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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 or 800.696.4543.

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Which of Your Clients Are Subject to The ACA’s “Play or Pay” Provisions?

Which of Your Clients Are Subject to The ACA’s “Play or Pay” Provisions?

By Ken Ruotolo, Chief Operating Officer, Feb 21, 2017, < 1 Minute Read

Despite the intense media focus on repeal, replace and repair, the laws and regulations of the ACA are still in effect, including the Employer Shared Responsibility provisions (“Play or Pay”). Early each year, your clients should answer the following critical question: Was their count of full-time plus full-time equivalent employees 50 or more on average during the prior year?

If the answer is “yes,” then your client is an Applicable Large Employer (ALE) and must offer coverage to full-time employees or potentially incur penalties. You will want to quickly have a discussion with them about putting a plan in place.

However, if the answer is “no,” then they are not at risk of incurring penalties if they choose not to offer coverage. This includes not offering coverage during the current year even if they were an ALE in prior years.

Have your clients asked and answered that key question? If not, you may want to quickly engage in a discussion with them about the topic. For your reference, Claremont has developed a comprehensive Play Or Pay Guide for Brokers. In it you and your clients can learn how to:

If your client determines they are an ALE for the first time, there is transition relief that permits them to not offer coverage through March of their first year as an ALE. This article provides helpful information for new ALE’s and their deadline for offering coverage.

Contact the small group experts at 800.696.4543 or