2017 Individual and Family Plans Broker Cycle Guide. Effective: January 1, 2017

Transcription

1 we are california 2017 Individual and Family Plans Broker Cycle Guide Effective: January 1, 2017

2 Hello, Thank you for your focus on service and dedication to Blue Shield of California s clients. You ve helped make Blue Shield of California #1 on Covered California and we couldn t have done it without you! New for 2017 We are excited to introduce our new Trio ACO HMO plans that will help simplify the healthcare experience, maintain the high quality of care and provide our members with even more affordable coverage. Additionally, you ll find other updates for 2017 including the addition of Teladoc to all non-grandfathered plans and the expansion of our Telehealth services. We are dedicated to exploring new ways to help your clients access care the way they want it. Rate changes We are pleased to announce that Blue Shield holds the #1 price position for Silver PPO health plans in regions 2, 5, 6, 11, 12, 14, 15, 17 and 19.* Our rates for Individual and Family Plan (IFP) products will increase by an average of 19.9% due to higher utilization rates and the phase-out of the federal reinsurance program. Our rates for grandfathered plans will remain unchanged. We ve also made strides to maintain consistent rates for our dental, vision and life insurance products. Look for more information on our specialty rate updates in this guide. Commissions You can count on the convenience of online commission statements. Visit the Producer Connection homepage and access our new Broker Compensation Management Tool that allows you to review commission statements online anytime. We re here for California Blue Shield of California has been caring for Californians for more than 75 years and we couldn t do it without you. We appreciate your hard work and dedication to everyone throughout the state. We re here for you Your Producer Services team is here for support at (800) We re ready to help you renew your current clients and sell new business. Regards, Jeff Smith Vice President and General Manager Individual and Family Plans * Rate position is based on pricing for the Silver 70 PPO plan. 1

3 Table of contents The new Trio ACO HMO changes... 6 Reminders...18 Client notifications...19 Online resources Sales materials and forms...21

4 The new Trio ACO HMO Introducing Trio ACO HMO Blue Shield s next-generation health plan In this year s open enrollment, Blue Shield will extend our Trio ACO HMO offering to 22 counties in the IFP market with the participation of 37 ACO s serving approximately 340,000 people. These plans will be available on- and off-exchange and will provide our members with access to coordinated care and simplified communication, all while holding Blue Shield, doctors, and hospitals accountable for the quality and cost of care. Our new IFP Trio ACO HMO health plans help create a sustainable healthcare system while giving your clients personal attention they can trust. Our HMO plans are priced lower than our PPO plans in regions 7, 9, 12, 15, 16, 17 and 18, giving both prospects and current PPO members a lower price option and access to a quality network.* 2017 Trio ACO HMO plans When enrolling a customer into Trio ACO HMO, look for the Blue Shield HMO plans offered directly with Blue Shield or with Covered California. Whenever you see Blue Shield HMO, know that your customers will have access to our Trio ACO HMO network. 1 Blue Shield Platinum 90 HMO 2 Blue Shield Gold 80 HMO 3 Blue Shield Silver 70 HMO 4 Blue Shield Silver 73 HMO 5 Blue Shield Silver 87 HMO 6 Blue Shield Silver 94 HMO Plan features and member benefits Shield Concierge One phone number gives your customers access to all of their customer service needs. Our Shield Concierge team is made up of customer service representatives, registered nurses, pharmacists, pharmacy technicians, health coaches and social workers all working together for our Trio ACO HMO members. With one point of contact, we re making it easier for your customers to navigate the healthcare system and get care faster and easier than ever before. Shield Concierge helps our members navigate their health plan benefits by: Speaking with a Blue Shield of California representative who has a 360 view of their medical history Receiving assistance with scheduling appointments, getting a prescription filled, and transferring records Gaining access to wellness care and general health coaching Getting answers to billing and claimsrelated questions And much more. Primary care physician (PCP) After enrolling in a Trio ACO HMO plan, a PCP in the Trio ACO HMO network will be selected for each member. This doctor will help keep the member focused on their health and wellbeing, while helping coordinate care if they need to see a specialist. If a member prefers a different doctor, they can change their PCP after they have enrolled. Teladoc Members covered with a Trio ACO HMO plan will also have access to Teladoc, giving them the convenience of seeing a doctor without leaving home. Additional features and benefits are available further in the 2017 changes section of this guide. * Rate position is based on pricing for the Silver 70 plans. 3

