March 2021

A Time to Lead: A timeline of Blue Shield of California standing for what’s right during the pandemic

Over a year into the greatest public health crisis in a century, we can look back on the journey from initial state of emergency, through a challenging summer and fall, and entering a new year with several approved vaccines and renewed hope.

During the hardest months of COVID-19, Blue Shield of California relied on our values of being human, honest, and courageous to best serve our members, employees, and the communities we serve.

Now, with the end of the pandemic in sight, we’ve created an interactive, web-based timeline reflecting on how Blue Shield of California navigated the pandemic by leading with our values and mission.

March 2021

Get to know our Statewide Vaccine Delivery Network

California is shifting from a COVID-19 vaccination system in which local health jurisdictions allocate vaccines within their communities to a Statewide Vaccine Delivery Network administered by Blue Shield of California. The goal is to accelerate the delivery of vaccines safely and equitably across the state. The COVID-19 pandemic has not only highlighted the disproportionate impact of this virus on Californians, but the importance of addressing the health of those disproportionately impacted, including communities of color and the disabled. Consequently, a vaccine equity framework has been proposed by the state and supported by Blue Shield of California as part of vaccine distribution.
  • Establishing Equity FAQs
We encourage all Californians to register on My Turn. The digital tool will centralize management, reporting, and data that will empower the state to provide accurate information to book appointments and distribute vaccines to all Californians as quickly as possible. Last week, Blue Shield shared progress on the statewide vaccine delivery network, with more than 12,000 providers included. Read this story, find the list of providers, and see related content on our Blue Shield News Center.

March 2021

California enters next vaccination phase

California is entering the next phase of vaccinations, extending eligibility to individuals age 16-64 who are deemed to be at the very highest risk for morbidity and mortality from COVID-19 as a direct result of one or more severe health conditions [see list of conditions].

Beginning this week, Blue Shield will send emails and letters to members with qualifying health conditions, based on claims history. Providers will also be conducting outreach. Members may consult with their physician if they believe they are eligible to be vaccinated in this phase. While vaccine administrators other than providers (e.g. public health departments) should only require individuals to attest that they meet eligibility guidelines, the letter may serve as confirmation of their eligibility.

The California Department of Public Health (CDPH) also updated prioritization guidelines on March 11 to include individuals who reside or work in congregate settings, and those would work in public transit.

Individuals eligible for the vaccine in this latest phase should register and book an appointment through My Turn, as should eligible populations in phases 1A and 1B who have not already received the vaccine. This digital tool will centralize management, reporting, and data that will empower the state to provide accurate information to book appointments and distribute vaccines to all Californians as quickly as possible.

My Turn FAQs

The phased approach for vaccination eligibility does present additional complexity for employers’ return to workplace planning. Our B2B COVID-19 site has resources that may assist in planning, including articles addressing vaccination policies and vaccine hesitancy.

We recognize that the vaccination process may cause anxiety for many reasons. We’re getting closer to the end of this pandemic, but we are not there yet. As we move through the phases together, we encourage you to maintain safety protocols: wear a mask, maintain distance, and wash your hands often.

Finally, for those who may be hesitant, Blue Shield encourages you to get the shot.
March 2021

Updated COVID-19 testing under new federal guidance

After much anticipation for additional clarity on COVID-19 testing, the Biden Administration announced updates to the existing Federal Testing Mandates under the FFCRA/CARES Act late February this year.

The guidance loosens testing criteria to allow for more expansive COVID-19 diagnostic testing for all members with no cost-share. Previously, providers were required to individually evaluate patients to determine whether COVID-19 diagnostic testing is “medically appropriate” for testing to be covered with $0 member cost-share. This included testing for those who were symptomatic, had an upcoming medical procedure, or had known or suspected exposure.

Members can now get tested with $0 cost-share as long as a licensed or authorized provider is involved in providing or ordering the COVID-19 test. Coverage of testing is not limited to patients with symptoms or exposure. This includes tests conducted at pharmacies and state and local government testing sites. Tests ordered by telemedicine providers will also be covered at $0 cost-share, however it is important to note that Teladoc providers are unable to order COVID-19 tests at this time.

The federal guidance reaffirms that plans are not required to cover testing for public health surveillance or employment (return to work) purposes.

All changes are effective February 26, 2021, and any claims received will be retroactively processed in accordance with the federal mandate.

Please see the updated federal testing guidance for more details.
March 2021

Evolving dental trends during COVID-19

After a year of living with the virus there are clear trends that are emerging in dental care and we’re here to help navigate the shifting dental environment.

