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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.
For assistance, please contact our Quotes team at quotes@claremontcompanies.com or 800.696.4543.
Login To PrismBlue 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.
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.
The Relaxed Participation promotion has been extended through December 31, 2025.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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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:
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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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.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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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:
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.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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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
Can’t make it live? Register now and get access to the recording.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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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.
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.
The Relaxed Participation Promotion has been extended through December 31, 2024.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Get The Latest News with Text Messaging!
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.
Virtual Blue PSP portfolio will include five of the most popular plan designs. Several will be HSA-compatible:
The most popular Full PPO Savings plans will be available with the pharmacy Value Formulary, providing more client choices:
Assisted Reproductive Technology riders with varying dollar maximums and coinsurance levels for fertility coverage flexibility will be offered on these plans:
IRS Minimum Deductible for HSA Compatible 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:
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:
Offer your prospects and clients Blue Shield’s diverse range of affordable plans tailored to the needs of large groups (101-299 employees).
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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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.
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.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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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.
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.
The Relaxed Participation Promotion has been extended through December 31, 2024.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Get The Latest News with Text Messaging!
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.
Article last updated: March 19, 2024.
Most of your clients likely have upcoming deadlines under the federal prescription drug benefits reporting (RxDC) requirements. Here’s a summary of the requirements, how carriers are helping, and the deadlines.
Under Section 204 of the 2021 Consolidated Appropriations Act (CAA), insurance companies and employer-based health plans must submit information regarding prescription drug benefits and health care spending. The information must be submitted to the Centers for Medicare and Medicaid Services (CMS) by June 1st of each year for the prior year’s coverage.
According to the CMS, the information that is required to be submitted by insurance companies and employers are:
Blue Shield will collect D1 Premium information from groups between February 5, 2024 and April 19, 2024. Blue Shield will also submit D2 for all groups and D3-D8 for groups with prescription drug benefits under a Blue Shield health benefit plan, and P2 accordingly. If a group does not have prescription drug benefits with Blue Shield, they should coordinate submission of D3-D8 with their pharmacy/prescription drug benefits carrier, and P2 accordingly.
Key Details
Other Details:
Information Requested
Due to technical issues on their end and updated guidance from CMS about the 2024 submission, below are revised dates:
UnitedHealthcare will complete the CAA Prescription Drug (RxDC) reporting for its fully insured and self-funded/level funded groups, including those with OptumRx as the integrated PBM. However, groups with these will need to complete the Request for Information (RFI) tool for RxDC reporting between February 1, 2024, and March 31, 2024. The March 31, 2024, deadline is firm.
To support its customers with this important filing, UnitedHealthcare will be submitting the P2 (Group Health Plan), D1 (Premium and Life Years) and D2 (Spending by Category) files for all employers who had active coverage during the reference year (2023). However, completion of the submission requires gathering some information not currently maintained in their system.
UnitedHealthcare will also submit the D3-D8 data files for customers with OptumRx as an integrated PBM. UnitedHealthcare has access to all data required to complete the submission of the D3-D8 data files. Customers who use any other PBM, including OptumRx Direct, must work with that PBM to submit the D3-D8 files.
Resources
Kaiser Permanente is required to submit information on prescription drugs and healthcare spending to CMS. On February 1, 2024 Kaiser Permanente began to send out a survey form from Kaiser-Permanente-RxDC@kp.org to all contract signers to request this information. The form must be completed by March 15, 2024.
Information Requested
Kaiser Permanente plans to submit all applicable reports and required responses for all employer groups to CMS by the June 1, 2024 deadline.
Employer groups must submit information to Sutter Health Plus regarding the average monthly premiums paid on behalf of enrollees and the amount paid by enrollees each year.
For calendar year 2023 reporting, employers or brokers are to submit the required information through the online Premium Reporting Form.
Submissions are due no later than March 1, 2024.
Cigna is reporting on behalf of Cigna + Oscar groups, so no action is required by employer groups or brokers.
Covered California for Small Business (CCSB) serves as an administrator of their participating Health Plan Issuers and is not an insurance company nor an employer-based health plan. Therefore, CCSB is not subject to RxDC data collection requirements on behalf of their employer groups. Claremont recommends that the employer follow the reporting guidelines for the enrolled carrier(s).
CCSB Resources – CCSB’s Small Business Service Center is available to help with questions at 855.777.6782.
CaliforniaChoice serves as an administrator of their participating Health Plan Issuers and is not an insurance company nor an employer-based health plan. Therefore, CaliforniaChoice is not subject to RxDC data collection requirements on behalf of their employer groups. Claremont recommends that the employer follow the reporting guidelines for the enrolled carrier(s).
The carriers are taking action to support your clients with the federal reporting requirements. In order to do so, they require information from each employer group. Look out for emails directly from the carriers, and follow their instructions. If you or your clients have questions, we can help direct you to the right contacts at the carriers.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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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.