details.

The Best of Two Carriers

C+O The Best of 2 Carriers

With rates comparable to Kaiser, and networks that include Dignity Health, UCSF, Stanford, and Sutter, Cigna + Oscar brings together the power of Cigna’s nationwide and local provider networks, and Oscar’s member-focused tech-driven experience, to deliver small group health insurance that meets the unique needs of California small businesses and their employees. To learn more about Cigna + Oscar, view our web page.

Note: Only licensed and appointed agents who are contracted with Cigna + Oscar are eligible for the bonus. Check out the Cigna + Oscar Appointments Guide for full instructions.

Contact us today for a Cigna + Oscar quote!

Get a Quote

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

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