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Carrier Updates 8.7.17
by Rosa Tessandori » Tuesday, August 08, 2017 6:45 PM


4th Quarter Updates

  • Rate Action:  Rate Pass for HMO, MC, and PPO medical plans for all rating areas
  • Network Updates: Who's new and who's going away.   Access Heal providers for on-demand house calls. Take advantage of Teladoc providers that available for phone or video consultations 24/7/365 days a year.  View the updated CA HMO comparison.  Click here for more information.
  • Springboard:  Aetna's online enrollment platform is available free of charge.
  • Renewal and Plan Changes:  Allow enough time for processing, submit renewal and plan changes no later than the last day of the month prior to the renewal.
  • Sold Case Submissions:  Aetna's underwriting team must receive sold case submissions by the requested effective date: the 1st or the 15th of the month.


Producer News Online - Small Group

  • 8/23/17 Webinar:  Reduce tobacco use in the workplace.
  • Employer Access:  The portal has been updated and is now available.
  • Form and Flyers:  The updated 2017 Anniversary Month and Plan Change request forms, and the New "Top 10 Reasons to Sell Anthem" flyer, are now available for Small Groups.

      Producer News Online - Large Group

  • Specialty Account Management:   Michele Bodie has been promoted to Director of Specialty Sales Account Management for California, Colorado, and Nevada.
  • 8/23/17 Webinar:  Reduce tobacco use in the workplace.
  • Online Billing and Payment Effective 9/1:  Anthem is moving Large Groups in California to electronic billing and online payment, starting September 1, 2017.


  • Trio ACO HMO:  BSC is waiving their participation requirements for groups of 1 to 100 eligible employees with Trio-only membership!  Click here for additional details.


  • Q4 Rate Action:  HMO/HSP Rate pass through December 15, 2017.  PPO/EPO insurance medical plan rates were given a 0.0% quarterly increase . While this is not a rate pass per se, you will find that most of the PPO/EPO Q4 rates are identical to Q3 rates.  Click here for additional details.


  • Covered CA:  Rates are available for quoting.

View Document
Carrier Updates 7.31.17
by Rosa Tessandori » Tuesday, August 08, 2017 6:26 PM

  • CA AB7:  Benefit updates have been implemented to meet new guidelines, click here to learn more for individual and small group contracts, click here.  For large group contracts, click here.  

  • Nivano Physician IPA:  Blue Shield of California has issued a termination notice to Nivano Physicians IPA (formerly Sierra Nevada Medical Associates IPA) effective August 10, 2017. Blue Shield is notifying affected HMO/POS members that they are being reassigned to alternate network IPAs in the area to help ensure uninterrupted access to care, effective August 10, 2017.  Members can call the Member Services number on their ID card to self-select a PCP or IPA.  Click here for more details.  
  • Digital Roadshow:  The invitation is coming soon, save the date - Wednesday, August 30th. or Thursday, August 31st., click here for more details.

  • Q4 Revised Health Net Rates:   Rates effective 7/1/17 will hold through 12/1/17 effective dates.  Please replace the previously published Rate Guide with the revised Rate Guide, click hereto download a copy.  Quotes processed prior to 7/20/17 will need to be requoted.

  • Choice Pharmacy Network:  Health Net is introducing their new, tailored pharmacy network designed for cost control.  Learn more, click here.

  • Northern CA SG 1-100 Webcast:  If you missed the webcast, click here for a copy of the presentation 7.21.17.  Get up to speed on UHC4Me, click here.  Check out the ancillary plan recommendations, in particular the dental $5K Max DPPO plan, click here.
  • CAHU SB 562  Tool Kit:  SB 562 would establish a state-run single-payer health care system.  Please review the CAHU Tool Kit for resources to use in your discussions with clients, colleagues and friendsClick here for more information.

  • Earn a Reward and Win A Trip:  Any broker that brings in 6 or more new clients (or 2 or more clients with >2500 lives) between 8/1 and 12/1, will get either an Apple Watch or $400 Amazon gift certificate,  plus a plaque as HY Top Performer and you could also win the Grand Prize! Click here for more details.   

View Document
Carrier & Compliance Updates 7.24.17 - part 1
by Rosa Tessandori » Monday, August 07, 2017 11:29 AM


      Producer Online News  - Small Group

  •  Q4 Rate Action:  The average quarterly rate increase for medical plans are PPO 3.2% and HMO 2.2%.  Dental, vision and life products, no rate increase. 

        Producer Online News  - Large Group

  •  Whole Health Savings Guarantee:  Some ASO large group clients that choose to combine Anthem medical, pharmacy, dental, vision, and behavioral health products,  may be eligible up to $30 PMPM savings guarantee.  
  • Vivity Broker Bonus Program:  Anthem brokers are eligible to receive a $100 bonus per subscriber for each new Vivity case sold!
  • Employer Access Enhancements: With the introduction of the new enhanced Employer Access benefit management resource tool will result in changes to Plansource arrangements for Large Groups effective 10/1/2017.


  •  Q4 Master Application:  Download a copy of the revised Master Group Application effective 10/1/17.   
  • Q4 Employee Enrollment Form:  Download a copy of the revised Employee Enrollment Form effective 10/1/17.