5 The Trio ACO HMO network Trio ACO HMO plans are available for purchase in 22 counties. In six of these counties (Orange, San Francisco, San Joaquin, San Mateo, Santa Clara and Santa Cruz), plans are available in every ZIP code. In 16 of these counties, plans are only available in select ZIP codes. The grid below shows the ZIP codes by county where Trio ACO HMO plans are available. Region County ZIP codes 1 Nevada 95712, 95924, , 95949, , and Solano 94503, 94510, 94589, and El Dorado 95664, 95672, and Placer , 95648, 95650, 95658, 95661, 95663, , 95713, and Sacramento , 94211, , 94232, 94234, , , , , 94252, 94254, , , , 94271, , , 94282, , , , 95615, 95621, 95624, 95626, 95628, 95630, 95632, , 95652, 95655, 95660, 95662, , 95673, 95683, 95693, , , 95763, , , , 95860, , and Yolo , 95612, , 95627, 95637, 95645, 95653, 95691, , , 95776, and San Francisco Full coverage 5 Contra Costa , 94509, 94511, , , , 94531, , 94553, 94556, 94561, , 94570, 94575, and Alameda , 94566, and Santa Clara Full coverage 8 San Mateo Full coverage 9 Santa Cruz Full coverage San Joaquin Full coverage 10 Stanislaus 95307, 95313, 95316, 95319, 95323, 95326, , , 95361, 95363, , , and Tulare 93219, and Ventura , , 91377, , , , 93040, , and Kern 93203, , , 93220, , , , 93255, 93263, 93268, 93276, 93280, 93283, 93285, 93287, , , 93380, , , , 93516, 93518, 93531, and Los Angeles North , , , , , , , , 90723, , , 90755, , , 90822, , 90840, 90842, 90844, , 90853, 90895, 90899, 91001, 91003, , , , , , , 91046, 91066, 91077, , , 91121, , 91129, 91182, , , 91199, , 91214, , , , 91510, , 91526, 91702, 91706, 91711, , , , , , , , , 91778, 91780, , , 91896, 91899, and

6 Region County ZIP codes 16 Los Angeles South , , , 90099, 90189, , , , , , 90245, , , , 90270, 90272, , , 90280, , , , , , 91313, 91316, , , , 91337, , , , 91367, , 91376, , 91390, , , 91416, 91423, 91426, 91436, 91470, 91482, , 91499, and Riverside 91752, 92220, 92223, 92230, 92320, , , , , , 92548, , , 92567, , , , , 92599, and San Bernardino 91701, , , 91737, 91739, 91743, , , , 92301, 92305, , , , , 92329, 92331, , , , 92350, 92352, 92354, , , , 92382, , , 92397, 92399, , , 92413, 92415, 92418, and Orange Full coverage 19 San Diego , , , 91921, , 91935, , 91948, , , , 91987, 92003, , , , 92033, , 92046, 92049, , , , , , , , , 92088, , 92096, , , , , 92145, 92147, , , , 92163, , 92182, , and By enrolling prospective clients or transferring existing clients into a Trio ACO HMO plan, you will give them regional access to health coverage that will help guide them through the challenging healthcare environment. From Shield Concierge serving as one point of contact for most of your clients needs, to a system where hospitals, doctors and Blue Shield are held jointly accountable for providing high-quality care and keeping premiums down for the patients they serve, the new Blue Shield Trio ACO HMO plans are designed with enhanced care coordination, communication and accountability in mind because we all know that better communication leads to better healthcare experiences and outcomes. For a high-level view of our HMO plan benefits, you can download our Plans at a Glance brochure or benefit summaries. The four easy steps to enroll a client in Trio ACO HMO 1. See if Trio is available in their area using the table above. 2. See if the Trio plan benefits meet a client s health and budgetary needs. 3. Your clients can see if their doctor participates in the Trio ACO HMO network by visiting blueshieldca.com/networkifphmo beginning in early October. 4. Sign them up. If a client does not meet the criteria, please consider one of our PPO plans. 5

