GROUP BROKER UPDATE

New Prescription Savings Program for 2023

Starting January 1, 2023, Blue Shield of California will be offering a Prescription Savings Program to Commercial plan members with outpatient prescription drug benefits through Blue Shield. This SMS text-based program provides discounts on member out-of-pocket costs for select medications. The program is designed to improve prescription drug affordability, medication adherence, and will be implemented in collaboration with Sempre Health, a digital health technology company.

The program works as follows:

1. Members taking select preferred medications will receive email/direct mail invitations to enroll
2. Once enrolled, members will receive a discount ID to use when picking up their medication at any retail pharmacy
3. Participating members receive text messages with refill reminders and what they will pay for each on-time refill

Enrollment in the program is at no extra cost to the member. The amount members save depends on their benefit design and prescription refill frequency, but the more they fill on time, the more they can save.

Contact your account manager if you would like more information about this program. More details can also be found here.

Expanding our networks in San Diego County

We are excited to share that UC San Diego (UCSD) Health will join our Trio HMO and Local Access+ HMO networks for San Diego County effective January 1, 2023. This addition expands our members’ access to many providers in UCSD Health’s comprehensive network who are already available on the full HMO Access+ network.

Blue Shield members enrolled in a Trio or Local Access+ plan can select primary care physicians at the below UCSD Health clinics and gain access to all contracted UCSD specialists and facilities.

• UC San Diego Health - Community Group
  • Vista | Downtown
• UC San Diego Health - Monica Perlman Clinic
  • Vista | Downtown | Mira Mesa | La Mesa
• UC San Diego Health - One Medical
  • Downtown | Carlsbad*
• UC San Diego Health
  • Owen Clinic | La Jolla | Kearny Mesa | Scripps Ranch
• UC San Diego Health - Physicians Network
  • College area | Sorrento Valley

Not all UCSD Health locations or providers will be in the Trio network or Local Access+ networks. Our Find a Doctor tool is updated to reflect this network expansion. Potential enrollees can use the Find a Doctor tool to check if their current primary doctor and/or specialist providers are part of their selected network.

You can also reference our Network Comparison Tool now to see how UCSD Health complements the existing HMO network options for San Diego. UC San Diego Health is repeatedly the top-ranked health care system in San Diego, with a mission to deliver outstanding patient care through commitment to the community, groundbreaking research, and inspired teaching.

Click here to learn more about our Trio HMO network, where Blue Shield members have access to a select network of doctors, hospitals, and specialists committed to delivering a better healthcare experience.

*Local Access+ only

Healthy Dose of Dialogue podcast: Price transparency and reducing Rx costs

Thank you for subscribing to Healthy Dose of Dialogue podcast on your favorite podcast app and joining the conversation on LinkedIn and Twitter. In case you missed it, catch up on our most recent episode with Dr. Ed Fotsch, CEO and founder of Gemini Health in conversation with host Salina Wong, Blue Shield of California’s Senior Director of Clinical Pharmacy Programs, about price transparency and where the industry continues to have opportunities to help reduce the cost of prescription medication.

Employer Enrollment Tool benefits and updates

During a busy fourth quarter, managing your new business pipeline to meet enrollment deadlines requires reliable, effective tools. Reward yourself with added convenience and time saved by quoting and enrolling Small Business groups through the Employer Enrollment Tool.

Not yet familiar with the Employer Enrollment Tool? Watch this short video to see how we changed group enrollments for Small Businesses.

The EET is built to maximize your selling productivity though the ability to complete multiple enrollment tasks in a one-stop-shop. This single tool allows you to shop, quote, and enroll your new business and the tool’s automated process review feature means installations can now be completed within hours.

We previously shared plans for significant enhancements to benefits administration on Employer Connection. Our teams made great progress improving the broker and employer experience managing member benefits and group records. These improvements come from new functionalities built into the Employer Enrollment Tool such as:

• Transactions feature clear, guided steps, real-time tracking.
• Streamlined system integration ensures the accuracy of your enrollment data across all Blue Shield systems.
• No more black holes and no more paper resubmissions.
• The book of business reporting is improving, too, increasing transparency around the clients and businesses you manage.

Next up for the EET is piloting the tool to a handful of your peers and incorporating their feedback. Once the final touches are complete, we will introduce a new toolset to you and your clients!

Keep an eye out for our upcoming communications and resources, providing everything you need for easier benefits management with Blue Shield.

New broker verification process, updating passwords, and connecting with us via email

We recently updated our broker verification process. Now, when calling Producer Services, our agents will ask for the last four digits of your Broker Tax ID number instead of the assigned Broker ID to identify you and locate your account.

This change is being implemented to better align you with your clients as the Broker of Record. If the tax ID number is unavailable, we can take other steps to find your account, but it may take slightly longer to process. Please try to have this information available when calling Producer Services for assistance.

Broker Connection Passwords

This year we introduced new password requirements to help protect your Broker Connection account and improve our website security. Every 90 days passwords reset and the next time you visit Broker Connection you may be required to change your password. Don’t worry. Your account is still active & there is NO NEED to re-register.

