Second Quarter 2018 Blue Shield Rate Adjustments

There will be a second-quarter rate action of 1.9% s for all PPO medical plans and 1.0% for all HMO medical plans. All portfolio dental, vision, and life insurance plan rates will remain unchanged.

Small Group Renewals Through June Are Now Available

It’s only January, but you can manage your 2018 Blue Shield renewals through June. All of your second-quarter small business renewal materials will be available on Shield Renewals beginning January 16, making it easier to manage your book of business.

Your RBG Team is here to help with new sales quoting and enrollment. Talk to your RBG Representative about online enrollment and submission of Blue Shield groups through EaseCentral. Enrollment forms are available on the RBG website under ENROLLMENT FORMS.

No-Cost Vaccines at Retailers for HMO and PPO Members

Select vaccines are covered under the pharmacy benefit and provided at no extra charge through retailers. Members still have the option to receive vaccines at their providers’ offices. Download Vaccines at Retail Pharmacies for more information.

Flexibility in HMO Plan Design for 2018

For 2018, all Blue Shield of California HMO plans can be offered with or without supplemental infertility (INF) coverage. Please keep the following important reminders in mind regarding INF:

  • Renewing groups with off-exchange HMO plans will be mapped to plans without INF coverage. To select supplemental INF benefits, a group must complete a Request for Contract Change (RCC) form.
  • Renewing groups that have selected the INF rider for off-exchange PPO plans will be mapped to HMO plans with the INF rider as well.
  • Selecting the optional INF rider applies to all plans and members.
  • An optional benefits rider for supplemental INF will be offered for all off-exchange HMO and PPO plans and is included in renewal kits. Rider summaries can be downloaded from the RBG website: Infertility Rider Summary for HMO Plans and Infertility Rider Summary for PPO and HSA Plans

Growing Networks for More Choice

Blue Shield introduced the Tandem PPO Network for 2018 with six plan options. The Tandem network is a subset of
the Full PPO Network, with 60% of Blue Shield providers statewide, including access to doctors in all areas of
specialty and access to all Blue Shield Full PPO Network hospitals.¹ Tandem PPO plans provide the same benefits
as the Full PPO Network plans but are offered at a lower rate. For more information download Introducing the Tandem PPO from the RBG website.

Beginning with April 2018 effective dates, groups may offer both Tandem PPO and Full PPO plans together for savings and flexibility.

Similarly, your small business clients can offer the Trio ACO HMO plans alongside full network Access+ HMO® plans. The Trio ACO HMO Network continues to expand with new medical groups and hospitals, with coverage now in 24 California counties. Visit blueshieldca.com/aco for more information.

The Blue Shield dental PPO network is also growing, with more than 45,000 access points, and the Blue Shield vision provider network is the largest in California.

¹ (Includes Sutter Health hospitals only where necessary to achieve minimum coverage requirements: Alameda and Del Norte counties).

Richer Benefits in 2018 PPO Savings Plans

Chiropractic services are embedded in all 2018 PPO Savings plans. HealthEquity is offered as the health savings account (HSA) administrator for all 2018 Blue Shield PPO Savings plans, including Silver 2000/20%.

Keep in Mind…

These additional notes below are some important things for you to keep in mind to help you effectively manage your small business accounts with Blue Shield of California:

  • If a group currently offers all small business plans, and wants to continue doing so for the next policy year, you must be sure to elect the “Select All” button in the online renewal tool, which can be found right under the list of medical plans on the Custom Quote screen.
  • An updated Notification of CMS Reporting Requirements form is required upon renewal for all groups. To continue to comply with CMS requirements, please ensure that your groups complete the CMS form enclosed in their renewal packet and return it to Blue Shield within 10 days.
  • Beginning in 2018, Blue Shield will be using Summary of Benefits (SOB) throughout all marketing materials in place of Benefit Summaries. You will see this change on Broker Connection and in your pre- and post-enrollment materials.