7 2017 changes The following changes are effective January 1, 2017: Rate changes Medical rates With our large network of doctors and hospitals, competitive rate positions, and our new portfolio of Trio ACO HMO plans, we continue to offer our members freedom to choose their networks and gain access to a wide range of care. With this in mind, our medical rates are increasing because of two key factors: Phase-out of the federal reinsurance program: The ACA (Affordable Care Act) premium stabilization program s reinsurance and risk corridor payments will be phased out. The reinsurance program had provided funds to plans with higher-cost enrollees to offset those medical costs and guarantee coverage regardless of health status. The sunset of this program alone adds approximately 5% to our rates. Higher utilization rates: Our 2015 healthcare expense has shown that our members utilization is significantly higher than in It is important to note that tax credits will mitigate the premium impact for many of your clients (87% of exchange members receive a tax credit). Our pricing for 2017 is focused on providing long-term financial sustainability for your clients. Dental rates New for 2017, our dental HMO rates will be differentiated by region instead of one rate throughout the state. Our dental HMO rates will experience a rate pass except for regions 1, 2 and 12 due to increased usage of benefits. These three regions will experience a 29% rate increase. Our dental PPO plan will continue to hold steady; however, the Enhanced Dental PPO 25/500 and Enhanced Dental Plus PPO 25/500* will experience a 5% increase. Our Enhanced Dental PPO 50/1250 and Enhanced Dental Plus PPO 50/1250* dental plans will have a 10% increase. Vision rates The majority of our vision rates continue to hold steady except for the Ultimate Vision 15/25/150, which decreased by 9%. All non-grandfathered plan changes Teladoc In 2017, Blue Shield of California is adding the Teladoc service to all non-grandfathered plans. This virtual care service offers members the convenience and affordability of seeing a doctor without leaving home. Teladoc s easy-to-use telephone and video access saves time and money, especially for members living in remote areas. Teladoc doctors are U.S. board-certified and licensed physicians who can diagnose and treat many common conditions and prescribe medications 24/7 via phone or online video consultations. Have your clients visit teladoc.com/bsc or call Teladoc. Teladoc doctors Practicing primary care providers, pediatricians and family physicians with an average of 15 years of experience Available 24/7/365 via telephone and video Able to write prescriptions when necessary Ideal for your clients on vacation, a business trip or away from home A convenient alternative to the ER or urgent care center for a non-emergency * These plans are closed dental plans that are not available to new clients. 6

8 Talk to a doctor in minutes Teladoc doctors can treat many medical conditions including: Cold and flu symptoms Respiratory infection Ear infection Urinary tract infections Allergies And more While most plans provide access to Teladoc for a $5 copay, the chart below shows plans with different member copays. Plan Bronze 60 PPO Bronze 60 HDHP PPO (Formerly Bronze 60 HSA PPO) Minimum Coverage PPO Bronze 5550 PPO Copay details $5 for first three combined visits prior to deductible Then $5 after deductible 40% after deductible No charge for the first three combined visits prior to deductible Then no charge after deductible $5 first three consultations prior to deductible Then $5 after deductible Teladoc does not provide specialist services, treat emergency situations, or do anything that requires physically examining the patient or diagnostic testing. Please refer to the Evidence of Coverage documents for each plan s specific details. 7

9 Telehealth network expansion Blue Shield is excited to introduce enhancements to our members Telehealth services through a special collaboration between Blue Shield of California and Adventist Health. Telehealth continues to improve access to specialty medical care for our members in rural and urban areas. Telebehavioral health services are also available through Blue Shield of California s mental health service administrator (MHSA). With four new clinics that opened in Mad River Community Clinic, Tehachapi, Imperial Valley and Metropolitan State Hospital, Telehealth offers members the ability to see a specialist via interactive video technology without having to travel far to a specialist s office. Clinical coordinators use real-time diagnostic tools to send data to the physician during your client s visit. Special high-definition cameras and computer screens let the patient see, hear and interact with their specialist over a secure connection. Telehealth services through California Adventist Health offer specialist consultations which include: cardiology, dermatology, endocrinology (diabetes), rheumatology (arthritis) and many more. Telehealth saves members the time, expense and stress of traveling to an appointment far away. 8

