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Covered California for Small Business – New Blue Shield Plans
New Cigna + Oscar (C+O) small group sales and renewals will not be offered in 2025. At C+O’s request, all plans and rates have been removed from the quote engine. However, you can still quote or renew your C+O groups through December 15, 2024 by contacting us at quotes@claremontcompanies.com or 800.696.4543. Please note: the last day of coverage will be December 14, 2025.
Blue Shield of California remains committed to providing small businesses and their employees with accessible, affordable, high-quality health benefits. Below is a summary of the 2025 updates to the pharmacy program and Tandem network.
Pharmacy Updates
As part of the Pharmacy Care Reimagined initiative, Blue Shield is implementing several pharmacy updates for 2025, including:
Retail pharmacy network. Beginning in 2025, Navitus will manage Blue Shield’s retail pharmacy network for commercial, IFP, and medicare members. Impacted members will be notified in advance and provided with in-network retail and Amazon Pharmacy home delivery options. Learn more.
Amazon Pharmacy home delivery. Prescription drug home delivery will shift from CVS Caremark Mail Service Pharmacy to Amazon Pharmacy on January 1, 2025. This applies to commercial, IFP, and medicare members.
New member ID cards. Beginning with October 1 plan effective dates, Blue Shield members received new ID cards with updated pharmacy information. This applies to commercial, IFP, and medicare members.
The University of California, San Diego (UCSD) hospital will join the Tandem network in 2025, completing statewide access to all University of California (UC) hospitals and adding approximately 1,800 value-based primary care providers across California.
Effective January 1, 2025, Stanford and Cedars-Sinai facilities will no longer be included in the Tandem network.
The new bonus program is in effect from February 1, 2025 through January 31, 2026.
Brokers can earn points for each new member as follows: • 25 points per new enrolled medical member on all plans as part of the initial sale. • 10 points per new enrolled member in a small business dental plan. • 5 points per new enrolled member in a small business vision plan. • 5 points per new enrolled member in a small business life insurance plan. • 2x points for each new member enrolling in all three: dental, vision, and life (40 points total).
The current Small Business Incentive Program is good through January 31, 2025. It includes the following: • 100 points per new enrolled member in a Tandem PPO or Virtual Blue plan as part of the initial sale. • 50 points per new enrolled medical member on all plans, excluding Tandem and Virtual Blue PPO plans as part of the initial sale.
The 10% specialty discount is a perpetual program that is applied to the dental and/or vision premium when a dental and/or vision plan is added to a new or existing small business medical group. Learn more.
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
Blue Shield of California continues to deliver comprehensive health benefits tailored to the needs of small businesses and their employees – offering healthcare that is accessible, affordable, high quality, and universal. Here’s a summary of the changes for 2025.
Q1-2025 Rates
Q1 plans are now available through PRISM, our free and easy online quoting system.
The Q1-2025 rate action is a statewide average of 1.3%.
Effective January 1, 2025, all three HMO networks (Access+, Local Access+ and Trio) can be sold alongside each other. This will be applicable to new sales and renewals.
Accolade Virtual Providers All Trio HMO members can now access virtual health services including primary care physician visits, behavioral health, and specialty care through Accolade Care.
DispatchHealth At-Home Care At-home medical support post-hospitalization is now available at $0 for all PPO members.
2025 Dental Plan Updates
Blue Shield is withdrawing three dental plans effective January 1, 2025:
• 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
The new bonus program is in effect from February 1, 2025 through January 31, 2026.
Brokers can earn points for each new member as follows: • 25 points per new enrolled medical member on all plans as part of the initial sale. • 10 points per new enrolled member in a small business dental plan. • 5 points per new enrolled member in a small business vision plan. • 5 points per new enrolled member in a small business life insurance plan. • 2x points for each new member enrolling in all three: dental, vision, and life (40 points total).
The current Small Business Incentive Program is good through January 31, 2025. It includes the following: • 100 points per new enrolled member in a Tandem PPO or Virtual Blue plan as part of the initial sale. • 50 points per new enrolled medical member on all plans, excluding Tandem and Virtual Blue PPO plans as part of the initial sale.
The 10% specialty discount is a perpetual program that is applied to the dental and/or vision premium when a dental and/or vision plan is added to a new or existing small business medical group. Learn more.
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
Miss the Q1-2025 Blue Shield Small Business Broker Roadshow? Watch it on demand for valuable insights and updates to help you during the upcoming open enrollment period.
Highlights Include:
Competitive rate adjustments, both for the quarter and the year.
Actuarial trends impacting 2025 healthcare costs.
“Pharmacy Reimagined” and enhancements to the digital member portal. These include one-click access to pharmacy tools, proactive notifications about lower-cost drug options, and integration with Amazon Pharmacy for home delivery.