  •  Q4 Revised Health Net Rates:   Rates effective 7/1/17 will hold through 12/1/17 effective dates.  Please replace the previously published Rate Guide with the revised Rate Guide, click here to download a copy.  Quotes processed prior to 7/20/17 will need to be requoted.


       Partner News - July

  •  Agent Portal Access:  Via DocuSign, CCSB will reach out to all agencies to obtain a new signed Agency Agreement and/or Non-Monetary Agreement, this will be required to be able to sign in to the new Agency Portal.       
  • LinkedIn:  Use LinkedIn to gain immediate access to informational articles and education posting to share with your clients and followers.
  • First Month's Payment:  Please inform new groups to only submit the first month's payment after receipt of their first invoice.
  • Redesigned Invoice:   For details on the changes, see the CCSB Employer Invoice Redesign Tutorial.
  • 2017 Employer Guide:  The CCSB Employer Guide has been updated and is now available on the Resources for Participating Employers page on the CCSB website.
  •  Late Submissions:  If a new group is submitted after the 25th of the month prior to the effective date, a late submission form must be completed. Late submissions are accepted up to the 5th day of the requested effective month and are subject to management approval.

View Document
Carrier & Compliance Updates 7.24.17 - part 2
by Rosa Tessandori » Monday, August 07, 2017 11:19 AM


  • 7/26 Webcast - Q4 updates and more:   Registration is not required but space is limited so join early!  July webcast on 7/26/17 at 2:00 p.m.  Click here to learn more.  Add it to your calendar, click here.

     Broker Connection - July
  • Digital Onboarding Webinars: For new and renewing groups with 101+ employees, Join a UHC webinar on July 26, 28 and August 1. For more details about Digital Onboarding and to register for a webinar, go to
  • Wellness Program:  Employers Honored by UnitedHealthcare for Creating a Culture of Wellness.
  • Prescription Drug List Changes:  View the latesPDL Tracker for a recap of changes outside the Jan. 1 and July 1 pharmacy benefit updates.
  • Prior Authorization Required for Renflexis and Brineura: For dates of service on or after Aug. 1, 2017, UHC require notification/prior authorization for Renflexis and Oct. 1, 2017 for Brineura.
  • Premium (Physician) Program:  This program evaluates physicians in 16 specialties for quality and cost efficiency.  UHC is changing the timing of the UnitedHealth Premium designation release from the end of the year to September. The ability to identify Physicians with Tier 1 status designation will be available during the standard fourth quarter Open Enrollment period. 
  • PCORI Fee Reminder: All Savers Alternate Funding plan sponsors must file a Form 720 and pay the PCORI fee directly to the IRS by July 31, 2017 of the calendar year following the last day of the plan year.

  • Expansion into Bay Area:    Effective 1, 2018, WHA is partnering with Canopy Health as part of their expansion into four additional Bay Area counties: San Francisco, San Mateo, Alameda and Contra Costa.  Click here for more details.


     HR Support Center Update
  • Use the HR Fitness Test to Grow Your Business:  Connect with your prospects and generate new leads, use this tool to identify their organization’s HR  strengths and weaknesses.  
  • Offer Branded "Insight" HR Webinars:  Presentations are 30 and 60 minute webinars on popular HR topics presented by one of their certified HR professionals. Take advantage of their Summer Insight Savings offer. 
  • Enhance your website: Use eAlert to bring cutting edge HR content directly onto your website to keep clients informed of federal and state employment law changes.
  • HR Support Center Enhancements:  Filter HR Topics by employee count.
  • Interested in HR AnswerLink?  Email us at to request additional information.

  • Does a Domestic Partner have COBRA Rights?  Read more about the complexities of when a domestic partner can or cannot be covered under COBRA,click here for more details. 

View Document
Carrier Rate Update 7.20.17
by Rosa Tessandori » Friday, July 21, 2017 9:25 AM


Q4 Released Rates as of 7/20/17:

Carrier & Compliance Updates 7/17/17
by Rosa Tessandori » Thursday, July 20, 2017 10:50 AM


       Producer News Online

  • Medical Specialty Precertification:  Anthem is expanding their precertification program to include medical specialty edits.
  • MyAnthem News:  The July issue is available for your California Small Group clients.
  • Updated 2017 Small Group HMO Network Guide:  The updated HMO Guide includes 6 new Sutter Providers added in Northern California effective July 1, 2017,  view the updated 2017 Small Group HMO Network Guide*. 