10 All non-grandfathered PPO plan changes PCP selections Starting in 2017, Blue Shield will match all IFP members with a primary care provider (PCP) for our on-exchange and off-exchange nongrandfathered PPO plans. This match offers our members the ability to build a relationship with a PCP; however, it is important to note this does not change the way our members access care. Our members on non-grandfathered PPO plans will continue to have the freedom to choose specialists and other providers without referrals inside or outside the network as they do now. Both Covered California and Blue Shield will continue to provide you with additional information on PCP selections as it becomes available. Diabetes self-management This benefit is now covered at no charge to the member. Pediatric vision A maximum allowance for pediatric contact lenses will be added. The maximum allowance is $150 for elective (cosmetic/convenience) and $600 for non-elective (medically necessary) pediatric contact lenses. Other practitioner office visits Some plan changes involve lowered copay amounts for other practitioner office visits in Please refer to the plan-specific changes in the document below. Other practitioners may include the following: nurse practitioners, licensed clinical social workers, marriage and family therapists, acupuncture practitioners, registered dieticians and other nutrition advisers, certified nurse midwives, licensed occupational therapists, physical therapists and licensed acupuncturists. Pediatric dental The coinsurance for diagnostic preventive pediatric dental care for non-participating providers will decrease from 20% coinsurance to 10% coinsurance.* Caries risk management, which includes exams and fluoride varnish treatment for prevention of cavities, has been removed. This benefit still applies to Silver 1850 PPO, Silver Seven 3750 PPO and Bronze 5550 PPO. * Not applicable to Silver 1850 PPO, Silver Seven 3750 PPO or Bronze 5550 PPO plans. 9

11 Platinum 90 PPO changes Copay changes The copay for the following services will decrease from $20 to $15 when using participating providers: Primary care visits to treat an injury, illness or condition Other practitioner office visits Mental/behavioral health outpatient office visits Substance use outpatient office visits Outpatient rehabilitation and habilitative services The copays for the following services will also decrease: Urgent care The copay for an urgent care visit will decrease from $40 to $15 when using participating providers. Emergency room The coinsurance for emergency room physician fee will decrease from 10% to no charge when using participating and non-participating providers. Gold 80 PPO changes Copay changes The copay for the following services will decrease from $35 to $30 when using participating providers: Primary care visits to treat an injury, illness or condition Other practitioner office visits Mental/behavioral health outpatient office visits Substance use disorder outpatient office visits Outpatient rehabilitation and habilitative services The copays for the following services will also decrease: Urgent care The copay for an urgent care visit will decrease from $60 to $30 when using participating providers. Emergency room The coinsurance for emergency room physician fee will decrease from 20% to no charge when using participating and non-participating providers. The copays for the following services will increase: Emergency room The copay for emergency room facility fee will increase from $250 to $325 (copay still waived if admitted) when using participating and non-participating providers. Tier 2 drugs The copay for retail pharmacies will increase from $50 to $55 for up to a 30-day supply when using participating providers. Tier 3 drugs The copay for network retail pharmacies will increase from $70 to $75 for up to a 30-day supply when using participating providers. X-rays and diagnostic imaging The copay for X-ray and diagnostic imaging services will increase from $50 to $55 when using a participating provider. 10

