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  Small business (2 to 50) updates

         January 2009




                                     blueshieldca.com
    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
    at blueshieldca.com/producer.




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
         •	 Copayments
         •	 Coinsurance
         •	 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.



         What’s new?
         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
        Prescription drugs
                                       Retail     $15
        Generic
                                       Mail       $30
        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†,*,#
            P
         •	 	 articipation	is	lowered	 –	only	65%	participa-
            tion required
                                                                                              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
             regulatory review.
         # 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
              1
         	 •	 	 0-point	RAF	reduction	for	groups	of	6	to	9	enrolling	employees1
              A
         	 •	 	 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
              1
         	 •	 	 .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
           sales representative.

           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


      Here’s how:
      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:

       I
    •	 	f	offered	as	the	sole	carrier,	a	minimum	of	two	enrolled	employees	is	required,	subject	to	standard	underwriting	guidelines.
       I
    •	 	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.



       Dual Choice
            D
       	 •	 	 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.
            E




    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)
         Life: $15,000*
                                                                                           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 3000*
         Life: $20,000*
                                                                                           Plan 750 Value*
         Vision Plus plans*
                                                                                           Plan 500 Value*
         Dental HMO Plus
                                                                                           Plan 1000
         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
         Life: $25,000*
         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 40
                                                                                           Plan 25
                                                                                           Plan 30
                                                                                           Plan 20 Value
                                                                                           Plan 20
                                                                                           Plan 15
                                                                                           Plan 10
                                                                                           Plan 5

                                                                                           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.
     to creditable:
                                                                                    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
      Creditable                                                                                              Non-creditable
      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
                                                                                          and supplies:
         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
         at drugstore.com.

         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
         most items.




         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:
         	      A
             •	 	 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
     Service updates
     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:



        V
     •	 	 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.

        C
     •	 	 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
        V
     •	 	 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
        S
     •	 	 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
        reach them.




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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                                                                                                FPO
                                                       Joe Sample
                                                       123 Any Street
                                                       Anytown, CA 9XXXX-XXXX
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     blueshieldca.com




An Independent Member of the Blue Shield Association
 A15870 (11/08)

				
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