What emotional, behavioral and mental health services and benefits does Blue Shield provide for employees and their families?

• Teladoc costs waived, including for tele-behavioral services. 
• Tele-behavioral benefit the same as in-person visits. 
• Sanvello, a mental and wellness health app, available in Wellvolution, free to members. 
• Virtual programs such as nutrition and fitness support also available in Wellvolution. 
• LifeReferrals 24/7 EAP available to fully insured large groups (101+). 

Contact Claremont for more information.

What is Blue Shield doing to make it easier for members to receive their prescriptions?

• Early refill limits have been waived.
• 90-day supplies of maintenance medications are available through mail-service pharmacy CVS Caremark.
• No fee mail service is available through CVS Caremark.
• Free home delivery is also available through several pharmacy chains.

Learn more.

What is the “Premium Payment Plan” Program?

Blue Shield has introduced a flexible payment program for the month of April, May and June for Individual and Family Plan and Medicare Supplemental plan members, and Small Business groups.

Learn more.

Is Blue Shield allowing employer groups to change plan selections off-cycle to accommodate revenue and workforce reduction due to COVID-19?

Blue Shield will allow a one-time buy-down (leaner plan design with lower premiums) change off-cycle for employers and employees to adjust their health plan selection to meet their current needs.

Note: rates for employees who choose a buy-down plan off-cycle will be based on the age of the member at the time of the change.

Learn more.

If an employee is laid off and then re-hired, how long is the waiting period before they can join the medical plan?

Blue Shield standard provision allows for waiving of waiting period if rehired within 6 months of cancellation of coverage. Employers should check their contract for further details.

What services does Blue Shield offer for members with anxiety over this outbreak?

Through September 30, 2020, Blue Shield is making Teladoc health, including behavioral health services, available with no member cost sharing for all members with access, including all Blue Shield fully insured commercial plans.

During this time, all Teladoc behavioral health services will be exempt from copays, regardless of the reason for the visit, including encounters with psychiatrists, psychologists, licensed clinical social workers, and marriage family therapists.

Mental health services also continue to be available from providers other than Teladoc. If the Evidence of Coverage (EOC) or Certificate of Insurance (COI) states that mental health services are available through Mental Health Services Administrator (MHSA) network, members can search for providers in the MHSA network through the provider directory. The standard office visit copay applies to MHSA Tele-behavioral health appointments.

Are there any extensions to new group application deadlines?

Yes. Check the Carrier Responses section of our COVID-19 resource page for the latest information.

Are there any extensions to new business submission deadlines?

Yes. Blue Shield will allow new groups to be submitted up to the last business day of each month for effective dates through January 2021. Once approved, the effective date cannot be changed. Please note on the submission cover sheet that the group agrees to the requested effective date and understands the effective date cannot be changed.

If employees are required to work a reduced schedule (temporary layoff, furlough, reduction-in-hours, etc) will they remain eligible for coverage?

Fully insured groups:

Blue Shield will continue to provide coverage through June 30, 2020 as long as premiums are received. Coverage must be offered on a consistent, non-discriminatory basis to all employees, and employee premium contributions must be the same or less as prior to the layoffs, furloughs or reduction of hours.

Options for continuing coverage for laid-off employees:

• Employees can remain on a group plan to keep them covered in the same manner as prior to COVID-19 if premium payments continue for laid-off employees.
• Employees can elect COBRA or Cal-COBRA, if eligible, and will be liable to pay the full cost of coverage (unless their employer chooses to subsidize COBRA premiums).
• Employees can enroll in the individual marketplace. Employees may benefit from government subsidies to help pay premiums.

Learn more.

Is Blue Shield allowing employer groups to change plan selections off-cycle to accommodate revenue and workforce reduction due to COVID-19?

Small Business (1-100): Blue Shield will allow a one-time buy-down (leaner plan design with lower premiums) change off-cycle for employers and employees to adjust their health plan selection to meet their current needs. Buy-down selections must be consistent with the current plan type offered by the group: PPO plan to PPO plan or HMO plan to HMO plan.

Note: rates for employees who choose a buy-down plan off-cycle will be based on the age of the member at the time of the change.

As a reminder, specialty benefits – dental plans, vision plans, and life insurance – may be added at any time.

Learn more.