Small business (2 to 50) updates
Small group update
A summary of cycle changes effective January 1, 2009
Welcome to your guide to what’s new and changing for the January 2009 small group cycle. Inside
you’ll find rate information, product updates, news announcements, and more. Here’s what you
need to retain your Blue Shield business and show your clients that Blue Shield is still the right choice
for providing their employees with access to quality health coverage.
We’re here to stay
Highlights of key updates Effective January 1, 2009
Blue Shield of California has remained the company
you and your clients can always count on. For nearly News and announcements
70 years, we’ve earned your trust by offering you and
your clients: No benefit changes1
• Quality health plans NEW PLAN! Shield Spectrum PPO Plan 2000 Value2,3
• Friendly service and helpful resources medical plan can be sold as a standalone or as
• More advanced programs and services part of our Suite Deal, PlanSelect, and Dual Choice
multiple plan packages.
• Company stability
Suite Deal – Two newly added plans
Plus, Blue Shield of California Life & Health Insurance • Shield Spectrum PPO Plan 2000 Value
Company has continued to serve your clients for nearly • Shield Spectrum PPO Plan 500 Standard2
50 years. Together, we’re committed to providing your
small group clients with affordable quality health January 2009 rates updates
coverage, and we are here to stay.
0% quarterly increase on our two fastest-growing
Small Group HSA-eligible high deductible health plans*
Our quality matters – Blue Shield gets
“Excellent” accreditation the second On average: HMO less than 2%†
year in a row On average: PPO less than 3%†
We pride ourselves on a reputation for maintaining an
excellent accreditation from the National Committee Easier underwriting guidelines for the
for Quality Assurance (NCQA). Once again, NCQA Shield Spectrum PPO Savings Plan 4800 2
awarded us its highest rating of “Excellent” for both
Commercial HMO/POS and Medicare Advantage
Specialty benefit updates
products. An “Excellent” accreditation from NCQA
is only awarded to plans that meet or exceed NCQA’s
Ancillary is now Specialty Benefits
rigorous requirements for consumer protection
and quality improvement, and have results in the Expanded dental network
highest range of national performance. NCQA is an
independent, non-profit organization that assesses NEW! Vision plan information card improves experience
the quality of the nation’s managed care plans.
1 For more details on benefit changes, refer to the Plan Modifications in your renewal packet.
2 Underwritten by Blue Shield of California Life & Health Insurance Company.
3 Pending regulatory review.
† Note: January 2009 rate actions are average changes for new business. Renewal changes are based upon cumulative rate actions that have occurred
during the contract period. Percentages are averages only. The percentage for a specific group may vary. Rate actions quoted are based on rates for
January 2009. Average PPO rates exclude HSA-eligible plans.
* Shield Spectrum PPO Savings Plan 1800/3600 and Shield Spectrum PPO Savings Plan 3000/6000 are underwritten by Blue Shield Life & Health Insurance
Company. PPO Savings Plan 1800/3600 is pending regulatory review.
For complete details on our products and services, please refer to the Producer Information Booklet for Small Business, A10864 or visit Producer Connection
2 Small business updates January 2009
What’s not changing?
Medical coverage updates
To make retention easier, we’re pleased to announce that there are no benefit changes
to our medical plans, including:
No changes to:
• Annual deductibles
• Out-of-pocket maximums
Though there are no benefit changes to any of our plans for January 2009, we’ve made
clarifications to benefit descriptions, which can be found in your clients’ Plan Modifications.
New plan announced
With an expanded range of flexible and affordable offerings, we’re making it even easier
for you to meet each of your client’s needs with the right plan. We’ve now extended the
PPO Value plan family to include the newest plan, the Shield Spectrum PPO Plan 2000 Value.*
Generic only drug coverage is one of the reasons why this plan is now the lowest-cost plan
we offer in the small group market. In today’s economic climate, this plan is ideal for your
cost-conscious clients, and your business retention efforts. And we didn’t stop there.
