Small Business Broker Update

Q1 2025 rates now available through your preferred quoting engine

We are pleased to announce Q1 2025 rate book is now available on the dedicated Small Business Rates page of Broker Connection. Our first-quarter 2025 rate action is a statewide average of 1.3%. Remember! The Employer Enrollment Tool lets you easily find quotes and provides a streamlined, digital experience for all your enrollments. Closed rate books and more information about our rates are available on the Rates page.

January, February, and March 2025 renewals

Groups renewing in January will be available to brokers through Shield Renewals on Tuesday, October 15* while group-level changes can be made using the newly launched Employer Enrollment tool for renewals starting Thursday, October 17.* Groups renewing in February and March will be available on Tuesday, November 12* while group-level changes will be available starting Thursday, November 14.* Dates are subject to change.

The employer enrollment tool now has the added functionality of managing your group-level changes. You can review this EET Renewals user guide for more information or visit the Employer Enrollment Tool resources page.

Group renewal information is available as a microsite for each group, and these can be accessed through Shield Renewals. No download is required; you can open the site, find the information you need, and send the link or selected components to your clients. You can also access the medical choice chart option, (which provides information about your clients’ current and new plan rate) to buy up or buy down with the rate differential if you choose to move your client.

To review exact renewal and enrollment dates, plus enrollment materials and updated rates books, visit our Renewal Center page.

2025 medical plan updates

Minimal changes are expected for plan portfolios. Changes include improved deductibles and out-of-pocket maximums, added benefits, easier HMO pairing, and expanding access to care.

Impacted PPO plans with cost share and name changes are listed below (there are no name changes within our HMO portfolio). You can view the full list of 2025 plan name changes here.

PPO
2025 Plan Name	2025 Plan Name
Silver PPO 2000/60	Silver PPO 1700/60
Silver PPO 2350/65	Silver 2100/65
Silver PPO 2550/70	Silver PPO 2350/70
Gold PPO 1000/35	Gold PPO 1000/30
Bronze PPO 5500/65	Bronze PPO 4500/65
Mirror Bronze 60 PPO 6300/60	Mirror Bronze 60 PPO 5800/60

The Changes To page on Broker Connection has a full list of 2025 plan changes and updates. To view exact terms and conditions of coverage for all 2025 plan offerings, refer to the Evidence of Coverage, or contact your Blue Shield account manager. You can also use the Plan Comparison tool to see plan updates across multiple years and compare plan benefits within the same plan family.

Making it easier to offer HMO to your groups

Effective January 1, 2025, you can now offer all three HMO (Access+, Local Access+, Trio) networks alongside each other, applicable to both new sales and renewals allowing for more simplification and growth.

Virtual providers now available in all Trio HMO areas through Accolade

Members in all Trio HMO counties can now access virtual health services including PCP visits, behavioral health appointments, and specialty care. Virtual services, provided by Accolade Care, mean members have a 24/7 care team available and the flexibility of making appointments seven days a week. Learn more about Trio HMO here. Virtual appointments can be used in combination with in-person care, and please note referrals are required for specialty visits.

Providing improved accessibility to at-home care with DispatchHealth

Through DispatchHealth we are offering employers and their employees convenient and prompt at-home medical support post-hospitalization. Now available at $0 for all PPO members. A referral is needed by a case manager or a provider.

Our commitment to equitable access to health care

Effective January 1, 2025, we will expand travel reimbursements for other eligible Covered Services subject to bans or restrictions that make the services unavailable in a member’s state of residence. Coverage will include gender affirmation care services as an additional category of eligible Covered Services. This is to assist members with access to these services in other states where they remain legally available.

Important pharmacy updates

Learn more about Blue Shield’s first-of-its-kind pharmacy solution on the pharmacy care model resource page (authentication required). This page covers Blue Shield’s Pharmacy care model, Amazon Pharmacy for home delivery, new I.D cards, and more.

Updates to Member Pays Difference Penalty (MPD)

When the MPD penalty applies, your group’s employees will pay the difference in cost plus the applicable tier cost share of the brand drug. The MPD penalty will be expanded to brand drugs that have an available preferred biosimilar drug. An exception process continues to be available when the brand drug is medically necessary.

Changes to weight loss drug exclusions

Beginning January 1, 2025, upon group renewal the weight loss drug benefit exclusion will be reinstated to align with the market. Weight loss drugs will be excluded from coverage except when medically necessary. For exact plan coverage details please refer to the plan’s Evidence of Coverage.

2025 dental plan PPO plan withdrawals

As part of our product transformation and portfolio simplification efforts, three DPPO plans will be withdrawn from our Specialty portfolio beginning January 1, 2025. See mapping grid for list of withdrawn plans and corresponding recommended available plans. You can also use the Plan Comparison Tool to compare benefits between a withdrawn plan and new available plan by using the compare year over year function. Plans being withdrawn are:

Smile℠ Deluxe 50/1500/Ortho/MAC
Smile℠ Deluxe Gold 50/1500/Ortho/U85/NR
Ultimate Dental Plus PPO for Small Business 50/2000/Ortho/MAC/NR

Many ways to earn more

Blue Shield of California has multiple bonus programs and brokers can be eligible for all of them at the same time maximizing your new group sales

Small Group Incentive Program: Sell more and earn more. We’re making it easier for you to earn more when you enroll in membership.
Direct Eliete Rewards: Boost your earnings with this program that will benefit direct-selling small business brokers who sell directly.

For more on our available rewards programs, you can contact your Blue Shield representative or go to our Broker Connection Rewards and Commissions page (authentication required).

Tools for the trusted advisor: 2025 Broker roadshow, plan cheat sheets, and more

Being a subject matter expert for your clients is fundamental to your work and, when the subject is Blue Shield of California, we want to ensure you are always prepared.

Thank you to all who joined the recent 2025 Broker Roadshow! A recording of the session is available here.
Your group’s plan documents for Q1 2025 are available on the Summary of Benefits 2025 page. For all other plan documents (SBCs, EOCs, Contracts/COI) visit the benefits and coverage plan documents page for small business.
Once logged in to Broker Connection, the Broker Health Plan Document Center is your place to download group renewal packet, Evidence of Coverage, and contracts. You can also access your group’s renewal and post-enrollment microsites.
Q1 2025 medical and dental, vision, life Sales Guides provide comprehensive information about selling Blue Shield of California products with added value propositions.
The plan cheat sheet is a short quick guide to all our 2025 medical plan offerings. You can use this guide to easily identify richer and leaner plans and compare plan benefits within a plan family.

Your Blue Shield support team is available throughout the year. Contact Broker Services: (800) 599-5905 or email producer.services@blueshieldca.com.