Updates to the broker digital portal to improve your efficiency and workflow. Learn about single sign-on capabilities, a “renew as is” checkbox for easier book of business management, and dedicated support teams.
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
Starting September 1, 2024, all Stanford Medicine providers and hospitals are in-network for Blue Shield Commercial HMO and PPO members. This includes Stanford Hospital, Lucile Packard Children’s Hospital, Tri-Valley Hospital, Stanford Medicine Partners, and Packard Children’s Health Alliance.
However, Stanford Hospital and Stanford Medicine Partners are out-of-network for Blue Shield’s Individual and Family Plan (IFP) PPO and Trio HMO networks. Lucile Packard Children’s Hospital, Packard Children’s Health Alliance, and Tri-Valley Hospital are in-network for these plans.
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
As part of Blue Shield’s ongoing product transformation and portfolio streamlining initiatives, three DPPO plans will be discontinued from their specialty portfolio, effective January 1, 2025. Blue Shield will email each broker a list of affected clients.
Dental PPO Plans Unavailable as of January 1, 2025:
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
Groups enrolled in one of the three plans being discontinued will be automatically transitioned to a recommended plan during their 2025 renewal. For a list of withdrawn plans and corresponding recommended plans based on group size (1-50 and 51-100), please refer to the dental plan map. To confirm benefits, review the Summary of Benefits for each plan. You can also compare available dental plans by visiting blueshieldca.com/employerplans. Moving clients to a new dental plan early will help ensure a smoother renewal process for 2025.
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
Join Blue Shield’s Small Business leadership team for their annual Broker Roadshow on September 25th at 1:30 pm PT. Learn what’s new for Q1-2025, and get a look inside the steps they’re taking to improve the member and broker experience through their digital ecosystem.
Date and Time: Wednesday, September 25, 2024, 1:30 pm PT
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
Blue Shield of California continues to deliver comprehensive health benefits tailored to the needs of small businesses and their employees. Here’s a summary of the fourth quarter changes.
Q4-2024 Rates
Rates are now available through PRISM, our free and easy online quoting system.
The Q4-2024 rate action is a statewide average of 1.5%.
October groups are available now through Shield Renewals. Use the Small Group Online Renewal (SGOR) tool for group-level changes.
November groups will be available on July 30.
December groups will be available on August 27.
November and December group-level changes will be available on the new Employer Enrollment Tool (EET) for renewals beginning August 1 and September 1 respectively.
Visit the Renewal Center page on Broker Connection for more information and resources.
The bonus program is in effect from February 1, 2024 through January 31, 2025.
Brokers can earn points for every new Tandem and Virtual Blue PPO membership for renewing groups. • 100 points per new enrolled member in a Tandem PPO or Virtual Blue plan as part of the initial sale. • 50 points per new enrolled medical member on all plans, excluding Tandem and Virtual Blue PPO plans as part of the initial sale. • 10 points per new enrolled member in a small business dental plan. • 5 points per new enrolled member in a small business vision plan. • 5 points per new enrolled member in a small business life insurance plan. • 2x points for each new member enrolling in all three: dental, vision, and life (40 points total).
The current Small Business Incentive Program is good through January 31, 2024. The new program above includes a change in points earned for non-Tandem and Virtual Blue plans.
The 10% specialty discount is a perpetual program that is applied when a dental and/or vision plan is added to a new or existing small business medical group.
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
As part of its commitment to providing comprehensive and affordable healthcare solutions, Blue Shield of California is expanding its large group medical plans for 2025. These enhancements are designed to provide more comprehensive coverage options to employers with 101-299 employees.
The Expanded 2025 Large Group Plan Portfolio Includes:
Virtual Blue PSP portfolio will include five of the most popular plan designs. Several will be HSA-compatible:
Virtual Blue PPO Savings Embedded Deductible 3300
Virtual Blue PPO Savings Embedded Deductible 3300 100%
Virtual Blue PPO Savings Embedded Deductible 4400 100%
Virtual Blue PPO Savings Two-Tier Embedded Deductible 1650/3300/3300
Virtual Blue PPO Savings Two-Tier Embedded Deductible 1800/3300/3600
The most popular Full PPO Savings plans will be available with the pharmacy Value Formulary, providing more client choices:
Full PPO Savings Embedded Deductible 3300 100% with Value Formulary
Full PPO Savings Embedded Deductible 3500 with Value Formulary
Full PPO Savings Embedded Deductible 4000 with Value Formulary
Full PPO Savings Embedded Deductible 4400 100% with Value Formulary
Full PPO Savings Embedded Deductible 6350 100% with Value Formulary
Full PPO Savings Two-Tier Embedded Deductible 1800/3300/3600 with Value Formulary
Full PPO Savings Two-Tier Embedded Deductible 2250/3300/4500 with Value Formulary
Assisted Reproductive Technology riderswith varying dollar maximums and coinsurance levels for fertility coverage flexibility will be offered on these plans:
To meet the 2025 IRS minimum deductibles for HSA-compatible plans, all of the January 1, 2025 PSPs have been updated to comply with the new guidance. The changes include:
Individual deductible increased from $1,600 to $1,650.