Our Suite Deal medical plan package is bigger and better with more flexible choices
through two newly added plans. Then we created easier underwriting guidelines, so more
of your groups can qualify for coverage with the Suite Deal package.
Those are among the many things we’re doing to help keep your business healthy and growing.
Blue Shield is the healthy choice for you and your clients.
* Underwritten by Blue Shield of California Life & Health Insurance Company, pending regulatory approval.
Small business updates January 2009 3
Retain more business with Shield Spectrum PPO Plan 2000 Value*
Provide quality and value to your clients with Shield Spectrum PPO Plan 2000 Value, the lowest-cost PPO
plan offered by Blue Shield Life in the small group market, with rates starting as low as $39.†
Shield Spectrum PPO Plan 2000 Value benefits highlights1
In-network benefits listed
Calendar-year deductible $2,000 individual (all providers combined)
Office visit $40/visit – first two visits/year (Not subject to the calendar-year plan deductible)
Subsequent visits – member pays 100% until the calendar-year copayment
maximum is met. Once the calendar-year copayment maximum is met,
Blue Shield pays 100%.
Coinsurance 65% in network/50% out of network
Lifetime benefit maximum $6,000,000
Copayment maximum $5,000 per member
Formulary brand-name drugs Formulary brand-name drug not covered
Non-formulary brand-name drugs Non-formulary brand-name drug not covered
* Underwritten by Blue Shield of California Life & Health Insurance Company (Blue Shield Life), pending regulatory approval.
† Using January 2009 rates at a 50% contribution level for the Shield Spectrum PPO Plan 2000 Value at a 0.9 RAF in Region 1 within the 0.29 age band.
Rates are subject to change.
1 This document is only a summary for informational purposes. It is not a contract. Please refer to the Certificate of Insurance and the group policy
for the exact terms and conditions of coverage. Please also refer to the Benefit Summary Guide, A16609 for a comprehensive listing of plan details,
exclusions, and limitations. Benefits are subject to modification by Blue Shield for subsequently enacted state or federal legislation.
4 Small business updates January 2009
Suite Deal medical package builds on its “sweet” success
How can we make an excellent medical plan
package even better? By adding two more plans. Our Suite Deal plans include:
That’s right – Suite Deal has become even more
flexible! You can offer your small group clients
a wider range of options, such as the new Shield Access+ HMO® Plan 20 Value
Spectrum PPO Plan 2000 Value†,* – a lower-cost
option with leaner benefits, or the Shield Spectrum
Access+ HMO Plan 30
PPO Plan 500 Standard† – a richer benefit plan.
With these two newly added options to Suite Deal,
our flexible plan portfolio goes further to meet Shield Spectrum PPOSM Plan 500 Value†
your clients’ needs.
And, if you haven’t offered Suite Deal to your clients Shield Spectrum PPO Plan 1000 Value†,*
yet, cycle renewal is a great time to start. The Suite
Deal medical package includes nine competitively
priced plans from three categories: two HMO Shield Spectrum PPO Plan 1500 Value†,*
plans, five PPO plans, and two HSA-eligible PPO
plans. Clients choosing the Suite Deal medical NEWLY ADDED!
package offer all plans within the package, Shield Spectrum PPO Plan 2000 Value†,*
giving their employees many attractive choices.
Plus, enrollment in all plans is not required. NEWLY ADDED!
Shield Spectrum PPO 500 Standard†
On the next two pages, you can find more informa-
tion on the following key reasons to sell Suite Deal:
Shield Spectrum PPO Savings Plan 1800/3600†,*,#
• articipation is lowered – only 65% participa-
Shield Spectrum PPO Savings Plan 3000/6000†,#
• We offer two RAF programs specific to Suite Deal
• You earn double MVP points
† Underwritten by Blue Shield of California Life & Health Insurance Company.