12 Out-of-pocket maximum The calendar-year out-of-pocket maximum per individual/family will increase from $6,200/$12,400 to $6,750/$13,500 when using participating providers and from $9,200/$18,400 to $9,750/$19,500 when using non-participating providers. Silver 70 PPO changes Copay changes The copay for the following services will decrease from $45 to $35 when using participating providers: Primary care visits to treat an injury, illness or condition Other practitioner office visits Mental/behavioral health outpatient office visits Substance use disorder outpatient office visits Outpatient rehabilitation and habilitative services The copays for the following services will also decrease: Urgent care The copay for an urgent care visit will decrease from $90 to $35 when using participating providers. Emergency room The copay for emergency room physician fees will decrease from $50 (deductible applies) to no charge when using participating and non-participating providers. The copays for the following services will increase: Emergency room The copay for emergency room facility fees will increase from $250 (deductible applies) to $350, and deductible does not apply (copay still waived if admitted) when using participating and non-participating providers. Tier 2 drugs The copay for retail pharmacies will increase from $50 to $55 for up to a 30-day supply when using participating providers. Tier 3 drugs The copay for retail pharmacies will increase from $70 to $80 for up to a 30-day supply when using participating providers. X-rays and diagnostic imaging The copay for X-ray and diagnostic imaging services will increase from $65 to $70 when using a participating provider. Imaging (CT/PET scans, MRIs) The copay for imaging services will increase from $250 to $300 when using a participating provider. Medical deductible The calendar-year medical deductible per individual/family will increase from $2,250/$4,500 to $2,500/$5,000 when using participating providers and from $4,500/$9,000 to $5,000/$10,000 when using non-participating providers. Out-of-pocket maximum The calendar-year out-of-pocket maximum per individual/family will increase from $6,250/$12,500 to $6,800/$13,600 when using participating providers and from $9,250/$18,500 to $9,800/$19,600 when using non-participating providers. 11

13 Silver 73 PPO changes Copay changes The copay for the following services will decrease from $40 to $30 when using participating providers: Primary care visits to treat an injury, illness or condition Other practitioner office visits Mental/behavioral health outpatient office visits Substance use disorder outpatient office visits Outpatient rehabilitation and habilitative services The copays for the following services will also decrease: Urgent care The copay for an urgent care visit will decrease from $80 to $30 when using participating providers. Emergency room The copay for emergency room physician fee will decrease from $50 (deductible applies) to no charge when using participating and non-participating providers. The copays for the following services will increase: Emergency room The copay for the emergency room facility fee will increase from $250 (deductible applies) to $350, and deductible does not apply (copay still waived if admitted) when using participating and non-participating providers. Tier 2 drugs The copay for retail pharmacies will increase from $45 to $50 for up to a 30-day supply when using participating providers. Tier 3 drugs The copay for retail pharmacies will increase from $70 to $75 for up to a 30-day supply when using participating providers. X-ray and diagnostic imaging The copay for X-ray and diagnostic imaging services will increase from $50 to $65 when using participating providers. Imaging (CT/PET scans, MRIs) The copay for imaging services will increase from $250 to $300 when using participating providers. Medical deductible The calendar-year medical deductible per individual/family will increase from $1,900/$3,800 to $2,200/$4,400 when using participating providers and from $3,800/$7,600 to $4,400/$8,800 when using non-participating providers. Out-of-pocket maximum The calendar-year out-of-pocket maximum per individual/family will increase from $5,450/$10,900 to $5,700/$11,400 when using participating providers and from $8,450/$16,900 to $8,700/$17,400 when using non-participating providers. 12

14 Silver 87 PPO changes Copay changes The copay for the following services will decrease from $15 to $10 when using participating providers: Primary care visits to treat an injury, illness or condition Other practitioner office visits Mental/behavioral health outpatient office visits Substance use disorder outpatient office visits Outpatient rehabilitation and habilitative services The copays for the following services will also decrease: Urgent care The copay for a network urgent care visit will decrease from $30 to $10 when using participating providers. Emergency room The copay for emergency room physician fee will decrease from $40 (deductible applies) to no charge when using participating and non-participating providers. Medical deductible The calendar-year medical deductible per individual/family will increase from $550/$1,100 to $650/$1,300 when using participating providers and from $1,100/$2,200 to $1,300/$2,600 when using non-participating providers. Out-of-pocket maximum The calendar-year out-of-pocket maximum per individual/family will increase from $2,250/$4,500 to $2,350/$4,700 when using participating providers and from $5,250/$10,500 to $5,350/$10,700 when using non-participating providers. The copay for the following will increase: Emergency room The copay for the emergency room facility fee will increase from $250 (deductible applies) to $350, and deductible does not apply (copay still waived if admitted) when using participating and non-participating providers. Silver 94 PPO changes Copay changes The copays for the following services will decrease: Urgent care The copay for an urgent care visit will decrease from $6 to $5 when using participating providers. Emergency room The copay for emergency room physician fee will decrease from $25 (deductible applies) to no charge when using participating and non-participating providers. The copay for the following will increase: Emergency room The copay for the emergency room facility fee will increase from $30 (deductible applies) to $50, and deductible does not apply (copay still waived if admitted) when using participating and non-participating providers. 13

