Blue Shield of California
Blue Shield of California (BSCA) is a not-for-profit medical insurance company that operates exclusively in California. While its nearly $18 billion in annual revenue makes is significantly smaller than the behemoths of UHC and Anthem; those other companies operate in many states. In 2015 Blue Shield covered about 20 percent of the small group employers (1-100 employees) in California, which makes it second only to Kaiser in market share.
Large Provider Networks: Blue Shield of California has contracted with a huge number of doctors and hospitals which makes their small group HMO and PPO provider networks very large. Since 2015 BSCA has been very price competitive and they have become one of the most popular insurance companies for small businesses, particularly for those employers who want to offer PPO coverage – because of their great benefits, extensive provider networks, and very low rates.
Low Participation Requirements: Blue Shield has the lowest participation requirements for new groups. When 5 or more employees enroll; BSCA requires that only 25 percent of the eligible employees enroll in the health plan. Many other companies require 70 percent of the eligible employees to enroll in the plan. This means that your company may qualify for coverage with Blue Shield whereas they might not qualify with a different insurance company.
No Participation Requirement with Trio ACO HMO: When a small group employer (1-100 employees) offers only the Blue Shield Trio ACO HMO plans there is no minimum participation requirement.
Networks Combinations: Blue Shield offers a narrow network HMO plan, called “Local Access+” (“Local Access Plus”) which excludes the highest priced hospitals and doctors. Unfortunately, BSCA won’t allow a small employer to offer their full network, Access+, with the narrow network, Local Access+. Other insurance companies (e.g., UHC, Aetna) allow a small employer to offer all HMO and PPO networks; but not BSCA.
Large HMO Renewal Rate Increases: Another challenge is that BSCA’s HMO small group plans have seen pretty large percentage rate increases in recent years. While their PPO plans have had modest increases (3 to 7 percent) their HMO rates tend to be higher. True; BSCA’s HMO rates are still competitive; but sometimes it can be sticker shock for an employer to see a large renewal increase in rates after only a single year of coverage.
Pricing and Employer Strategy
Blue Shield of California has been extremely price competitive for the last few years; offering the inexpensive PPO and HMO plans. Their price advantage has diminished recently and UHC and Anthem are competitive and less expensive in some parts of California.
Employers with high wage employees who are looking for solid PPO and HMO provider networks and well-priced plans should take a close look at BSCA.
Companies with very low wage employees (e.g., restaurants, small manufacturers, etc.) may also find that BSCA is a good fit. Their Trio ACO HMO plans have very low premiums and BSCA has the lowest participation requirements (i.e., only 25% of eligible employees must enroll) compared to other California medical insurance companies.
Blue Shield Small Business Health Insurance FAQ
What is Blue Shield small business insurance Off-Exchange Package?
Blue Shield offers small businesses group medical insurance in California either through Covered California for Small Business (CCSB) or directly through Blue Shield or through a broker/agent. CCSB is called an “exchange” by policymakers and “off-exchange” refers to plans sold directly through Blue Shield and brokers. Blue Shield’s off-exchange plan benefits and rates are different from the plans offered through CCSB. There are more plan choices and provider networks in Blue Shield’s off-exchange portfolio of plans, however, the on-exchange plans in CCSB have good benefits and are also priced competitively.
What is Blue Shield small business insurance Mirror Package?
Mirror package plans from Blue Shield of California are identical to plans offered through California’s “exchange” called Covered California for Small Business (CCSB.) An employer can purchase the mirror plans directly from Blue Shield and a broker or agent and not go through CCSB. It is uncommon for an employer to offer employees Blue Shield mirror plans because the “off-exchange” plans provide more plan choices and are competitively priced. Also, if an employer wants the mirror plans then the small business should just sign up through CCSB. The Affordable Care Act (ACA, Obama Care) requires insurance companies to offer identical plans on and off the exchange and Blue Shield calls these identical off-exchange plans “mirror” plans. It’s just another way to make something that is already too complicated, more complicated.
Does Blue Shield for business offer any optional health benefits?