* Shield Spectrum PPO Plan 1000 Value, PPO Plan 1500 Value, PPO Plan 2000 Value, and Shield Spectrum PPO Savings Plan 1800/3600 are pending
# HSA-eligible high-deductible health plans.
Small business updates January 2009 5
1. Participation requirement for the Suite Deal medical package is 65%. This lower participation
requirement is only available for groups that enroll under the Suite Deal program. If offered with
another carrier’s HMO, the minimum participation in the combined Blue Shield plans must be equal
to the greater of five actively enrolled employees or 50% of the total number of actively enrolled
employees. To determine participation requirements, see the chart below.
Participation requirements for the Suite Deal medical package
The reduced participation requirement for Suite Deal is 65% with a minimum of 2 enrolling employees.
To determine if your group qualifies: ExAMPLE
1. Add the total number of full-time employees including owners. 16
2. Subtract all waivers for other group coverage (including Medicare/Medi-Cal/military). -4
The resulting number is the total number of eligible employees. 12
3. If at least 65% of the eligible employees enroll with Blue Shield, your group has met this
At least 8
requirement. (Example: 12 employees x .65 = 7.8)
When offering the Suite Deal medical package with another carrier’s HMO
Follow steps 1 and 2 from the participation requirements above to confirm at least 65% of ExAMPLE
eligible employees are enrolling in coverage from either carrier under this employer AND
the minimum participation in the combined Blue Shield plans must be equal to the greater of At least 8
five actively enrolled employees or 50% of the total number of actively enrolled employees.
(Example: 8 employees x .50 = 4, minimum Blue Shield enrollment must be at least 5) 50% of total enrolling employees
with a minimum of at least 5
5 employees required
to enroll with Blue Shield
Contribution options for the Suite Deal medical package:
The employer must contribute either:
1. A defined contribution of a minimum $100 per employee (or the cost of the total employee rates,
whichever is less), or
2. A minimum of 50% of the total employee rates
6 Small business updates January 2009
2. Two RAF programs are available for a limited time to clients who choose the Suite Deal package,
making it “sweeter” and more affordable for groups who qualify.
Suite Deal RAF program – for qualifying groups, we guarantee:
• 90 RAF guarantee for groups of 10 or more enrolling employees
• 0-point RAF reduction for groups of 6 to 9 enrolling employees1
• pplies to groups within nine months of their most recent renewal*
Suite Deal RAF for groups with no prior coverage:
• 90 RAF guarantee for groups of 10 or more enrolling employees
• .0 RAF guarantee for groups of 6 to 9 enrolling employees**
• No health statement required
Groups with no prior coverage is defined as a group in business for one year or more with no prior
group coverage for at least 12 months, or a group in business for less than a year that meets the
Blue Shield interpretation of AB1672 and has no prior group coverage.
3. Get double MVP points when you sell either the Suite Deal medical or Suite Deal Dental package.
For more information on Suite Deal, go to blueshieldca.com/producers or contact your Blue Shield
1 The lowest RAF available is .90. For example, if a group has a renewing RAF of .95, it will receive only a .90 RAF from Blue Shield.
* This program extends the eligibility of the renewal RAF letter from the prior carrier from 60 days to nine months. A valid renewal
letter from the prior carrier dated within nine months is required to qualify for the Suite Deal RAF program. This RAF promotion
is only available for new groups that select the Suite Deal package.
** Groups may apply for a lower RAF via standard underwriting guidelines and the submission of a health questionnaire.
Small business updates January 2009 7
Suite Deal Dental
To complement the affordability and flexibility of our
Suite Deal medical plan package, the Suite Deal Dental The Suite Deal Dental package includes:
plan package offers your clients the same benefit designs.
Don’t forget to offer your clients Suite Deal Dental with Dental PPO SmileSM Basic
their Suite Deal medical plan package. When purchased
together, your groups can enjoy the added convenience Dental PPO Smile Value
and support of one-source account management.
Suite Deal Dental is a package of five dental plans from Dental PPO Smile Deluxe Plus 2000
two different categories: HMO and PPO plans. Like the
Suite Deal medical package, the participation requirement Blue Shield Dental HMO Basic Plan
is lowered to 65% of eligible employees. Employees can
select among the five plans listed to the right. Participation Blue Shield Dental HMO Plus Plan
in all plans is not required.