15 Out-of-pocket maximum The calendar-year out-of-pocket maximum per individual/family will increase from $2,250/$4,500 to $2,350/$4,700 when using participating providers and from $5,250/$10,500 to $5,350/$10,700 when using non-participating providers. Silver 1850 PPO and Silver Seven 3750 PPO changes Out-of-pocket maximum The calendar-year out-of-pocket maximum per individual/family will increase from $6,500/$13,000 to $6,800/$13,600 when using participating providers and from $9,500/$19,000 to $9,800/$19,600 when using non-participating providers. Bronze 60 PPO changes Copay and coinsurance changes The copay and coinsurance for the following services will decrease: Urgent care The copay will decrease from $120 to $75 for the first three combined visits per calendar year prior to the deductible, and then from $120 to $75 after deductible when using participating providers. Emergency room The coinsurance for emergency room physician fee has changed from 100% coinsurance (deductible applies) to no charge when using participating and non-participating providers. The copays for the following services will increase from $70 to $75 for the first three combined visits per calendar year prior to the deductible, and then from $70 to $75 after the deductible when using participating providers: Primary care visits to treat an injury, illness or condition Other practitioner office visits Mental/behavioral health outpatient office visits Substance use disorder outpatient office visits The copays for the following services will also increase: Specialist visit The copay amount will increase from $90 to $105 for the first three combined visits per calendar year prior to deductible, and then from $90 to $105 after the deductible when using participating providers. Outpatient rehabilitation and habilitative services The copay will increase from $70 to $75 when using participating providers. Medical deductible The calendar-year deductible per individual/family will change from $6,000/$12,000 to $6,300/$12,600 when using participating providers and from $9,500/$19,000 to $9,800/$19,600 when using nonparticipating providers. Out-of-pocket maximum The calendar-year out-of-pocket maximum per individual/family will increase from $6,500/$13,000 to $6,800/$13,600 when using participating providers and from $9,500/$19,000 to $9,800/$19,600 when using non-participating providers. 14

16 Bronze 60 HDHP (High-Deductible Health Plan) PPO changes (Formerly Bronze 60 HSA PPO) Emergency room The coinsurance for emergency room physician fee will decrease from 40% (deductible applies) to 0%, and deductible applies when using participating and non-participating providers. Prescription benefit changes A $500 per prescription cap will be added for all prescription tiered drugs (Tier 1, Tier 2, Tier 3 and Tier 4). Integrated medical and pharmacy deductible The calendar-year integrated medical and pharmacy deductible per individual/family will increase from $4,500/$9,000 to $4,800/$9,600 when using participating providers. Out-of-pocket maximum The calendar-year out-of-pocket maximum per individual/family will increase from $6,500/$13,000 to $6,550/$13,100 when using participating providers and from $9,500/$19,000 to $9,650/$19,300 when using non-participating providers. Bronze 5550 PPO changes Copay changes The number of office visits available under first dollar coverage will change from three visits to one visit when using participating providers. The first visit will not be subject to the calendar-year deductible and can include one of the following: a primary care physician office visit, other practitioner visit or urgent care visit. Subsequent visits are subject to the calendar-year medical deductible. Out-of-pocket maximum The calendar-year out-of-pocket maximum per individual/family will increase from $6,500/$13,000 to $6,800/$13,600 when using participating providers and from $9,500/$19,000 to $9,800/$19,600 when using non-participating providers. Minimum Coverage PPO changes Integrated medical and pharmacy deductible The calendar-year integrated medical and pharmacy deductible per individual/family will increase from $6,850/$13,700 to $7,150/$14,300 when using participating providers and from $9,850/$19,700 to $10,150/$20,300 when using non-participating providers. Out-of-pocket maximum The calendar-year out-of-pocket maximum per individual/family will increase from $6,850/$13,700 to $7,150/$14,300 when using participating providers and from $9,850/$19,700 to $10,150/$20,300 when using non-participating providers. 15