Trends in Care
  • COVID-19 may have permanent effects on dentistry from how dental procedures are performed to access to care. The pandemic has raised the awareness of office disinfection in dental offices; while disinfection was always routinely performed, more care is being taken to limit cross contamination from patient to doctor and vice versa. There is greater awareness of disinfecting dental chairs, dental instruments, and increased use of single-use disposable barriers in dental operatories.
  • Certain dental procedures that generate an aerosol have been curtailed, or temporarily or permanently eliminated to prevent the spread of the virus and replaced with other, alternative methods of treatment that may be here to stay.
  • Root canal therapy is expected to decline as implants become “mainstream” and the cost of implants decline relative to salvaging a broken tooth.
Teledentistry
  • While the types of services available through virtual visits is and always will be limited teledentistry may have found a “niche” market among orthodontists along with triaging dental emergencies and conducting follow-up appointments for observation.
Provider Trends
  • Last year the American Dental Association projected 1-3% of dental offices to close due to the pandemic, however, it looks like that is closer to 1% now which is nearly the normal rate of retirement, merger, and other closures.
  • Many recent dental graduates will probably choose not to open a private office, electing instead to work for large dental service corporations for a steady paycheck and benefits.
  • With SmileDirectClub prevailing before the California Dental Board to provide orthodontic services without dentist supervision, there may be a slow but steady decline in the number of dentists seeking to enter the specialty of orthodontics.
  • Dentistry is rebounding and offices are running more efficiently with less pre-COVID-19 overhead, such as labor costs. Struggling practices before COVID-19 are struggling the most, but well managed offices prior to the pandemic are actually doing better due to more care per visit, more elective care during same visits, lower labor overhead costs, and addressing the back-log of needed care.
How Blue Shield addresses the changing trends:
  • In an effort to ensure the safety of our members, Blue Shield temporarily reimbursed dentists for additional personal protective equipment during the first few months of the pandemic.
  • Several teledentistry codes are reimbursable under Blue Shield’s dental plans for those that are more comfortable accessing care virtually during this time.
  • Effective October 2020, Blue Shield dental PPO members have access to SmileDirectClub that provides a convenient alternative to traditional in-office orthodontic care from the convenience of one’s home.
    • How the program works:
      • Employees can get free impressions by visiting one of more than 235 SmileShops for a 3D scan at no cost or order an at-home impression online (no cost with rebate)
      • A licensed dentist or orthodontist will work to create a personalized smile plan
      • Once your new smile is complete you will get your first retainer at no cost with subscription
    • With SmileDirectClub coverage employees will enjoy the following:
      • Average treatment plan 6 months or less
      • Clear aligners for up to 60% less than braces
      • Free premier teeth whitening
      • Free first set of retainers with subscription
      • No monthly office visits
More information can be found at https://smiledirectclub.com/insurance/bsca/

March 2021

Direct Elite Rewards broker bonus program continues in 2021

Our Direct Elite Rewards program will continue to benefit direct-selling small business brokers in 2021, with elevated bonuses for new Blue Shield of California small business medical member sales. The rewards program is available to all small business brokers who sell direct.

Direct Elite Rewards offers $75 to $100 per member for new small business membership that comes direct to Blue Shield with effective dates from February 1, 2021, through January 31, 2022.*
  • $100 per member if 75% to 100% of new business comes direct
  • $75 per member if 50% to 74% of new business comes direct
Be on the lookout for more broker bonus updates next month, with updates to our medical and specialty incentive programs, as we continue to reward Blue Shield producers for the work they do.

Learn more about Blue Shield commissions and rewards on Broker Connection (login required).

* Membership calculation is for medical plans only and for new groups sold between February 1, 2021, and January 31, 2022. Calculations will include all new business from an agency using the same tax ID number and is not based on individual producers

March 2021

SB 855: Mental health is more relevant now than ever

California Senate Bill (SB) 855 updates and expands the California Mental Health Parity Act of 1999 and requires health plans and insurers to provide treatment for all mental health and substance use disorder conditions under the same terms and conditions that are applied when treating medical conditions that are medically necessary.

SB 855 applies to health plans and policies, including grandfathered plans, issued, delivered, amended, or renewed on or after January 1, 2021.

The bill defines “medically necessary treatment of a mental health or substance use disorder” as “a service or product addressing the specific needs of that patient, for the purpose of preventing, diagnosing, or treating an illness, injury, condition, or its symptoms, including minimizing the progression of that illness, injury, condition, or its symptoms,” and defines “mental health and substance use disorders” as those conditions listed in the most recent edition of the World Health Organization’s International Classification of Diseases or in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.

SB 855 further requires that plans utilize utilization management guidelines and criteria developed by nonprofit professional associations, when available, and that clinical staff is trained in the application of these guidelines and criteria. Training will also be available to providers and enrollees.

SB 855 does not apply to Medicare Advantage, Med-Supp, Medi-Cal, Cal Medi-Connect (CMC), Stand-Alone Dental or Vision, and Self-funded, ASO and Shared Advantage.

Please see California Mental Health Parity for additional information.

March 2021

Get to know your Blue Shield support team

While many of you may know your Blue Shield small business account executive as your go-to resource for all things Blue Shield, we want you to know your Producer Services team as well. Producer Services has a new lineup of small business experts dedicated to making it faster and easier to manage your business.

Our Producer Services team has increased their service level performance and is prepared to be a key resource for your work with Blue Shield. This team can now do more to help ensure that your client's needs are being addressed. Our dedicated sales, account management, and Producer Services teams are available to support you throughout the year – in that spirit we’ve updated our service model for brokers to better meet your needs.

Not only do you have a high performing Producer Services team to provide assistance, but you also have 24/7 access to self-service through Broker Connection. You can read our full Producer Services announcement here, and don’t hesitate to reach out with any questions.

Producer Services: (800) 559-5905

March 2021

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 in the know.
  • Blue Shield COVID-19 resources
    Stay informed of Blue Shield COVID-19 response with vaccine and testing resources, return to work planning, and more at our dedicated B2B COVID-19 page.
  • Plan Comparison Tool | Network Comparison Tool
    We’ve recently updated our tools to allow users to quickly filter networks to view just what matters to them: county, physician networks, and more. This tool allows you to quickly select from our portfolio medical, dental, or vision plans and compare key benefits side by side. These high-level comparisons are easy to share with clients before diving into more comprehensive plan documents (SBC, EOC, etc.).
  • Small business plan documents
    Summary of Benefits (SOB), Summary of Benefits and Coverage (SBC), and Evidence of Coverage (EOC) documents for medical plans, pharmacy plans, dental plans, and life insurance plans are available in one location.
  • Blue Shield News Center
    Stay informed of Blue Shield’s latest news, including press releases, leadership, health reform, innovation, and community engagement. Subscribe to receive updates here.