Blue Shield offers chiropractic and acupuncture care as a part of their Access+ HMO health plans. Blue Shield also offers an infertility rider which includes Gamete Intrafallopian Transfer (GIFT) but excludes In Vitro Fertilization (IVF), Zygote Intrafallopian Transfer (ZIFT), and other treatments. You should check the benefit description to confirm coverage. Blue Shield requires an extra monthly premium for each enrolled member of a small group when adding the infertility rider. Blue Shield of California also offers discounts and a wellness program called “Wellvolution.” Give us a call at BenefitsCafe.com (800)746-0045 if you want to know more.
What is Blue Shield for small businesses PPO plans?
Blue Shield of California “Preferred Provider Organization” or “PPO” plans allow small business members to obtain medical care from doctors and hospitals who have agreed to reduce their fees for services to Blue Shield members. These medical providers are referred to as “in-network.” PPO members can also obtain care from “out-of-network” doctors and hospitals and their Blue Shield small employer health plan will pay a portion of the cost. Out-of-network medical providers have not agreed to reduce their fees for Blue Shield members. So, these doctors and hospitals can charge whatever they want, and the patient is obliged to pay. Blue Shield PPO plans pay a lower percentage for services from out-of-network providers, so, it’s best to stay in-network. Blue Shield PPO network for small businesses is one of the largest in California and includes most of the providers, but not all, so check to see if your doctor is in-network.
What is Blue Shield HSA-compatible HDHP?
Blue Shield of California offers small employers Silver and Bronze level PPO plans that are HSA-compatible. Health Insurance plans that are compatible with Health Savings Accounts (HSA) are referred to as “High Deductible Health Plans” (HDHP.) When an employee is covered by an HDHP he/she can open a tax-advantaged savings account that the employee can use for medical expenses. Blue Shield’s HSA compatible plans use either the full PPO network or the “Tandem” PPO network which has fewer doctors and hospitals than the full network plans. Currently, a California small employer can offer Blue Shield HSA PPO Silver plans with either a $2,100 or $2,600 deductible and/or Bronze HSA with a $5,700 or $7,000 deductible. The out-of-pocket maximum is also important on HSA-compatible plans and this amount varies by plan. Contact BenefitsCafe.com for up-to-date info at 800-746-0045.
What is Blue Shield HMO plans for small businesses?
Blue Shield offers small employers in California Platinum, Gold, and Silver level HMO plans. These plans range from zero deductible plans to plans with nearly $3,000 deductible. Normally, the deductible only applies to in-hospital services but sometimes the deductible applies to some lab work and x-rays and MRIs. The plans with deductibles cost less on a monthly basis than the plans with no deductibles. Blue Shield HMO plans are competitively priced and include many doctors and hospitals. Call BenefitsCafe.com (800)746-0045 and we can answer your questions, prepare proposals, help you select plans for your employees, communicate the information to your employees, help them enroll, and assist you and your employees throughout the time that you have your health plans. Best of all, there is no additional fee for our services, so give us a call.
How do I know which Blue Shield medical insurance is best for my employees?
Blue Shield offers many different types of plans including PPO plans with large and small networks of doctors and hospitals; HMO plans that offer access to large, middle-size and small number of doctors and hospitals. Unfortunately, Blue Shield disguises the size of the number of doctors and hospitals that accept a plan by calling the “provider networks” names like, Full, Tandem, Access Plus, Local Access Plus and Trio, which mean nothing to an employer unless he or she spends a lot of time researching plans and knowing which questions to ask. Selecting the best plans for your employees also requires an employer with 1 – 100 employees in California to know that some employees want plans that will charge them little for in-hospital care (for example when having a baby); or be very inexpensive on a monthly basis for healthy employees. It is complicated and expensive. The good news is that a California small employer can work with a knowledgeable broker or agent to determine which plans are best for your employees and pay no additional charge for the advice. Better yet, the broker can explain things to your employees, set up online enrollment systems, prepare required compliance documents like Section 125 POP plans, SPD Wrap documents and help you comply with COBRA or CalCOBRA. In our humble opinion – and in the opinion of our clients who have given us glowing reviews on Google and elsewhere – we at BenefitsCafe.com do it better than anyone else. So, give us a call at (800)746-0045.