17 Keeping a Minimum Coverage PPO plan If your clients are age 30 or older and previously had a Minimum Coverage PPO plan, they must take action to stay enrolled. Plans purchased through Covered California To keep your clients Minimum Coverage PPO plan, contact Covered California directly. For more information, visit Healthcare.gov. Plans purchased directly from Blue Shield Blue Shield will automatically enroll your clients in the Bronze 60 PPO plan effective January 1, To keep your clients Minimum Coverage plan, they need to be approved for an exemption due to hardship or an inability to afford coverage. They can obtain the Hardship or Affordability (SBM) exemption form. Follow the instructions on the appropriate form and mail the application to the address listed on the form. If your clients hardship is approved by the Healthcare Marketplace, they will receive an eligibility determination letter. Have them fax this eligibility determination letter to Blue Shield at (209) If you need more help, please have your client call the number on the back of their Blue Shield member ID card. Grandfathered medical plan withdrawals Effective January 1, 2017, we will withdraw 12 grandfathered plans. Plans to be withdrawn 1 Active Start Plan 25-G 7 Shield Spectrum PPO Plan 5000 Guaranteed Issue Coverage-G 2 Active Start Plan 25 Generic Rx-G 8 Shield Spectrum PPO Plan 500-G 3 Blue Shield Life PPO Plan 1500-G 9 Shield Spectrum PPO Plan 750-G 4 Blue Shield Life PPO Plan 1500 Guaranteed Issue Coverage-G 10 Shield Spectrum PPO Plan 1500-G 5 Blue Shield Life PPO Plan 2000 Guaranteed Issue Coverage-G 11 Shield Spectrum PPO Plan 1500 Guaranteed Issue Coverage-G 6 Shield Savings 4000/8000 Guaranteed Issue Coverage-G 12 Shield Spectrum PPO Plan 2000 Guaranteed Issue Coverage-G We notified affected grandfathered members in July that their plan will be withdrawn. A second letter will be sent in late September with the recommended replacement plan and new rate. The recommended plan provided has the richest available benefits with the least premium impact compared with the member s grandfathered plan. If your client agrees to transfer to the recommended plan, no further action is required on their part. They simply pay their January bill and Blue Shield will transfer them into the new plan effective January 1,

18 Specialty updates Dental plans Our Blue Shield dental PPO network has grown by 6,092 providers, giving your clients a total of 51,469 points of access to care. This is a 28% increase in network coverage from last year, making Blue Shield dental plans an excellent addition to your client s overall health and wellness. The regions that grew by more than 40% include regions 4, 7, 8, 12, 15, 18 and 19. Vision and life plans 2017 vision and life plan benefits remain unchanged and continue to be a stable product portfolio for your clients. 17

19 Reminders Open enrollment Open enrollment for 2017 begins November 1, 2016, and continues through January 31, Covered California will begin accepting and transmitting renewals in early October. Your client may select or change plans anytime before December 15, 2016, for a January 1, 2017, effective date. Starting in early October, all Blue Shield members can compare plans using our Online Renewal Tool at blueshieldca.com/renew. Off-exchange members can request a plan change through the tool. On-exchange members will have to contact Covered California. Effective dates If a new health plan is purchased by the 15th of the month and payment is made, the plan s effective date will be the first day of the month. For example, a request received on December 15 will be given a January 1, 2017 effective date. Requests received between the 16th and the last day of the month will be effective the first of the next month. For example, a request received on December 17 will be given a February 1, 2017, effective date. Alaska Native and American Indian plans On-exchange plans are available to eligible Alaskan Native and American Indians with the option to receive covered services from Alaskan Native and American Indian providers with no cost-share to the member. Covered California certification If you have been certified by Covered California in the past, you will not be required to be recertified to sell plans through Covered California for 2017 open enrollment. 18

