Blue Shield's mission is to provide access to quality health coverage that is sustainably affordable. Today, that mission is more important than ever. To help ensure access to health coverage in light of the coronavirus (COVID-19) outbreak, Blue Shield is changing some eligibility requirements and enrollment processes for you. March 2020
Special Enrollment Period for individuals who previously declined coverage
To help ensure access to health coverage, Blue Shield is providing a Special Enrollment Period (SEP) through June 30, 2020 for employees who previously declined coverage for themselves or their dependents. This applies to all fully insured small group (1-100) and large group (101+) employers.
Self-funded plan sponsors typically determine eligibility of group coverage, which is described in your Plan Document.
SEP enrollees’ coverage will be effective:
- For an April 1, 2020 effective date, enrollment requests must be received no later than April 15
- For May 1, June 1 and July 1 effective dates, enrollment requests must be received on or before the first of the month being requested
Please indicate your preferred effective date on the enrollment form.
Dependents enrolling during SEP must enroll in the same plan as the subscriber. Standard waiting periods are waived for this SEP, but other existing eligibility guidelines apply.
- Small group (1-100): Enrollment must be submitted on the paper enrollment or Subscriber Change Request (SCR) form, with the “Other qualifying event (specify)” box checked and indicating “COVID” as the Qualifying Event. No additional documentation is required.
- Large groups (101+): SEP enrollments should be made through the group’s standard EDI (834) process. Groups who do not have EDI should contact their Blue Shield account team. Contact your account team if you have an immediate need to enroll your employees. We are in the process of reviewing retroactivity for April 1 enrollment dates.
A special enrollment period is also in effect through June 30, 2020 for IFP members, both through Covered California and off-exchange.
Changing circumstances may mean changing coverage levels
COVID-19 has created challenging circumstances for businesses. In light of that, Blue Shield is making changes to our policies geared toward helping you maintain your health plan and continue to cover your employees. Plan changes, at the group and member levels, are generally allowable only during your renewal period for the next contract year. In response to COVID-19, we will allow a one-time buy-down plan change off-cycle for employers and employees to adjust their health plan selection to meet their current needs. Plan election changes, for both groups and members, can be made through June 30, 2020 with July 1, 2020 as the latest effective date.
This applies to all fully insured small group (1-100) and large group (101+) employers.
Large group employers (101+ employees) who cannot afford contributions due to loss of income should contact their Blue Shield account team to discuss buying down to a more affordable plan design.
For quick comparison and clear understanding of possible premium reductions, small group renewals include a plan options census. The census features a buy-down option from your current plan(s), as well as Trio HMO and Tandem PPO plan options comparable to your current selections. This census shows rates by individual and at the group level.
As a reminder, specialty benefits – dental plans, vision plans, and life insurance – may be added at any time.
Keeping employees covered through layoffs, furloughs, or reduction in work hours
Fully insured groups
Employers across the country are managing difficult decisions to keep their employees safe and businesses open. Maintaining health coverage through layoffs, furloughs, or reduction in work hours can be challenging and we will continue to provide coverage through June 30, 2020 as long as premiums are received. Coverage must be offered on a consistent, non-discriminatory basis to all employees, and employee premium contributions must be the same or less as prior to the layoffs, furloughs or reduction of hours.
Plan sponsors typically determine eligibility and continuation of group coverage, which should be described in your Plan Document. If the Plan Document does not detail furlough or reduction-in-force situations, the Plan Sponsor would have to make a determination of how to proceed with employees in these situations. For example, employees (and their dependents) who lose eligibility for coverage due to a furlough or reduction in force may be eligible to elect continuation coverage under COBRA or Cal-COBRA.
Assuming the Plan Sponsor continues to pay administrative fees, claims, and stop-loss premiums (if applicable) for the workforce that is laid off and not actively at work in the same manner as prior to the COVID-19 crisis, there would be no change in coverage. For groups that have stop-loss coverage outside of Blue Shield, please confirm these eligibility requirements with your stop-loss carrier.
Options for continuing coverage for laid-off employees – Fully insured or Self-funded
- Employees can remain on a group plan to keep them covered in the same manner as prior to COVID-19 if premium payments continue for laid-off employees.
- Employees can elect COBRA or Cal-COBRA, if eligible, and will be liable to pay the full cost of coverage (unless their employer chooses to subsidize COBRA premiums).
- Employees can enroll in the individual marketplace. Employees may benefit from government subsidies to help pay premiums. Information about Blue Shield individual health plan options can be found here.
Stay up to date
Blue Shield is closely monitoring the trajectory of COVID-19, including state and federal policy. We will continue to keep you informed of policy changes affecting you and your employees.
More information is available on our Employer Connection resource page for COVID-19
– which is updated daily. You can also see the latest updates from Blue Shield on our News Center
or have them emailed to you by subscribing here
. Coming up
Wednesday April 1 at 4:00 p.m. PST: Facebook Live Q&A on COVID-19 with Terry Gilliland, MD
Dr. Gilliland will go live to answer questions and share what we’re doing for our members, our employees and our communities to help them stay healthy, get the care they need and slow the spread of this pandemic.
Join the discussion, submit questions, or add it to your calendar, here