       Producer Alert 

  • Trio ACO HMO: Trio leads the way in Q4 with an average 4.8% rate decrease across the state.  
  • Q4 Rate Action:  HMO OffEx plans are experiencing on average a -0.9% rate change and PPO plans +0.5%.  The average overall rate action for renewals is 1.1%.  Click here to view the Alert.
  • Specialty:  No change to dental, vision or age banded life insurance rates from Q1 2017
  • Relaxed Participation OffEx Medical and Specialty:  BSC has extended their Relaxed Participation Guidelines through the end of 2017, requiring only 25% employee participation (minimum of five enrolled employees for medical plans).
  • Streamlined Life Underwriting - BSC has extended their promotion through the end of the year.  The  Small Business Quick MatchSM  matches renewal rates from the group's current life insurance company
  • Trio - Participation Requirement Waived:  Effective 7/1, Trio-only groups may enroll in a Blue Shield small business plan with just one eligible member.  Click here to learn more.
  • October & November Renewal Kits:  Visit the Shield Renewals site to download kits starting Monday, July 17.  Group-level changes will be available on SGOR starting July 20.
  • Health Equity:  Offer HSA administration through Health Equity for all of the BSC HSA qualified plans, now including the Silver Full PPO Savings 2000/20% OffEx plan.
  • Teladoc:  Renewing existing members,  they can begin using this program at renewal.  For new groups, no wait required.  View the flier.
  • Trio Bonus:  Earn an additional $250 per group and $25 per member for adding Trio to your fourth quarter groups with the Trio Incentive Program (TIP).
  • Bundled Savings:  As of May 1, 2017, anytime you add dental and/or vision to a new or existing small business client's medical coverage – a 5% discount applies, view the Small Business Bundled Savings.
  • Value Add Services:  Clients have access to Wellvolution, ID protection, HealthEquity, and Blue Shield's updated mobile app. Learn more by by


  • Q4 Rates:  Quoting is now available on the California Choice Website.  Quoting through EBIX/HealthConnect is expected to be available 7/17.  Click here for the 4th Quarter Rate Guide.
  • Q4 Summary of Changes:   For groups renewing 10/1/17 and 1/1/17, distribute a copy of the Summary of Changes to employers and employees, click here to download a copy.
  • Q4 Benefit Summary Guides:  The guides are not yet available.
  • Employer Administrative Guide:  Keep your clients informed on how to best administer their Cal Choice group health plans, click here
    to download a copy.


  • Get Certified:  Not certified to sell Covered Ca small group insurance policies?  Create an account today, click here to get started.


      Broker Briefing

  • Q4 Renewals:  Broker will be able to access renewal packet through the broker portal 105 days prior to the renewal date, 
  • Preventive Care Guidelines:  View the 2017 preventive care guidelines.
  • Updated New Group Application:  Download the  New 7/1/17 group application (PDF).
  • COBRA:  Learn more about small business service tip for COBRA reporting.  
  • Sales Tools:  Support your client discussions with fliers that highlight key benefits included in SG plans like DME, Chiro & Acupuncture and Pediatric Vision.


  • 7/26 Webcast - Q4 updates and more:   Registration is not required but space is limited so join early!  July webcast on 7/26/17 at 2:00 p.m.  Click here to learn more.  Add it to your calendarclick here.


  • Rebranding:  The CONEXIS® name and logo is being retired and will be rebranded to WageWorks® over the remainder of 2017.  Click here to learn more.
  • PCORI Fees Due by 7/31/17:  Self-insured groups, groups offering a health Reimbursement Arrangement (HRA) or Flexible Spending Account (FSA) should consult with their Third Party Administrator to determine any applicable PCORI fees.  Click here to learn more. 

View Document
Carrier Updates 7.10.17
by Rosa Tessandori » Tuesday, July 11, 2017 2:41 PM

  • Webinar July 19th:  Invite your groups to join the employer webinar to learn  how Anthem is fighting the opioid epidemic.  Webinar is open to small and large group clients.  For more information, click here.

BLUE SHIELD OF CA - Small Group (1-100)
  • 2018 NEW Summary of Benefits (SOB): The new SOB will replace the current medical Benefit Summary for HMO, PPO, PPO Savings and POS plans.  Get the details, click here.

BLUE SHIELD OF CA - Large Group (101 to 249)
  • Bundling Discount:  With the NEW Benefit Solutions package, your clients can save up to 2.75% off their medical premiums when they bundle dental, vision and life insurance* with their benefits package.  View the Flier.


Q4 Released Rates as of 7/10/17:

View Document
Carrier & HR Update 7.5.17 Part 1
by Rosa Tessandori » Tuesday, July 11, 2017 2:02 PM


June Newsletter

  • Heal & PayForward - Just Launched:  Heal provides on demand doctor house calls.  PayForward lets members earn redeemable rewards.
  • Medical Network Updates:  The Small Group HMO Network now matches the Large Group HMO Network in Northern California with the addition of 6 new Sutter providers effective July 1, 2017.    
  • Health and Wellness:  View a health and wellness on the run webinar, view the calendar.
  • Resources for Brokers:  Access quick links to forms, benefits, underwriting guidelines and more.

Producer News Online - Large Group

  • Manifest MedEx: This organization helps doctors and health plans securely share critical health information, making sure that members get the safest and highest quality health care possible. 
  • Vivity Broker Bonus:  Vivity is one of the most innovative delivery systems to hit the Southern California health care market. 


  • Q4 Rate Action:  Trio ACO rates reduced on average 4.8%; HMO plans -0.9%; PPO plans +0.5% and the average overall rate action for renewals is 1.1%.  Click here to view the Alert.
  • HMO Renewal Packet Error:  August and September renewal packets included a benefits error in the "Changes To" document. This incorrect version of "Changes To" was sent only to customers with HMO plans.  Click here to view the Alert.
  • CA Assembly Bill (AB) 72 - Balance Billing Protection:  Members will receive an EOC endorsement letter informing them of the changes and how it affects them. Click here to view the IFP Alert.