20 Client notifications We will begin to notify your renewing clients of rate, benefit and/or plan changes in September. Additionally, clients who have grandfathered plans experiencing a withdrawal will receive their notice in late September. In our ongoing effort to protect the environment, we no longer send members paper copies of their contract and other plan documents. Your clients can access their updated plan documents at blueshieldca.com/policies. If your clients need a printed version, they can always call us at the number on their ID card and we will take care of their request. Important dates Early October Member and Broker Renewal Tools will be available. November 1 Open enrollment begins. Quote and Apply Tool is available. December 15 Application deadline for a January 1, 2017, effective date. January 31 Open enrollment ends. 19

21 Online resources We want to make selling Blue Shield plans as easy as possible and our online tools are available to help you succeed. Log in to Producer Connection to easily enroll new members, manage your current book of business, keep up to date on your commissions and much more. Online commission statements Blue Shield is pleased to announce online access to broker statements of commissions (formerly statement of accounts) via our new Broker Compensation Management Tool. Brokers are able to access our new tool from Blue Shield s Producer Connection portal. This new automated tool will enable brokers to view, download and print their statement of commissions. In addition, brokers will have access to new reports, easier-to-read statements and the convenience of 24/7 online access to their commission information anytime, anywhere. Quote & Apply Tool Our Quote & Apply Tool lets you quickly generate quotes for your clients and monitor their application status. You can create a customized URL to make it easy for your prospective clients to access on the Quote & Apply Tool on your website or in an and ensure you get credit for the sale. The Quote & Apply Tool will be available for your prospective clients beginning November 1. To learn more, visit Producer Connection at blueshieldca.com/quoteandapply. 20

22 Sales materials and forms Download and print the latest sales materials: Understanding healthcare coverage Trio ACO HMO Plans at a Glance PPO Plans at a Glance Specialty Plans at a Glance Rates Benefit summaries Legal disclosure Benefit summaries Benefit summaries are a convenient, detailed summary of our medical, dental, vision and dental + vision package plans. Use these summaries for additional benefit details that are not included in the Plans at a Glance brochure. Download the benefit summaries in English from Producer Connection (Spanish will be available by October). Understanding healthcare coverage This new brochure is ideal for your clients who are new to the healthcare market. It explains how health coverage works, the value of health coverage and why they should choose Blue Shield of California for their health coverage. Access this resource for your clients on Producer Connection by November 1. Plans at a Glance Our popular Plans at a Glance (PAAG) brochure is a valuable sales tool, providing your clients with a broad overview of our plans and a side-by-side comparison. When you need a concise summary of our plan offerings, our Plans at a Glance brochure is the sales tool for you. There will be three PAAGs this year: One for Trio ACO HMO medical plans, another for PPO medical plans, and a separate PAAG for Specialty products. All PAAGs are available for download now including translated PAAGs in Spanish, Chinese, Korean, and Vietnamese. Additionally, printed versions of the brochures will be available in English by October 1 and in Spanish by mid-october. Visit the Sales resources and collateral page on Producer Connection to download them today. IFP rate books The IFP rate books contain rates for our medical, dental, vision and individual term life insurance* plans. Two versions are available: Standard metal-level plans Alaska Native and American Indian plans 21

23 IFP and Medicare Supplement Plans Application and Underwriting Process Guide Everything you need to know about submitting new IFP and Medicare applications can be found in this guide, from effective date rules to payment information. IFP broker webinars Beginning September 13, the Blue Shield IFP Sales Team will conduct webinars on the following schedule: 9/13/2016 to 1/26/2017 IFP open enrollment period webinars presented each Tuesday, Wednesday and Thursday at 2 p.m. 2/01/2017 to 9/01/2017 IFP special enrollment period webinars presented on the first Thursday of every month at 2 p.m. You can view the most up-to-date schedule and webinar access links on Producer Connection. * Underwritten by Blue Shield of California Life & Health Insurance Company (Blue Shield Life). 22

24 blueshieldca.com/producer Blue Shield of California is an independent member of the Blue Shield Association A37988-NOPRA (1/17)