Group Broker Update

Open Enrollment tools and resources

It’s our goal each year to provide the tools you need for a successful Open Enrollment. Key resources include:

• Customized microsite links, including benefit summaries.
• The Broker Connection Account Management Tool (AMT) for self-service agency account administration.
  • Primary agents can open new user accounts, assign roles, grant permissions, and customize access.
• Virtual open enrollment meetings can be conducted via Zoom.
• The Employer Enrollment Tool makes it easy to submit and track enrollments during our high-volume months.
  • Plus, real-time data updates and streamlined eligibility across new group enrollments, renewal, and open enrollment means you receive approvals and ID cards faster than submitting applications via email.
  • The Employer Enrollment Tool resource page has all the materials you need for success with our primary enrollment channel.
• The small business and large group Broker Connection Plan Documents pages house key resources like SOBs, EOCs, and rate information.
• Employer Connection’s Administrative Resources page contains integral links and materials like:
  • Administrator Guides for both Small Business and Large Group.
  • The Reference Library with forms, help topics, and Summary of Benefits and Coverage.

Reminder: The Employer Enrollment Tool's (EET) renewal solution will fully replace the Small Group Online Renewal (SGOR) tool on 11/1/2024. Make sure to complete any final tasks in SGOR by end of business 10/31/24. Starting 11/1, you will be redirected to EET to complete all your digital enrollment submissions. Refer to the original announcement for more information.

Contact your Blue Shield representative for additional assistance and, as always, we look forward to our continued partnership. 

Blue Shield’s Digital Roundup

Blue Shield is invested in creating seamless digital experiences across all our platforms, for you, your clients, and our members. Here are the latest in our digital efforts.

Member experience

Blue Shield of California is preparing to roll out the Member Health Record feature for all members in Q4 of this year. This feature allows members to view their historical health data, aggregated from multiple sources, in a single location. With a holistic view, members and providers are empowered to make more informed health decisions. The Member Health Record will be available through a member’s online account at blueshieldca.com and their mobile app.  

We are also excited to introduce digital enhancements that make it easier for members to access prescription drug information.

• Homepage navigation improvements: Members can access the “Prescription Drug Benefits page” with a single click from their dashboard. There, members can view prescription coverage and spending information.
• Price Check My Rx enhancements: By the end of 2024, members will be able to find lower cost alternatives to their current medications (generic medications or at different pharmacies) using the Price Check My Rx online tool. Enhancements to this tool will also allow members to view and compare alternatives side by side for an optimal experience.

Employer Connection updates

We recently launched a set of new features to create a more personalized experience for our employer groups.

• Homepage personalization: Personalized dashboard for quick and easy access to users' top tasks. Ability to add frequently accessed links to “favorites” and widgets such as invoices, payments, and delegate updates.
• Billing & Payment updates: Enhanced invoice status information and easy-to-manage billing address information.
• User management improvements: Simpler way to search delegates, grant and track delegates' access, and view a historical record of all changes made.

New pharmacy home delivery service

We're thrilled to announce new pharmacy updates for our members with pharmacy benefits, starting January 1, 2025. 

Amazon Pharmacy is here

Amazon Pharmacy will replace CVS Caremark Mail Service Pharmacy as our new prescription home delivery service. This change means a smoother, digital-first experience for your clients.

New ID Cards are on the way

Beginning with October 1 plan effective dates, members will receive new ID cards with updated pharmacy information. An insert will be included with additional information and instructions for members to bring their new ID card to the pharmacy on their next visit. Updated ID cards can be accessed through the member's online myblueshield account and via the Blue Shield mobile app.

Pharmacy digital enhancements

Here are some of our latest digital enhancements to improve members’ experience with their pharmacy benefits:

• Price Check My Rx for cost comparisons
• Notifications for lower-cost alternatives
• Spending Tracker to monitor expenses
• Pharmacy Locator for easy access to nearby pharmacies

For more information and to see how these changes will benefit your clients, visit our 2025 Pharmacy Care Model page on Broker Connection.

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.

Blue Shield of California and Stanford Medicine reach new agreement

We are pleased to announce all Stanford Medicine providers and hospitals are in-network for Blue Shield Commercial HMO and PPO members effective 9/1/2024. You can find more details about the successful negotiation with Standford in the initial announcement.   

New endorsements now available

We’ve posted the latest endorsement updates on our dedicated Endorsement Updates page. As new updates become available, we will continue to add them there, ensuring you have access to the most current information to support your business.

Reminder: Gag Clause attestation due December 31, 2024

The annual Gag Clauses compliance attestation is due to the Centers for Medicare and Medicaid Services (CMS) on December 31, 2024. Please see the recent broker alert for full details.

Blue Shield of California has determined its provider contracts to be compliant and will be submitting an annual compliance attestation on behalf of our fully-insured/flex-funded groups by default. Like 2023, we will also submit the attestation on behalf of self-funded administrative services only (ASO) groups, if an agreement allowing us to do so is submitted to Blue Shield. This option is only available to ASO groups that have all their provider networks with Blue Shield.  

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.  

• Doing business with Blue Shield of California: resources for our Small Business brokers. 
• Visit the Small Business Contact Sales & Support page on Broker Connection to easily find the dedicated Account Executive and Sales Executive in each region.  
• Small business plan documents (SOB, SBC, EOC) for medical plans, pharmacy plans, dental plans, and life insurance plans all in one place.  
• 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. 

Important Update to the Outpatient Prescription Drug Benefit

Blue Shield of California will be implementing an update to the outpatient pharmacy benefit regarding member cost shares for brand drugs with generic equivalents available.

What is the cost share for brand drugs with generic equivalents today?

When a member chooses a brand drug over the generic, the member pays the difference in cost between the brand and generic drug in addition to the applicable tier cost share of the brand drug. This is in place to encourage generic utilization. When a provider chooses a brand drug over the generic, the member pays the applicable tier cost share of the brand drug.

What is the update

To further encourage generic drug utilization, starting on January 1, 2025, upon group renewal, the cost share for brand drugs with generics available will be the same, regardless if the member or the provider chooses the brand drug. Members will pay the difference in cost between the brand and generic drug in addition to the applicable tier cost share of the brand drug. This means some members may pay more when a brand drug is selected instead of the generic.

If the member switches to the generic drug, they will not pay the additional difference in cost between the brand and generic drug.

ASO (self-funded) & Custom Fully Insured Large Group plans may choose to opt out of this change at a higher cost.

What members can expect

Members who have recently filled a prescription for a brand drug and are impacted by this update will be notified in advance to encourage them to switch their brand drug to the generic option to avoid paying the additional difference in cost.

If the member or prescriber feels the brand drug is medically necessary, they may request an exception to allow the member to continue taking the brand drug without paying the difference in cost.

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.