Family or individual on a family plan from $3,200 to $3,300.
New HMO Pharmacy Riders
Based on market demand for a lower premium products, Blue Shield will introduce a new Enhanced RX $15/50% pharmacy rider option in 2025. With this rider, Tier 1 will feature a $15 copayment encouraging generic drugs. Tiers 2-4 will apply a 50% coinsurance, up to $250 maximum per prescription. These riders will be available for either the Plus or Value formulary.
Factor Pharmacy Network
As part of Pharmacy Care Reimagined, Blue Shield of California has transformed how members receive specialty medications for rare bleeding disorders like hemophilia. Members with hemophilia now have more network options to receive high-quality and comprehensive care management.
Starting January 1, 2024, Blue Shield:
Expanded their network of specialty pharmacies that provide hemophilia specialty medications for factor and Hemlibra to include Red Chip, CVS Caremark®, and Accredo.
Provided members access to a federally funded network of Hemophilia Treatment Centers via Red Chip, per the contract pharmacy program. Treatment centers include University of California San Diego, Children’s Hospital of Los Angeles, University of California San Francisco Benioff Children’s Hospital, and Center for Inherited Blood.
Began requiring prior authorization for new factor requests, or for members who change prescribing providers.
Offer your prospects and clients Blue Shield’s diverse range of affordable plans tailored to the needs of large groups (101-299 employees).
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
As a trusted advisor to small businesses, your clients rely on your guidance to maintain a healthy and productive workforce. Musculoskeletal (MSK) conditions like back pain, arthritis, and muscle strains are becoming increasingly common among employees, resulting in significant costs for employers. According to “The Burden of Musculoskeletal Diseases in the United States,” more than 50% of Americans over the age of 18 suffer from an MSK injury, with nearly 40% of Californians affected. Additionally, 22% of the workforce misses work days due to debilitating MSK pain. With more employees working remotely and potentially having improper home ergonomic setups, MSK risks are exacerbated, making your guidance even more valuable.
To prevent and treat MSK pain, Blue Shield of California is expanding its Wellvolution digital health program to include three new services:
SworkIt – a mobility and exercise app for everyone, with or without musculoskeletal pain. The program offers video-guided workouts to help prevent and recover from injury. The app features stretching, strength, cardio, yoga, barre and Pilates workouts.
Kaia – an evidence-based digital therapy addressing various musculoskeletal conditions, including back, joint and chronic pain. Kaia provides tailored care plans with exercises, mindfulness techniques, educational content, and one-on-one support from Nationally Certified Health Coaches. It also includes Motion Coach™, an industry leading motion analysis technology that guides members through each exercise session with real-time feedback.
Sword Health – a clinically rigorous program designed to predict, prevent and treat pain. Members have a dedicated, licensed physical therapist who creates tailored exercise plans and connects with them two to three times weekly, offering empathy, support and compassion throughout their journey.
By offering programs that address the direct costs of musculoskeletal (MSK) disorders and promote overall employee wellness, you can help your clients reduce healthcare costs, improve productivity, and create a healthier workforce. Dealing with MSK issues early can prevent conditions from escalating and avoid costly treatments in the future.
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
Blue Shield of California continues to deliver comprehensive health benefits tailored to the needs of small businesses and their employees. Here’s a summary of the third quarter changes.
Q3-2024 Rates
Rates are now available through PRISM, our free and easy online quoting system.
The Q3-2024 rate action is a statewide average of 1.3%.
The bonus program is in effect from February 1, 2024 through January 31, 2025.
Brokers can earn points for every new Tandem and Virtual Blue PPO membership for renewing groups. • 100 points per new enrolled member in a Tandem PPO or Virtual Blue plan as part of the initial sale. • 50 points per new enrolled medical member on all plans, excluding Tandem and Virtual Blue PPO plans as part of the initial sale. • 10 points per new enrolled member in a small business dental plan. • 5 points per new enrolled member in a small business vision plan. • 5 points per new enrolled member in a small business life insurance plan. • 2x points for each new member enrolling in all three: dental, vision, and life (40 points total).
The current Small Business Incentive Program is good through January 31, 2024. The new program above includes a change in points earned for non-Tandem and Virtual Blue plans.
The 10% specialty discount is a perpetual program that is applied when a dental and/or vision plan is added to a new or existing small business medical group.
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
In our library, you’ll find carrier forms, applications, enrollment kits, broker bonuses, marketing resources, and more (video tutorial). However, not all carrier forms are available online.
