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Why Choose Health Net?
✔ Lowest rates in the market – Affordable options without compromising quality.
✔ Robust PPO network – Competes with major carriers like Anthem and Blue Shield.
✔ Flexible HMO options – Networks to fit nearly every group statewide and every budget.
✔ Simplified underwriting – Only 25% participation required for groups with 5+ enrolling. No DE9C or prior carrier bill needed.
✔ Easy-to-sell benefits – $0 deductible HMO plans + four years of rate stability.
✔ Nationwide coverage – Cigna network access for out-of-state employees + state plurality rules for group qualification.
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Login To PrismYes. Blue Shield has announced that the recertification process is being waived in response to the Coronavirus. All groups with an April through July 2020 renewal date will have recertification waived.
Contact Claremont for more information.
Blue Shield is evaluating every decision or request from the State and Federal Government and their senior sales leaders are meeting daily to make proposals and decide on next steps. For now, they’re referring all clients back to their existing contracts and highlighting provisions that help in a time like this.
The terms of Blue Shield’s group service agreements continue to apply to employee eligibility for coverage. Employers should refer to the agreement and note that there are provisions in most group service agreements that may allow for continued coverage for members who are impacted by a temporary suspension of work or temporary reduction of hours in certain circumstances, such as a layoff, furlough, or approved leave of absence. This may be permitted under the employer’s policies regarding coverage, under the following conditions:
Employees who lose eligibility for coverage due to a reduction of hours or suspension of work may have the right to continue coverage under COBRA or Cal-COBRA. Employers should refer to their group service agreement for additional information.
You can find Blue Shield’s Coronavirus resources in the Coronavirus Carrier Resources section of our website. You can also stay up-to-date here with carrier actions in response to the Coronavirus.
Under the global care provisions of their plan, Blue Shield of California members are provided emergency medical assistance when traveling out of the country, This includes telephonic support, finding a provider, and assistance with subsequent claim payments. Should a member become infected with COVID-19, they would qualify for emergency international coverage. The approval for any coverage is subject to their covered benefits. (i.e. repatriation is not a covered expense).
If a member is improperly charged for a co-payment, the member should call the number on the back of their member ID card and Customer Care will work with them to get a reimbursement issued.
On March 18, 2020, Blue Shield began processing member co-pays, coinsurance, and deductibles at no cost. Any claims received between January 27 and March 18 will be readjudicated at zero dollars for COVID-19-related testing and screening services in accordance with state and federal law.
On April 1, 2020, Blue Shield announced it would also waive member co-payments, coinsurance, and deductibles for treatment, effective March 1 through May 31 for fully insured plans.
Blue Shield of California typically does not update Summary of Benefits and Coverage (SBC), Summary of Benefits (SOB), Evidence of Coverage (EOC) documents or contracts for a specific disease. However, they will evaluate the impact to contracts with direction from state regulators and Blue Shield of California’s mandates team.
At this time, Blue Shield and Blue Shield Promise will only cover self-administered test kits that are FDA-approved, or emergency use authorized, or authorized under other guidance from the Secretary of the Department of Health and Human Services consistent with the federal CARES Act. Other self-administered tests available on in the market are not covered.
Blue Shield and Blue Shield Promise require self-administered tests be ordered by a healthcare provider, sent to the approved laboratory specified on the kit, and processed in accordance with FDA and other guidance, as applicable. This policy is in accordance with applicable legislation, including the federal CARES Act.
Blue Shield and Blue Shield Promise will not cover self-administered test kits that fail to meet the conditions specified above. Members should call the phone number on the back of their member ID card to confirm coverage.
Blue Shield of California is waiving the need for prior approval and all cost-sharing for COVID-19 testing prescribed by a physician and administered by a health care professional for all members enrolled in Blue Shield’s fully insured commercial and Medi-Cal plans. Until recently, COVID-19 testing was only available from the CDC and was free. Private labs are now beginning to provide testing when ordered by a physician.