Best yet, you can sell Suite Deal Dental with any Blue Shield
health plan or on a standalone basis.
PlanSelect and Dual Choice
PlanSelectSM is more flexible than ever! As mentioned earlier, enrolled employees to pick from any combination
the new Shield Spectrum PPO Plan 2000 Value,1,2 is available of 28 different health plans.
not only as part of Suite Deal, but also available as part of
Groups with two or more enrolled employees can
PlanSelect and Dual Choice. With the addition of this new
use our Dual Choice program to offer multiple plans.
plan, our multiple plan offering allows groups of 2 to 50
FIRST: Pick any number of plans from these types: 8 HMO plans
12 PPO plans
5 HSA-eligible high-deductible health plans
2 Active ChoiceSM (first dollar) plans*
1 POS plan
THEN: Select a monthly employer contribution option, a minimum of: $100 per enrolled employee or 50% of total employee rates
DONE: With some of the largest provider networks and expanded choice of 28 plans3 – including our lowest-rate PPO plans –
there has never been a better time to choose Blue Shield.
Talk to your Blue Shield sales representative to get started.
To qualify, groups must meet one of two participation requirements:
• f offered as the sole carrier, a minimum of two enrolled employees is required, subject to standard underwriting guidelines.
• f offered in conjunction with another carrier’s HMO plan, the combined Blue Shield plan enrollment must equal the
greater of five enrolled employees or 75% of the total number of enrolled employees in all plans.
• ual Choice is also available for groups with as few as 2 enrolling employees.
• mployers can choose one HMO4 and any PPO or POS plan.
1 Underwritten by Blue Shield of California Life & Health Insurance Company.
2 Pending regulatory approval.
3 Plans are underwritten by Blue Shield of California and Blue Shield of California Life & Insurance Company.
4 Except Access Baja® HMO plans. One Access Baja plan can be offered in addition to the HMO and second
8 plan choice. Please see underwriting guidelines for complete details on Dual Choice. Small business updates January 2009
January 2009 rate updates
Effective January 1, 2009, our small group products will see the following average rate changes.
January 2009 rates
Average quarterly commercial rate Average commercial HMO/POS Average commercial PPO
action adjustment will be: rate action1 rate action1
Northern California 1.7% increase 2.6% increase
Southern California 1.6% increase 2.8% increase
Specific rate changes by region
Region 1: Fresno, San Luis Obispo, Merced 1.8% increase 2.6% increase
Region 2: Sacramento, Santa Clara 1.7% increase 2.5% increase
Region 3: San Francisco, Alameda, Monterey 1.7% increase 2.6% increase
Region 4: Marin, San Mateo 1.7% increase 2.5% increase
Region 5: San Bernardino, Santa Barbara 1.6% increase 2.8% increase
Region 6: Parts of Los Angeles 1.6% increase 2.6% increase
Region 7: San Diego 1.7% increase 2.6% increase
Region 8: Ventura, Orange 1.7% increase 2.8% increase
Region 9: Los Angeles Metro, Riverside 1.6% increase 2.9% increase
Specialty Benefits rate changes
Plan Rate change statewide
Dental HMO plans 3.1% increase
Dental PPO plans 4.5% increase
Vision and life insurance plans No increase
To review our rate tables, visit Producer Connection at blueshieldca.com/producer and select Small Group from
the Plans and Rates heading.
Note: January 2009 rate actions are average changes for new business. Renewal changes are based upon cumulative rate actions that have occurred
during the contract period.
1 Percentages are averages only. The percentage for a specific group may vary. Rate actions quoted are based on rates for January 2009.
Small business updates January 2009 9
Medical and specialty benefit plans
Use this comprehensive list to create the right balance of dental, vision, life insurance, and medical
plans to help your clients and their employees get the comprehensive health coverage they deserve.