  • Reduced Participation:  Through 11.15.17, take advantage of Health Net's reduced participation promotions, view the flier.


  • Master Application Updated:  The Master Group Application now includes a section for designating the Agency FEIN#, see page 2 step 3 #4 under Agent Information.  Click here to download the new application.  The form is available for immediate use.

View Document
Carrier and HR Updates 7.5.17 part 2
by Rosa Tessandori » Tuesday, July 11, 2017 2:01 PM

Broker Connection- June

  • New, Required Broker  Questionnaires and Attestations: As part of ongoing efforts to ensure protection of customer data, UHC will be asking agents to confirm that their computer equipment and practices are compliant with certain security standards, where applicable.
  • Specialty Medications:  AxelaCare® Health Solutions has a new name, BriovaRx Infusion Services.
  • Travel Protection Program:  Grow your business while helping to address your clients’ safety and well-being needs throughout their travels.
  • Specialty Broker Bonus Program:  View the requirements for earning a bonus.
  • Broker and Client Training:  Lean more about UHC's quoting tools, broker resources or how clients can better administer their benefit programs by attending an informational webinar.


HR Support Center - eAlert

  • Minimum Wage Increases:  Seven municipalities in California have passed minimum wages that are higher than the state rate and will go into effect or increase on July 1, 2017.  
  • Domestic Violence Victim Leave Notice:  Employers with 25 or more employees must provide this notice to all new hires (as part of a new hire packet is acceptable) and to any employee upon request.
  • Expanded Protections for Transgender Employees: New regulations going into effect July 1 extend existing protections by requiring that employers take affirmative steps to acknowledge and respect an employee’s gender identity.
  • Further Restrictions on Use of Criminal Histories: The Fair Employment and Housing Council released new rules related to the use of criminal histories in employment decisions, which take effect July 1. 


View Document
RBG Now Contracted with CA Health Net Small Group Eff 7/1/17
by Rosa Tessandori » Wednesday, June 28, 2017 1:52 PM

We are pleased to announce that CA Health Net Small Group plans are now available through Rogers Benefit Group!

We have enjoyed a successful large group partnership with Health Net for many years and the timing is perfect to expand the partnership to include small group products.

Health Net companies help more than five million people get the health coverage they need.

Whether you're looking for PPO, HMO or EPO coverage; Health Net offers a wide range of plan benefit designs at the right price point for maximum value and accessibility.

We look forward to partnering with YOU on your Health Net small group needs!

Please contact your RBG representative or our office for additional information, or if we can be of service in any way.

View Document
Carrier Updates 6.26.17
by Rosa Tessandori » Monday, June 26, 2017 3:59 PM


     Producer News Online
  • Optional PCP:  To engage members in the Anthem value-based model, members are encouraged to pick a PCP even if doing so is not required by their health care plan, click here to learn more.


     Broker Update
  • Trio Plans:  5 good reasons to sell Trio... Reasons #1 & #2, no participation requirements for medical and ancillary, click here to learn more.
  • HSA Administration:  Effective October 2017, HealthEquity can now also administer accounts the Silver Full PPO Savings 2000/20% plan in addition to the bronze level plans.
     Broker Update
  • California Assembly Bill (AB) 72:  Effective July 1, 2017, this new state law protects individuals from receiving unexpected "surprise or balance" medical bills from an out-of-network (OON) doctor when receiving inpatient and outpatient non-emergency care and services at an in-network healthcare facility such as a hospital, clinic, lab, imaging center or other healthcare facility.  
    Marketing Bulletin
  • Quick Match:  The program making it easier to sell life insurance has been extended through the end of the year and is available to groups with Groups 51 to 100 eligible employees.
  • Reduced Life Rates:  Effective 7/1/2017, BSC has lowered their composite life rates for groups with 10+ eligible employees.

View Document
Carrier & Compliance Updates 6.19.17
by Rosa Tessandori » Wednesday, June 21, 2017 10:43 AM


      Broker Announcement
  • New Venture with Sutter Health: This joint venture will deliver a differentiated, personalized experience for members and is designed to help lower the cost of care, resulting in competitively priced products. Sutter Health and Aetna anticipate offering self-insured commercial products starting mid-2018 in the greater Sacramento, Central Valley and Bay Area communities, as well as fully insured PPO products to follow in early 2019, pending regulatory approval. 


     Producer News Online -Small Group
     Producer News Online - Large Group

     Small and Large Group:
  • Cash Back Rewards: Members can earn up to 15% cash back from participating retailers
  • Voluntary and Optional Life:  Sell more life, Anthem offers Guarantee Issue up to $100,000.
  • Employer Portal:  Technical upgrade delayed to July 28, 2017.

     Small Group
  • Disability 2-9 Market View the underwriting guidelines 
    for Short Term and Long Term disability for groups with 2-9 eligible employees. Coverage is also available on a voluntary basis for groups with 10+ eligible and 10 enrolled.  A bundling discount with dental does not apply to 2-9 STD or LTD coverage (or voluntary).

