COVID-19 vaccine: here's what you need to know
We understand how important it is for your clients to have reliable information about the availability of FDA-emergency use authorized vaccines, while maintaining the fight against COVID-19. We are monitoring developments closely and will make regular updates to our COVID-19 Resources site
for brokers and employers. Cost
Blue Shield of California members can receive COVID-19 vaccinations, considered a preventive service, at no member cost share
and with no provider order
. Coverage will be provided for both in-network and out-of-network providers through the duration of the COVID-19 Public Health Emergency.
During the initial phase of vaccinations, the cost of the vaccine itself will be covered by the federal government, but the cost of the administration of the shots will be the responsibility of health plans. For fully-insured plans, Blue Shield will cover this cost. For self-funded plans, the plan will be responsible for reimbursing the cost of administration. For network providers, reimbursement will be based on the contracted rate, and for non-network providers, plans are required to reimburse a “reasonable” rate. According to Center for Medicare & Medicaid Services (CMS)
, the Medicare reimbursement rate will be considered reasonable. That rate will be $16.94 for the first dose and $28.39 for the second dose, when applicable. Distribution and Timing
Safety is still the most effective way to fight COVID-19
- The first doses of the vaccine have started to arrive in California.
- According to the CDC, people working in direct health care or in long-term care settings will receive first priority. Those with high-risk medical conditions will receive second priority. The CDC will provide directions for distribution. However, states are expected to play a big role in the distribution strategy.
- Health plans must provide coverage for a qualifying coronavirus preventive service no later than 15 business days after the date that the Advisory Committee on Immunization Practices (ACIP) or the US Preventive Services Task Force (USPSTF) makes an applicable recommendation. Coverage is not dependent on type of FDA approval or authorization. Grandfathered (pre-ACA) plans may be exempt from this requirement, and plan sponsors should refer to their health plan documents.
The availability of a safe and effective vaccine is just the first step in bringing the pandemic to an end. Distributing a vaccine to 40 million Californians will take tremendous coordination from state and local governments, with the help of health plans like Blue Shield of California. Member communications
Communications with similar essential information will be sent to employers and members as well, beginning December 17, and timely information will be posted on www.blueshieldca.com
Teladoc visits are here to stay
We are excited to announce that Teladoc virtual appointments will continue to be offered at no cost to members as part of their health plan coverage, with some variance by market segment.
- All fully-insured group health plans and IFP
- $0 copay for both Teladoc general medicine and Teladoc mental health visits
- Applies to all groups, regardless of renewal or effective date
- $0 copay includes HDHP, effective 1/1/21
Please note: while the benefit will be available at no cost beginning January 1, 2021, members’ ID cards will only be updated to reflect the $0 copay upon renewal. (Example: a member in a group that renewed July 1, 2020, may have an ID card that shows a $5 copay for Teladoc, but will not be charged a copay in 2021. Once the member renews in July 2021, they will be issued a new ID card reflecting the $0 copay.)
Specialty benefits: trusted, total care with integrated administration
Patrice Bergman, VP and General Manager for Specialty Benefits, shares how Blue Shield of California is supporting our members well beyond just their health plan.
- Add Specialty benefits with lower premiums and integrated administration
With our Bundled Savings program, dental plan and vision plan rates are 10% lower when offered alongside Blue Shield small business medical coverage.
Along with lower premiums, employer and employee benefits from combined plan offerings with integrated billing and administration with Blue Shield.
- Locating closed plan rates for specialty on Broker Connection
Rate plans and information can be found on Broker Connection’s Small Business homepage, towards the bottom of the page. The Rate link will take you to the rate table homepage and the 2021 Rate Book (login required).
myStrength: New digital behavioral health tool empowers members to take control of their health and wellness
In an ongoing effort to provide our members with access to high quality care, beginning January 2021, Blue Shield of California will offer a new digital behavioral health tool, myStrength, to fully-insured Trio and Tandem members
, upon new enrollment or renewal. myStrength digital behavioral health tool added to our suite of resources
myStrength is a self-service, digital tool that enables members, ages 13 and over, to manage their behavioral health needs in the comfort of their homes 24/7/365. This tool provides access to proven programs and techniques to help manage stress, sleep disorders, anxiety, depression and more.
myStrength will be an addition to our existing suite of behavioral health resources, with program availability depending on plan type. To explore these resources, our Healthy Living homepage
is a great place to start. Plan permitting, Blue Shield of California members are encouraged to access and use our wellness platform Wellvolution
for personalized health recommendations and routines.
Members may also have access to mental and behavioral health specialists through our mental health service administrator (MHSA), Magellan, and should contact customer care to confirm plan benefits.
Starting January 1, 2021, new and renewing fully-insured Trio and Tandem members will be directed to myStrength from blueshieldca.com/mystrength
. Member facing Trio and Tandem microsites and the Trio broker/employer site now include information on this new capability. Members can also access myStrength using the Blue Shield mobile app.
Reminder: ID cards are going paperless, and with a new Rx benefits manager
This is a reminder that, beginning October 2020, members who had previously opted into electronic delivery of communications stopped receiving printed ID cards. These members were directed to access a digital ID card at blueshieldca.com
. We are honoring the member’s preference to go digital by expanding digital communications preference to include ID cards. Key Takeaways
Members will receive new ID cards as a result of Blue Shield's transition to a new Pharmacy Vendor, CVS Health
- If a member has selected an electronic delivery preference, then they can access their updated digital ID card by logging into their member portal at blueshieldca.com or in the Blue Shield of California mobile app.
- Members with digital communications preferences will receive an email notification that will include a direct link to their updated ID Card when it is available.
- Everyone else will receive printed ID cards. The printed ID cards started going out at the end of November and will arrive by January 1, 2021, in the mail.