Specialty benefit plan options for groups of 2 to 50 Small group medical options
Rates from lowest to highest Shield Spectrum PPO Savings plans
Rates from lowest to highest †
Low-cost benefit options
Shield Spectrum PPO Savings Plan 4800* (HSA-eligible)
Shield Spectrum PPO Savings Plan 3000/6000* (HSA-eligible)
Blue Shield Life Vision Basic plans*
Shield Spectrum PPO Savings Plan 2500* (HSA-eligible)
Blue Shield of California Vision Basic plans
Shield Spectrum PPO Savings Plan 1800/3600* (HSA-eligible)
Vision Standard plans*
Shield Spectrum PPO Savings Plan 2250/4500 (HSA-eligible)
Dental HMO Voluntary
Dental HMO Basic Shield Spectrum PPO plans
Dental PPO SmileSM Basic Voluntary 75/1000/No Ortho/MAC Rates from lowest to highest †
Dental PPO Smile Basic 75/1000/No Ortho/MAC
Plan 2000 Value*
Dental PPO Smile Value 50/1500/No Ortho/MAC
Plan 1500 Value*
Mid-range benefit options Plan 1000 Value*
Plan 750 Value*
Vision Plus plans*
Plan 500 Value*
Dental HMO Plus
Dental PPO Smile 50/1500/No Ortho/MAC
Plan 500 Standard*
Dental PPO Smile Plus 50/1500/Ortho/MAC
Plan 500 Premier
Dental PPO Smile Plus Gold 50/1500/Ortho/U85
Plan 250 Standard
Rich benefit options Plan 250 Premier
Plan Zero Deductible
Vision Deluxe plans* Active ChoiceSM plans
Dental HMO Deluxe Rates from lowest to highest †
Dental PPO SmileSM Deluxe 2000 50/2000/No Ortho/MAC
Plan 500 SG*
Dental PPO Smile Deluxe 50/1500/Ortho/MAC
Plan 750 SG*
Dental PPO Smile Deluxe Plus 2000 50/2000/Ortho/MAC
Dental PPO Smile Deluxe Gold 50/1500/Ortho/U85 Access+ HMO® plans
Rates from lowest to highest †
Plan 20 Value
Added Advantage POSSM plan
* Plans underwritten by Blue Shield of California Life & Health Insurance Company. Shield Spectrum PPO plans 750 Value, 1000 Value, 1500 Value,
2000 Value, and Shield Spectrum PPO Savings Plan 1800/3600 are pending regulatory review.
† Plans are based on an RAF of 0.9 for the 0-29 age band, Region 1, effective January 1, 2009. Rates are subject to change.
10 Small business updates January 2009
Easier underwriting guidelines
Blue Shield is offering enhanced administrative components to the small group underwriting requirements.
For more information, please refer to the Underwriting Guidelines for Producers, A16060.
Offering Shield Spectrum PPO Savings Plan 4800 part of Dual Choice alongside another carrier’s HMO plan,
with another carrier’s HMO the minimum Blue Shield of California and/or Blue Shield
Our Shield Spectrum PPO Savings Plan 4800,* which is an Life enrollment is the greater of five active employees or
HSA-eligible plan, can now be paired with another carrier’s 50% of overall enrolled employees (whichever is greater).
HMO by using the same relaxed guidelines currently in play for Please note that waivers are required for employees that
Active Choice plans* (separate from the Suite Deal package). are enrolling in another carrier’s plan.
* Underwritten by Blue Shield of California Life & Health Insurance Company.
When the Shield Spectrum PPO Savings Plan 4800 is offered
as a standalone from Blue Shield Life and is offered along-
side another carrier’s HMO plan, the minimum Blue Shield Start-up groups
Life enrollment is five active employees or 20% of overall We modified our administration of AB1672 waiting period
enrolled employees (whichever is greater). guidelines for start-up groups. We will now accept six
weeks of consecutive payroll without the six weeks
If Blue Shield Life’s Shield Spectrum PPO Savings Plan 4800 being specific to a fiscal quarter.
and Blue Shield of California’s HMO plan are offered as
Specialty Benefits coverage updates
Ancillary is now Specialty Benefits and orthodontia benefits for adults and children.