     Large Group
  • Integrated Health Care Report - Edition 2:  This new whitepaper contains industry research on Integrated Health Care (IHC), an employee benefits strategy that connects medical, dental, vision, pharmacy and disability data to engage employees in wellness programs and improve health outcomes.
  • Plansource Contract Changes:  Effective 10/1/2017, Anthem will no longer offer Plansource to new customers for free or at a subsidized cost. 


     Small Group
  • 4th Quarter Rates:  A formal rate release has not been announced, however rates have been posted 120 days in advance due to recent guideline requirements and the t is expected soon.
  • Q4 Rates are currently available online.  A formal announcemen
     Large Group


     Partner News
  • Broker Bonus Q3 Program: View the flyer to learn more.
  • Broker Bonus Q4 Program: View the flyer to learn more.
  • HMO 2017 Comparison Brochure:  The brochure has been corrected, please discard prior versionsclick here for the latest version.
  • 2017 Strong Presence CA Brochure:  View the flyer to learn more.

       UHC Broker Connection - June
  • MLR Rebate Timetable:  Rebates will be mailed to customers in the final two weeks of September.
  • eServices:  Browser updates will be effective July 21st.
  • Preventive Screenings:  Expanded screenings for colon cancer available beginning July 1st.
  • Vision:  New lense formulary goes into effective July 1st.
  • Rx Drug List Changes:  View the latest PDL Tracker.

E is for ERISA
  • ACA Reporting Penalty Process:  Until ACA is repealed, employers must continue to comply with the requirements of the law. The IRS is currently issuing notices to employers that require them to disclose whether they complied with ACA large employer reporting duties, or their excuse for not doing so, where applicable. This post describes the notices and how to respond to them.  View the article.

  • No More Pre-Tax Commuter Transit Benefit Plans?  Act now to preserve tax savings for you and your employees, click here to learn more.

View Document
Carrier, HR & Legal Updates 6.12.17
by Rosa Tessandori » Friday, June 16, 2017 8:31 AM


Producer News Online

Small and Large Group
  • Employer Portal Update:  On June 16, EmployerAccess, is moving to a new and improved platform as part of a technical upgrade.  Learn more.
  • Required Annual Notices:  Members will receive several required notices such as the Notice of Privacy Practices, Women's Health and Cancer Rights and other important notices.  Learn more.
  • ACA Reminder:  Collection of corrected names and Social Security numbers is currently under way.  Learn more.

Small Group
  • Dental Complete Online Member Guide:  View the Online Dental Guide Demoit includes information on benefit details, how to search for a dentist, a dental cost estimator and more.  Learn more.
  • Real-Time Online Enrollment:  Beginning July 1, 2017, the Anthem standard will be to submit new enrollments, changes and terminations online through EmployerAccessLearn more.

Large Group
  • Mandatory Online Payment:  Effective 9/1/17, the new Anthem standard will be to issue bills (invoices) online and accept premium payments online throughEmployerAccessLearn more.
  • Act Wise CHDP Webinar: Register today for the June 22 webinar. Find out why Act Wise CDHP is the solution for your large group clients. Learn more.
  • Dental Prime and Dental Complete Online Member Guide:  View the Online Dental Guide Demoit includes information on benefit details, how to search for a dentist, a dental cost estimator and more.  Learn more.
  • Disability Claims:  View the Overview Brochure for an explanation of what to do to file a claim, what information is needed and more.

  • UCLA PCP Transitions:  Effective July 1, 2017, UCLA Medical Group will be transitioning 24 primary care physicians (PCPs) to Providence Saint John's Health Center, dba Saint John's Health Clinic, a participating IPA/medical group in the Blue Shield HMO network.  Learn more.


Support Center HR Advisor Newletter - June
  • Five Tips for Effective Meetings 
  • Unpaid Internships - DOL's six specific criteria
  • State Defined Protected Classes
  • OSHA Delays Electronic Record-Keeping Rule Compliance Date
  • Working Families Flexibility Act 
  • American Health Care Act (AHCA) - Employer Penalties Reduced to Zero
  • Working with Summer Scheduling Challenges
Want to learn more about HR AnswerLink's Support Center?  Click here or email us at  

  • Special FSA Discount:  Take advantage of this limited time offer available from July 1st -  September 30th,  to learn more, click here!

View Document
Carrier & Compliance Updates 6.5.17
by Rosa Tessandori » Thursday, June 08, 2017 12:31 PM


  • MLR Survey:  Surveys were mailed beginning May 25th and will be staggered over several weeks. When groups receive the survey notice, they will be prompted to visit a link and complete the survey. As a reminder, responses are not due until July 31. NOTE: Although most fully-insured small and large group customers will receive the survey, a small subset of customers will not if it does not apply to them. If a customer has not received the survey by the end of June, it is most likely the survey does not apply to them. 



       Producer Alert

  • New VP: Blue Shield is pleased to announce Steve Shearer as the Vice President and General Manager for our Small Business market. He joined the company on May 1, 2017.


     Broker Connection

  • 2018 HSA Limits:  Guidelines recently releases by IRS.
  • Pharmacy Update: Updated PPACA/HCR Preventive Care Medication Lists available


  • Earn a trip to Las Vegas:  Sell five (5) EaseCentral subscriptions before August 31, 2017 and you'll qualify for the EaseCentral Partner President's Club celebration in Last Vegas, Nevada this September.  View the flier.