- The card will be accompanied by an insert with information on why the member is receiving a new card.
- Members will also be provided instruction to continue to use their existing card until December 31, 2020, and to present their new ID card to their pharmacy beginning January 1, 2021.
Also impacting the member ID card experience, is our transition to CVS Health as our new pharmacy claims processing vendor, effective January 1, 2021. This change does not impact benefits, formulary, or the pharmacy network
. We expect a seamless transition to the new claims processing platform with minimal member disruption.
To enable claims processing by CVS Health, ID card information will need to be updated to allow pharmacies to submit claims to CVS Health. As a result of this vendor change, all members will receive new ID cards so they can begin to use their new ID card on January 1, 2021.
Amazon Pharmacy launch and reminder of early prescription refill policy
Amazon Pharmacy announced operations as a home delivery pharmacy for both its Prime subscription members and non-Prime members, building upon its existing platform to offer a digital interface for prescription ordering and a customer profile. Fulfillment of prescriptions are through the PillPack pharmacies which are already contracted with Blue Shield. Prescriptions fulfilled through Amazon only include up to a 30-day supply at one time
with no 90-day supplies available. Delivery of prescriptions varies from 2 days up to 5 days depending on customer selection. Note, members can only order prescriptions for themselves and not for their dependents, children, or those who they may serve as caregivers at this time. Amazon Pharmacy is also not servicing individuals under the age of 18 at this time.
To meet member needs and promote social distancing, Blue Shield’s mail order pharmacy, CVS Caremark, allows members to receive up to a 90-day supply prescription delivered at no additional cost
. Additionally, many retail pharmacies are waiving fees for home delivery. These Blue Shield network retail chains pharmacies are offering free home delivery: CVS Pharmacy, Walgreens Pharmacy, and Albertson’s companies (Safeway/Vons/Osco/Sav-on pharmacies).
Tips and Tools for Trusted Advisors
Being a subject matter expert for your clients is fundamental to your work. Here are some additional reminders and updates to ensure you are always in the know. Vantage Medical Group added to Trio HMO network
We are happy to share that, effective January 1, 2021, Vantage Medical Group will join our growing network of Trio ACO providers serving the Inland Empire. This applies to all lines of business that offer Trio HMO
Vantage Medical Group, which recently joined the Prospect Medical Group family of independent practices, is located in both Riverside and San Bernardino counties. The addition of Vantage adds 99 additional physicians in the Inland Empire.
Our benefit plans based on the Trio HMO network, are our fastest growing products as they focus on delivering choice, coordinated care, and affordability. In addition to our growing network, Trio HMO members have access to the following benefits:
- $0 Teladoc® visits
- $0 cost share for first HealTM on-demand visit, with $0 prescription delivery
- No cost Healthy Savings® grocery discount program
- Shield Concierge
Please contact your sales and account management executives if you have any questions. Relaxed participation requirements for small busines extended to January 31, 2021
We’re are extending our relaxed underwriting participation requirements for groups with five or more enrolled employees to just 25% for our medical, dental, vision*, and life* insurance plans. Relaxed participation requirements allow for groups to enroll with as few as one member when enrolling in a Tandem PPO or Trio HMO plan. Rules and requirements apply, see our flyer on Broker Connection
for more information.
* Underwritten by Blue Shield of California Life & Health Insurance Company. Special Enrollment Period extended to December 31
New small groups requesting a January 1, 2021, effective date are eligible for coverage without meeting the minimum participation and contribution requirements during a special enrollment period* (SEP). We're extending this SEP from the standard November 15 through December 15 dates, and will accept submissions through December 31.
Groups enrolling during the special enrollment period must meet all other small group eligibility requirements.
* Note: Special Enrollment Period is an annual occurrence and not correlated with any COVID-19 related extensions. Reminder! Earn more with Broker Bonus Calculator and Employer Enrollment Tool
You can now earn $50 per new member, and $50 more for each member
– new or renewing – who enrolls in a Trio HMO or Tandem PPO plan. Check out the revamped calculator here
. You can also earn $25 per member
when you enroll using our new Employer Enrollment Tool.
Earlier this year we introduced our Employer Enrollment Tool
to streamline the new group enrollment process. With over half of new business submissions completed with straight through automation – meaning hit “submit” and be done – it’s no wonder there is growing confidence from our brokers in the new process. To learn more, visit our resource page, here
. Blue Shield ranked in top four best health insurance firms in the country
In a national customer satisfaction survey conducted by Insure.com, Blue Shield of California was the highest rated for claims service and ranked second for overall satisfaction. Customers were asked to rate customer service, cost, claims service, and website and/or apps. Blue Shield of California’s top-ranking for claims processing was attributed to our payer billing process and payment options as stand-outs. Reminder: avoid pends for renewing groups with "select all plans"
If a group currently offers all small business plans and wants to continue doing so for the next policy year, be sure to elect the "Select all" button in the online renewal tool, which can be found right under the list of medical plans on the Custom Quote screen. All Plans option does not automatically renew. It must be selected each policy year. Coordination of Benefits (COB) will be automated
On November 5, 2020, Blue Shield of California in collaboration with the Council for Affordable Quality Healthcare (CAQH), implemented an automated Coordination of Benefits (COB) solution to streamline the claims process for eligible members who also have coverage with another insurance company. Previously, this process was done manually and included outreach to members.
There is no action for members to take with this new automated solution. If a member has questions regarding their coordination of benefits, they should contact member services. This change does not pertain to dental, vision, or pharmacy plans. Your Blue Shield Support Team
Our dedicated sales, account management, and Producer Services teams are available to support you throughout the year. Producer Services: (800) 559-5905