It’s more than a name change. To reflect an improved Remember, you can visit blueshieldca.com and down-
integration process, our dental and vision products, and load a custom dental network directory for your area.
life insurance will now be referred to under the specialty * Dental providers outside California are contracted through Dental
benefits designation.* Say goodbye to ancillary, say hello Benefits Providers Inc. Dental providers in California are contracted
through Dental Benefit Providers of California.
to Specialty Benefits.
Specialty Benefits wants to help you retain more clients by Vision plan information card improves experience
offering a comprehensive suite of products that cover your
We’ve introduced a vision plan information card designed to
clients from head to toe. Make it your goal to provide a
improve member experience. With this card, it’ll be easier for
one-stop total health solution. Down below, you’ll find more
vision plan members to communicate to network providers
information on how Specialty Benefits has taken steps to
that their vision benefits are administered by MESVision.
make it easier for you to sell and retain your business.
* Dental products are underwritten by Blue Shield of California. Life Starting in October, Blue Shield began providing vision cards
and stop-loss insurance is underwritten by Blue Shield of California to in-force standalone vision groups in their monthly bill and
Life & Health Insurance Company (Blue Shield Life).
to new standalone vision groups in their welcome kits. Vision
groups who also purchase medical coverage will receive the
Bigger dental network means more access card in post-enrollment member handbooks and renewal
Since January 2008, we’ve added over 4,000 new providers packets, beginning with January 2009 effective dates. By the
to our dental PPO network, bringing our total number of end of 2010, all vision groups will receive new cards.
network providers to over 102,000 nationwide, including You can also print a card for your clients from the Vision
over 23,000 in California. Take advantage of this great section of Producer Connection. Members with vision
opportunity to boost and retain your dental sales by coverage will also be able to print a card anytime by
ensuring that your clients know we now have a larger logging on to blueshieldca.com, going to View my plan
network than before at an affordable price. Plus, they summary and scrolling to Additional coverage.
can benefit from dental plans with no waiting periods
Small business updates January 2009 11
Legislative and other changes
Please note that there are legislative and other changes affecting current plans. Refer to the Plan
Modification, Evidence of Coverage, and the plan contract, or the Certificate of Insurance and
the group policy for the exact terms and conditions of coverage.
Creditable and non-creditable plans
As of January 2009, the following plans will change their Medicare prescription drug coverage would be expected
Medicare Part D Creditability status from non-creditable to pay on average.
A health plan’s prescription drug coverage is non-creditable
Access+ HMO® Plan 20 Value when the amount the plan expects to pay on average for
Access+ HMO Plan 30 prescription drugs is less than that which standard Medicare
prescription drug coverage would be expected to pay on
Access+ HMO Plan 25 average. Medicare-eligible individuals who have prescrip-
Access+ HMO Plan 40 tion drug coverage that is non-creditable must purchase
Added Advantage POSSM Plan an individual Medicare Part D Prescription Drug Plan (PDP),
in addition to their health plan’s coverage or a premium
Shield Spectrum PPOSM Savings Plan 2250/4500 penalty will be charged if Medicare Part D coverage is
Shield Spectrum PPO Savings Plan 2500† purchased in the future.
Shield Spectrum PPO Savings Plan 4800† Medicare Part D eligible members are notified of the plan’s
Shield Spectrum PPO Plan 750 Value†,* status at their renewal with information provided in the
employer renewal packets.
A plan’s creditable coverage status is calculated on an
Please note that the above-referenced notice of plan status
annual basis and is based on updates from the Centers
does not substitute for the employer’s duty to provide notices
for Medicare & Medicaid Services (CMS). The change in
of credible coverage in accordance with CMS guidelines.
creditable coverage status relates to the small percentage
of the plan’s members who are Medicare Part D eligible. The following is a current list of creditable and non-
creditable plans for small groups.