  • HSA Webinar:  Join Benefit Resource, Inc, Thursday, June 8, 2017 at 1:00 ET for a webinar presentation; Be an HR Superhero: Drive HSA Adoption - Case Studies and Best Practices RevealedRegister now!


  • Wearable Technology:  What are the potential HIPAA compliance requirements that may apply when an employer receives health information that doesn't fall into the definition of Protected Health Information (PHI)? View the Alert.

View Document
Carrier & Compliance Updates 5.30.17
by Rosa Tessandori » Wednesday, June 07, 2017 4:53 PM


Producer Online News

  • ·         Cuidado Medico:  LiveHealth Online expanding.  Now members and consumers in 48 states will have access to Spanish-speaking doctors in their plans from the comfort of their home. 
  • ·         2017 Employer Application and Underwriting Guidelines:  Anthem has updated the language in the 2017 Employer Application in the Company Information, General Agreement, and Agent/Producer/Broker attestation sections.



     Small Business Broker Update

  • Relaxed Participation:  The employee participation requirement is just 25%, with a minimum of five enrolled employees. This promotion applies to dental, vision, and life* plans as well, as long as Blue Shield is offered as the sole carrier for specialty plans. View the flier.
  • Start-up Underwriting: Effective immediately, BSC has expanded their underwriting guidelines and will view new small business groups as a start-up based on the hire date of their first eligible common law employee.
  • Age Calculation Correction:  The new hire age calculation error for groups with effective dates prior to 9/1/16 has been fixed. Groups will be corrected as they renew.  Corrections will not be retroactive. Look for additional updates in July.

      Employer Connection Plus Update

  • EC+ Upgrade Rollout:  BSC has simplified and streamlined the renewal and benefit administration processes on EC+.  The new services will be available to select groups which renewed in the first quarter of 2017, and their respective brokers. Additional groups will be added through 2018. Eventually, all small business groups and brokers will have full access to the new services and tools.


E is for ERISA
  • Single-Payer: California is leading the discussion.
  • “Play or Pay”:  It is still in play.
  • Funding: If there are no penalties, revenue has to come from another source.
  • Renewals: 2018 Health insurance renewals will be business as usual.
  • Cost-containment:  Strategies that are gaining in popularity.



  • Teladoc Webinar:  Learn more about the telemedicine industry from a doctors' perspective, Teladoc's Senior Medical Director Dr. Kyon Hood.  Click here to view the recording.
  • Free HealthiestYou Membership:  As a thank you to brokers for viewing the Teladoc national webinar, HealthiestYou will provide you with a FREE Healthiest You VIP membership.  Contact to request assistance in setting up your free membership.


View Document
Carrier Updates 5.22.17
by Rosa Tessandori » Tuesday, May 23, 2017 8:46 AM

  • Member Portal:  View the update regarding the features and benefits of the Member tool, called Aetna Navigator. 
  • MC/PPO "HEAL" Benefit:  Aetna has partnered with HEAL to offer on-demand doctor house calls in two hours or less.  Click here for more info.
  • 8/1/17  Renewals:  As of Friday, May 19th, renewals will be available on the broker website and will be mailed out to groups on Thursday, May 25th.  Employers will be able to access a copy of their renewal through Employer Access (EA) as of Tuesday, May 30th.
     Producer Alert
  • Trio Only Groups - Participation Waiver Program:  Effective 9/1/17, BSC is waiving their participation requirements for groups of 1 to 100 eligible employees with Trio-only membership.  Frequently asked questions (FAQ’S)  will be sent out as soon as they are available.  Groups selecting Trio only for their medical health plans can also add specialty coverage – dental or vision – with the same minimum participation requirements waived! 
  • Updated Materials:  View the Q3 updated product guides, underwriting and marketing pieces.   Special underwriting note:  The additional Proof of Ownership requirements (listed based on business type), are ONLY Required for groups with less than 10 eligible employees –or- groups that don’t submit the Participation Certification Form (regardless of length in time in business).  Click here.
  • Quick Reference Sheet:  View a recap of product options, underwriting notes, commissions, Q3 rate action and network updatesClick here.

View Document
Carrier Updates 5.16.17
by Rosa Tessandori » Tuesday, May 23, 2017 8:36 AM

  • Athena WISDOM Study:  Members who choose to participate in the Athena Mammogram Study, may qualify for advanced testing options.  Blue Shield will send email invitations to potentially eligible members beginning May 8, 2017. Click Here to learn more.

     Broker Connection
  • Form 1095-B:  A new process will be used for collecting IRS 6055 Aggregate Information for 2-50 Small Group New Business.
  • Self-Funded Plan Sponsors:  A PCORI notice is scheduled for All Savers® Clients.  The employer groups will determine which counting method they wish to use, complete and file the IRS Form 720. The Federal Excise Tax return Form 720 can be found on the IRS website.
  • Vision:  The new vision network includes Target and Sears.
  • Sales Automation Management (SAM): The broker sales tool is now available in new markets.
  • Opiod Abuse:  Learn how UHC invests in a multi-dimensional programs to address opioid abuse.
  • PDL Tracker:  View the latest prescription drug list changes.