A reminder of password requirements:

– New passwords must be at least six (6) characters in length and include three of the following:

• upper case letters,
• lower case letters,
• numerals,
• special characters (e.g., !, @, #, $

– New passwords may not be the same as the previous password.

Note: Employers received a parallel communication for their employer portal. If groups reach out with any questions, please relay the information here.

Connecting with us via email

To continue improving the broker experience and minimizing the number of returned emails, please use this format when emailing Producer Services to ensure we capture all the necessary information to complete your request.

Subject Line: Medicare: (then your subject) …

Subscriber ID:
Subscriber Name:
Subscriber DOB/SSN:
Broker Tax ID/Broker ID:
Reason For Inquiry:

If portal/commissions related, please provide the username.

Thank you for helping us keep your account safe and we look forward to connecting with you soon.

COVID-19 Bivalent Boosters and Flu Shots are now available

COVID-19 and flu vaccines remain an important way to keep your clients, their employees, and their community protected as we head into this holiday season. The updated COVID-19 booster, known as the bivalent booster, is now available and fully covered at no cost to our members. These bivalent boosters provide immunity against both older and newer strains, are safe and effective, and can be received at the same time as the flu shot.

As the pandemic approaches an endemic state, it’s anticipated that the cost of the COVID-19 vaccine and booster will no longer be funded by the government and instead will be transferred back to health plans. Blue Shield of California believes that COVID-19 vaccines should be readily available to all our members without financial burden, but also that there is a shared responsibility for long term health care affordability. Encouraging your clients and their employees who plan to get vaccinated to do so before the end of the year may help keep the group’s plan costs lower.

Blue Shield recently reached out to our members to encourage them to get boosted and vaccinated against both COVID-19 and the flu. In this member outreach we also shared resources on when members should get the booster and how to secure an appointment.

We encourage you to reach out to your employer groups about encouraging employees to stay safe and protected by getting vaccinated before the holiday season rolls around.

See how Blue Shield is promoting health for our members during November’s national awareness month

We know supporting the health and wellness of our members goes beyond basic health care. November is the National Awareness Month for two important causes – and a chance for brokers and consultants to highlight the Blue Shield resources and services addressing these issues.

According to the U.S Department of Health and Human services, more than 96 million people in the country have prediabetes – although most don’t know they have it. November is American Diabetes Month, a perfect time to spotlight the diabetes services and resources available through Blue Shield of California. The place to start is our diabetes homepage, a one-stop hub of resources, knowledge, and benefit information. From receiving free diabetes supplies to learning about the importance of eye health in preventing and managing diabetes, the site is both comprehensive and easy to navigate

November is national Lung Cancer Awareness Month. The Wellvolution platform features several innovative programs built to help members quit smoking. Check out the smoking cessation page on Wellvolution for resources and information on the difficulty to quit smoking, nicotine replacement therapy, and much more.

Expanded Specialty offerings with 8 new DPPO plans

Specialty benefits are a critical part of full coverage for your clients. We are continually looking for ways to provide richer benefits while expanding coverage – all to make it easier for you to sell Blue Shield.

We are excited to introduce eight new DPPO plans, all effective January 1, 2023. With these additions, Blue Shield will have 30 DPPO portfolio plans available to the market in 2023.

The new plans are:

• Bronze DPPO/$1500/MAC
• Bronze DPPO/$1500/MAC/Child Only Ortho
• Bronze Voluntary DPPO/$1500/MAC
• Bronze Voluntary DPPO/$1500/MAC/Child Only Ortho
• Gold DPPO/$1500/MAC
• Gold DPPO/$1500/MAC/Adult+Child Ortho
• Gold DPPO/$2000/MAC
• Gold DPPO/$2000/MAC/Adult+Child Ortho

Further information is available, as always, in the current Specialty sales guide. To view rates for marketed and closed dental plans, log into Broker Connection and visit our dedicated Rates page.

Q1 2023 Cycle Launch recap

We are pleased to announce the Q1 2023 rate book is now available on the dedicated Rates page of Broker Connection. Our first-quarter 2023 rate action is a statewide average of 2.1%. Remember! The Employer Enrollment Tool lets you easily find quotes and provides a streamlined, digital experience for all your Q1 enrollments.

Closed rate books and more information about our rates can be found on Broker Connection Small Business rates.

Groups renewing in January were made available to brokers through Shield Renewals along with group-level changes can be made using Small Group Online Renewal (SGOR). To review exact renewal and enrollment dates, plus enrollment materials and updated rates books, visit our Renewal Center page on Broker Connection.

As a reminder, 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, which provides information about your clients’ current and new plan rate, option to buy up or buy down and if Trio or Tandem is available. The choice chart will include the rate differential if you choose to move your client.

Read the full Q1 2023 Cycle Launch newsletter here.

Get all your questions answered with the Small Business Sales and Support Contact page

The new Small Business Contact Sales & Support page on Broker Connection allows you to easily find the dedicated Account Executive and Sales Executive in each region. Just search by zip code, or select a county, and the page will provide direct contact information for the executives in that region.

If you can’t find the contact for your region, please reach out to one of the Account Managers, also listed on the page.