A health plan’s prescription drug coverage is creditable
if the amount the plan expects to pay on average for
prescription drugs is the same or more than what standard
Creditable and non-creditable plans
Access+ HMO Plan 5 Shield Spectrum PPO Plan 500 Premier Shield Spectrum PPO Plan 500 Value†
Access+ HMO Plan 10 Shield Spectrum PPO Plan 500 Standard †
Shield Spectrum PPO Plan 1000 Value†,*
Access+ HMO Plan 15 Shield Spectrum PPO Plan 750 Value†,* Shield Spectrum PPO Plan 1500 Value†,*
Access+ HMO Plan 20 Shield Spectrum PPO Plan 1000 Shield Spectrum PPO Plan 2000 Value†,*
Access+ HMO Plan 20 Value Shield Spectrum PPO Savings Plan 1800/3600 * †,
Shield Spectrum PPO Plan 3000†
Access+ HMO Plan 30 Shield Spectrum PPO Savings Plan 2250/4500 Active ChoiceSM Plan 750 SG†
Access+ HMO Plan 25 Shield Spectrum PPO Savings Plan 2500† Active Choice Plan 500 SG†
Access+ HMO Plan 40 Shield Spectrum PPO Savings Plan 3000/6000 †
Shield Spectrum PPO Plan Zero Deductible Shield Spectrum PPO Savings Plan 4800†
Shield Spectrum PPO Plan 250 Premier Added Advantage POS SM Plan
Shield Spectrum PPO Plan 250 Standard
For information on prescription drug coverage for your clients’ Medicare-eligible employees, please visit
blueshieldca.com, or speak to your Blue Shield representative.
† Underwritten by Blue Shield of California Life & Health Insurance Company.
* Pending regulatory review.
12 Small business updates January 2009
Wellness discount programs
Your group’s wellness is very important to us. To make it easier for Blue Shield members to take better
care of themselves and stay healthy, we offer a wide range of discount programs1 that can help them
save money and stay productive. Let your Blue Shield clients know that their employees can find more
information on these programs on blueshieldca.com/wellnessdiscounts, or give them our Wellness
Discount Program flier, A20019 (7/08). Member discounts include:
Weight Watchers Vision discounts2
Members can save in a variety of ways on local meetings, Vision care – Members can receive 20% off the published
online subscriptions, and at-home kits to help them lose retail prices when they use a participating provider in
those extra pounds and maintain a healthy weight. the Discount Vision Program network for these services
24 Hour Fitness
• Routine eye examinations
Members enjoy a variety of waived initiation and
• Frames and lenses
processing fees and discounted monthly dues.
• Photochromic lenses
Drugstore.com • Tints and coatings
Members receive a wide range of discounts when • Extra pair of glasses
they shop online for health and wellness products
• Non-prescription sunglasses
Alternative care discounts LASIK3
Members save on a variety of wellness services from Blue Shield vision plan members receive access to
participating practitioners including a 25% discount a 15% discount on LASIK and PRK laser vision surgery
on acupuncture, chiropractic services, message through the TLCVision provider network in California.
therapy, and up to 40% off on quality health
improvement products with free shipping on
1 The network of practitioners and facilities in the discount programs are managed by the external program administrators identified below, including
any screening and credentialing of providers. Blue Shield does not review the services provided by discount program providers for medical necessity
or efficacy. Nor does Blue Shield make any recommendations, representations, claims or guarantees regarding the practitioners, their availability, fees,
services, or products.
Some services offered through the discount program may already be included as part of the Blue Shield health plan covered benefits. Members should
access those covered services prior to using the discount program.
Members who are not satisfied with products or services received from the discount program may use the Blue Shield’s grievance process described in
the Grievance Process section of the Evidence of Coverage or Certificate of Insurance. Blue Shield reserves the right to terminate this program at any
time without notice.