  • IRS Announces 2018 HSA Limits: To view the announcement, Click Here. The new annual maximum contributions are $3,450 for Individuals and $6,900 for families.

View Document
Blue Shield of CA 9/1 Renewals - Revised Release Date
by Rosa Tessandori » Tuesday, May 09, 2017 9:23 AM

  •  September Renewals: The previously published expected release date for September renewals has been revised from May 12, 2017 to June 16, 2017. Printed copies will be mailed to employers on June 23, 2017. These dates may be subject to further changes. Visit the Renewal Center for future updates.

Carrier Updates 5.8.17
by Rosa Tessandori » Tuesday, May 09, 2017 9:15 AM

  • Producer e-newsletter: View the May 4th, 2017 issue. It includes topics on the Rx 90-day retail network, real-time online enrollment, disability insurance awareness month and encourage employers to learn about wellness incentives.
  • My Anthem (Employer) News: View the May 9th Issue, it includes topics on the wellness webinar updates, tips on choosing a broker, Telahealth insights, unlocking online wellness, Provider Care Management Solutions (PCMS) and the latest in pharmacy news.
  • Wellness Webinar: Invite your employer groups to register for the May 17, 2017, 11:00 a.m. wellness webinar. Small and large group employers are welcome.

  • September Renewals: Renewals will be available for downloading via the broker website May 12, 2017. Printed copies will be mailed to employers on May 19th.  For more information, visit the Renewal Center

  • Trio Rewards: You can start generating your Earned Rewards bonus with a minimum of two new business cases or 500 new medical members or 200 net new Trio members. Click here to learn more.

  • September Renewals: Renewals will be available for downloading via the broker website the last week of June. Printed copies will be mailed to the employer for arrival during the 1st week of July.

  • Broker Webcast: Join UHC May 24, 2017 2:00 p.m. for an overview of UHC4me Sales Tools (focusing on renewals), 7/1 Underwriting Updates, How to Obtain Deductible Credit and more. Registration is not required but space is limited. Click here for details and click here to add to your calendar.


View Document
Carrier & Compliance Updates 5.1.17
by Rosa Tessandori » Monday, May 01, 2017 6:32 PM


      Producer Online News
  • Provider Care Management Solutions (PCMS): New Video educates members on this web-based program.
  • LiveHealth Online: Starting the week of May 1, Anthem individual and group members will get a series of campaign communications from Anthem about LiveHealth Online. Learn how members who sign up for LiveHealth Online during the campaign get a chance to win the grand prize.
  • Life & Disability Quotes: Producer Toolbox life and disability quotes now include a Group Plan Summary page at the end of their quote.
  • Small Group Ace Broker Program: This brochure highlights the benefits of the Anthem Circle of Excellence (ACE) Broker program.

  •  Trio Incentive Program (TIP): Earn an additional $250 for groups and $25 for members enrolling in one of our Trio plans between May 2017 and January 2018. TIP applies to new sales and renewals. View the details and more.
  • AuthAccel Online Tool: There is a new online system for providers to obtain accurate medical and pharmacy authorizations. View the alert.
  • Athena WISDOM Study: This study aims to improve how women are screened for breast cancer. Blue Shield of California is collaborating with UC Medical Centers, and some members may be eligible for benefits to participate in the WISDOM study. To learn more, click here.


     Compliance Update
  • Nondiscrimination Tests: What are they?
  • Form 5500:  is the employer subject to Form 5500 filings?  What is a Welfare Benefit Plan? Who must file a form 5500?

View Document
Carrier Updates 4.24.17
by Rosa Tessandori » Monday, May 01, 2017 6:14 PM

  • 7/1 Rate Action: Average quarterly increase - PPO 3.2% and HMO 7.1%.
  • 7/1 Product Grid: View the updated product grid, which includes the new Silver HSA 2000 (Indv) / 2600 (Fam) Aggregate (Non Embedded) deductible plan.
  • 7/1 Product and Benefit Selection Form: View the updated form.
  • ACEC Program: The American Council of Engineering Companies (association) offers health plans utilizing UHC's National Choice Plus Network. To learn more about this program and benefits for engineering and land surveying based companies, contact your RBG sales representative.

View Document
Carrier Updates 4.17.17
by Rosa Tessandori » Friday, April 21, 2017 6:03 PM


 Producer News Online

  • Q3 Rate Action:  Average quarterly rate increase PPO +3.1%, HMO +2.8% and 0% on specialty benefits.  View the rate guide.
  • Emergency Room Member Outreach Campaign: Take a peek at a few of the campaign examples on how to reduce unnecessary ER expenses.
  • Real-Time Enrollment:  Communications begin in April 2017.  Beginning July 1, 2017, the Anthem standard will be to submit new enrollments, changes and terminations online through EmployerAccess, also known as the Employer Portal.
  • Special Benefits Broker Guide:  Your guide to everything about dental, vision, life and disability.
  • Webinar- Health & Wellness:  Invite your clients to a 30-45 minute webinar Wednesday April 19, 2017, 11 a.m. Pacific Time.