Tools for the trusted advisor

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.

Digital Tools for Employer Plans

We built the Plan Comparison and the Network Comparison tools for you to easily compare our available Medical and Specialty plans, and compare coverages across our six networks. You have at your disposal:

• The Plan Comparison Tool allows you to quickly select from our portfolio medical, dental, or vision plans and compare key benefits side by side. These high-level comparisons are easy to share with clients before diving into more comprehensive plan documents (SBC, EOC, etc.).
• The Network Comparison Tool is designed to compare coverage across our 6 networks. This tool will allow a user:
  • Download and share customized reports with clients
  • Choose from the following network displays:
    • Hospital, ACO, & IPA by Network
    • Network Comparison by Region
    • PCP and Specialist comparison

Microsite Kit Builder

Easily create group specific (open-enrollment) microsites that includes member facing resources such as:

• Summary of Benefits (SOB)
• Summary of Benefits and Coverage (SBC)
• Health programs and services
• Plan specific Find a Doctor link

You can access the Pre-enrollment (OE) site builder on Broker Connection.

For all your Small Business renewal needs, visit the Renewals Center. If you have questions regarding SGOR, a training guide is available on Broker Connection for guidance.

Small business plan documents (SOB, SBC, EOC) for medical plans, pharmacy plans, dental plans, and life insurance plans are available in one location for each line of business.

Your Blue Shield support team is available to support you throughout the year. Producer Services: (800) 559-5905.

The Blue Shield News Center is your go-to source for the latest news and services from Blue Shield of California. Stay up to date by following us on LinkedIn and subscribe here to have News Center alerts delivered directly to your inbox.

Blue High-Performance Network expansion: delivering quality care at a lower cost

Blue Shield of California’s High-Performance Network (BlueHPN^SM) is a national exclusive provider organization (EPO) designed to provide access to quality care at a lower cost while delivering better outcomes and value through provider collaboration. BlueHPN^SM offers access to carefully selected high-performing doctors and hospitals in more than 65 metropolitan areas nationwide. It also allows members to self-refer to specialists within the BlueHPN^SM network without a referral from their primary care physicians (PCP).

Effective January 1, 2023, BlueHPN will be available in 11 new Northern California and Central Coast counties, expanding the network to 33 total counties, covering more of the state’s rural areas that may currently have fewer low-cost options. The new counties are: Alpine, Amador, Calaveras, Colusa, Lake, Mariposa, Merced, Monterey, Napa, Nevada, and Sierra.

BlueHPN offers group plan sponsors more than 11 percent total cost of care savings on average (nationally), and up to 20 percent savings in some markets. This is in addition to the industry-leading savings with the broad PPO network available through Blue Cross Blue Shield companies. When offered alongside the broad PPO, the unique EPO structure of BlueHPN^SM creates a seamless national network leveraging a targeted set of providers to achieve greater savings and quality improvements.

Read more about BlueHPN on our News Center and download materials to share with your clients, here.

Please contact your sales representative with questions.

Revised home infusion services now costing members 2-3x less

Part of our mission is to create a health care system that’s sustainably affordable. Currently, infusions administered in a hospital or outpatient facility cost 2-3x more than if administered at home or in the provider office.

In 2023, we are modifying the cost share for home infusion and hemophilia home infusion services from a coinsurance to a flat $45 copayment to encourage our members to opt for home infusion when appropriate.

These changes will apply to PPO, EPO, and PPO Savings plans that previously applied a coinsurance for home infusion services. The Home Infusion modification is not a required change for our Custom or ASO plans. Group may decide to keep the same Home Infusion benefits if preferred.

Changes to the summary of benefits (SOB) template will be applied to all medical plans (HMO, PPO, PSP, etc.) across Portfolio and Custom business. Cost shares are not changing for HMO or POS plans, only the SOB format.

Supporting your success during Open Enrollment

We continue to provide support for virtual and in-person Open Enrollments by developing tools and resources to support your experience, including:

• Customized Microsite link which includes benefit summaries
• Virtual enrollment can be conducted via platforms like Zoom, Teams, and Webex
• The Forms and Applications page on Broker Connection features resources covering web-based enrollments, SOBs, and more
• Value-added flyers such as: Teladoc, Wellvolution, NurseHelp, LifeReferrals, Mobile App and Wellness Discounts. Benefit summaries, enrollment kits and additional wellness flyers may be made available via soft copy upon request.
• Wellvolution - www.wellvolution.com
  • Access to over 50 digital app platforms
  • Manage Sleep Better
  • Eat Healthier
  • Manage Stress
  • Move More
  • Ditch Cigarettes

Contact your Blue Shield representative for additional assistance. We look forward to our continued partnership and look forward to a successful enrollment season.

Tools for the Trusted Advisor

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.

Large group plan documents (SOB, SBC, EOC) for medical plans, pharmacy plans, dental plans, and life insurance plans are available in one location.

The Blue Shield News Center is your go-to source for the latest news and services from Blue Shield of California. Stay up to date by following us on LinkedIn and subscribe here to have News Center alerts delivered directly to your inbox.