Discount programs administered by or arranged through independent companies:
• lternative Health Services Discount Program – American Specialty Health Networks of California Inc. (ASH Networks)
• Discount Vision program – MESVision
• LASIK and PRK – Laser Eye Care of California, LLC
• Weight control – Weight Watchers North America
• Fitness facilities – 24 Hour Fitness
• Health products (excluding prescription drugs) – Drugstore.com Inc.
2 The Discount Vision Program through MESVision is a value-added feature for Blue Shield members who reside in California, and is not a covered benefit of
Blue Shield vision plans. None of the terms or conditions of Blue Shield’s health plans apply. Disposable and replaceable contact lenses, eyeglass frame
repairs, promotional eyecare offers, medical and surgical eye treatment, and any services not specifically included in this program, are excluded from
the Discount Vision Program. Blue Shield does not review the program’s practitioner services and products for medical necessity or efficacy, and makes
no representations, claims, or guarantees regarding their services or products. Members who use the discount program are responsible for the payment
of services provided by participating providers, including payment for cancelled or missed appointments. Members who are not satisfied with services
received from the program’s providers may use the Blue Shield grievance process. Blue Shield reserves the right to terminate this program without notice.
3 This discount program is not part of our vision plans, and is offered in addition to the benefits covered under the vision plans. Members who are not
satisfied with services received under the discount program may use the Blue Shield of California or Blue Shield Life (as applicable) grievance process.
Blue Shield reserves the right to terminate this program without notice.
Small business updates January 2009 13
Manage your Blue Shield clients online
It’s easy to manage your Blue Shield book of business online. Our online client tool – updated daily –
can make your business administration quick and easy, giving you more time to grow your business.
Along with putting client data at your fingertips 24/7, this online tool lets you:
• iew employee and dependent plan selections D
• ownload your client list in PDF or Excel format.
(including specialty benefit options chosen). Then, use your list to stay in touch with your
• erify group effective and renewal dates.
V clients – through direct mailings or phone calls.
• onfirm employee additions and deletions to The online client list now includes a search filter for
ensure that a group is being billed accurately. small groups. This enhancement includes search
• iew up-to-date payment status for your groups – and sort functions to help you locate particular
so you can reach out in time to clients who are groups or renewal parameters.
late on their payments and prevent cancellations.
This search filter tool is embedded into the online
• ort your client by group name, payment status, client list you’ll find on Producer Connection at
or renewal date. You control how you see your blueshieldca.com/producer.
list. Then, use this list to prioritize your actions and
contact your groups before their renewal letters
14 Small business updates January 2009
Marketing tools to help you sell
To download extra copies of these exciting marketing tools and to give as handouts to
clients, visit Producer Connection at blueshieldca.com/producer.
Producer Information Booklet for Small Business A10864 (11/08)
This is your guide to product portfolios, underwriting guidelines, service and support,
plus an overview of PlanSelect and Suite Deal.
(2 to 50) Plan Comparison Guide A11368-SM (11/08)
Available as a leave-behind, this side-by-side health plan comparison includes medical,
dental, life insurance, and vision product information.
Suite Deal Plans at a Glance A19561 (11/08)
Use this when presenting or quoting to your clients. It’s a quick overview of all the plans
included in the Suite Deal program.
PlanSelect flier A16408-SG (11/08)
Get the latest on our multiple-plan offering program.
Benefit Summary Guide A16609 (11/08)
This guide provides complete benefit summaries and general plan information.
Suite Deal RAF flier A17952-SD (1/09)
Use this when presenting or quoting to your clients. It’s a quick overview of all the plans
in the Suite Deal program.
Preventive Care flier A19701 (2/08)
This leave-behind informs your clients about the benefits of preventive care coverage,
and how they can help their employee stay healthy and on the job.
Wellness Discount Program flier A20019 (7/08)
Help promote wellness through discount rates on health and wellness products and
services. This flier informs employees of our wellness discount programs that can also
help them save money.
Suite Deal Dental FAQs for Producers and Employers A19736 and A19737 (5/08)
Refer to these FAQs for answers to questions that you or your clients may have about
our Suite Deal Dental package.
Small business updates January 2009 15
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