  • Q3 Rate Pass:  No rate increase for medical and specialty plans.
  • "No DE9C":  Program is continued through August 2017.  
  • Relaxed Participation:  Program is continued through August 2017, view the flier.
  • July Renewals:  Kits are available online to download, mailed copies go out to the employer on April 21st.
  • Trio ACO HMO Updates: Incentive program begins in May, dual HMO option alongside Access+ HMO reminder and don't forget to use the Trio Zip Code finder tool.
  • Specialty Benefits:  Additional details coming soon on the Small Business Bundled Savings program.
  • Teladoc: Clients have access to Teladoc upon renewal.  Other value added features include Wellvolution, ID protection, Healthquity and Blue Shields Updated mobile app.


      Producer Alert
  • Quoting Package Update:  Multiple options now included in one proposal.
  • Preventive Screening Changes:  Updated breast cancer and cholesterol screenings and changes to medications for cholesterol and cardiovascular disease.  ACA update on statins eligible for coverage at zero cost-share.
  • Health Discount Program: UnitedHealth Allies offers savings from 10% to 50% on health and wellness related products.
  • Self Funded Specialty Benefits:  View the updated portfolio.
  • Member Websites Enhanced: View the enhancements. 
  • Pharmacy:  View the PDL Tracker recap of changes.

View Document
Carrier Updates 4.10.17
by Rosa Tessandori » Friday, April 14, 2017 3:40 PM

  • Reduced Participation: This promotion has officially been extended through September 30, 2017. The official producer alert and flyer are expected to be released soon.
  • Q3 Rate Pass: BSC announced there will be a rate pass for all third quarter 2017 medical and specialty plans. Rates vary by region and rate tables can be found under Plans & Rates on Broker Connection.
  • Expo: Wednesday April 19, 2017 – Registration at 7:30 am, event from 8:00 am – 3:30 pm. Attend the Sacramento Association of Health Underwriters Business Development Expo. View the Flier.

View Document
Carrier Updates 4.3.17
by Rosa Tessandori » Tuesday, April 04, 2017 10:31 AM


Producer Alert


·         Q2 Amended SOBs and EOCs: Updated documents will reflect endorsements for 15 benefit changes.  Small business customers will only receive endorsements that impact plans to which they subscribe.  A list of the changes is also attached.  

  BLUE SHIELD OF CA 51 – 100

  • Life Insurance Quick Match Program:  Provides streamlined underwriting by matching  renewal rates from the group’s current life insurance company. For New and existing groups adding life with effective dates of April 1 through June 1, 2017.   View the announcement.


  • UHC’s April Webcast:  Registration is not required but space is limited so join early!  Topics will include: ACA Updates, 7/1 CASB Portfolio Changes, ACEC, Ancillary, UBES Free Services (COBRA, FSA 7 PTP), Wellness.  When? Wednesday, April 12 @ 2 p.m. PDT.  View the Flier for details.


  • Single Payer Conference Call/Workshop: CAHU's Vice President of Legislation, Dave Fear, Jr., is calling upon all CAHU members to participate on a conference call/workshop, Thursday, April 6 @ 3:00pm, which will focus on strategies to defeat SB 562 --  current Single Payer legislation.   Please click here and register to ensure your spot on the call!


View Document
Carrier & Compliance Updates 3.27.17
by Rosa Tessandori » Friday, March 31, 2017 6:04 PM


Website Update
  • New Look for BSC: Blue Shield has updated their website, all new pages means all new links. Visit Producer Connection today and get acquainted.

Broker Update
  • Heal™ - In-Home Care Benefit: Blue Shield introduces Heal™, PPO members can access on-demand visits to a member's home, office or hotel. Available in limited areas: Oakland, Berkeley, San Francisco, the Peninsula, San Jose, San Diego, Los Angeles and Orange County.
  • "No DE9C" Extended: Through June 2017 effective dates, groups with 10 or more enrolling in medical coverage can submit a completed and signed Eligibility/Participation Attestation and the billing statement from the group’s prior carrier in lieu of a DE9C.
  • The Trio Qualification Tool: The quick and easy way to see if the Trio ACO HMO plan is a good fit.
  • Renewal Kits: May and June kits are available for download in Producer Connection site.
  • Member Level Changes: Utilize Employer Connection Plus for your adds, terms and changes.
  • Wellness Discounts: See the list of available discount programs and vendors like ClubSport, Weight Watchers, 24 Hour Fitness and more.
  • BlueCard Services: Provide employees with access to quality care with best-in-class solutions worldwide.
  • "NEW" Blue Shield Global: Introducing the new Blue Shield GeoBlue Plans: Global Core, Global Traveler and Global Expat plans available for purchase by Individuals, employers and academic institutions.
  • Trio for Travelers: With Trio, unlike non-Blue carriers’ narrow network plans, members have access to a national and worldwide provider network through BlueCard.
  • Ethics: The Ethisphere Institute has named Blue Shield of California one of the World’s Most Ethical Companies for 2017.
  • Cal Index Becomes Manifest MedEx: Cal INDEX announced it is merging with the Inland Empire Health Information Exchange to create one of the nation’s most comprehensive health information exchanges (HIEs).


Producer News

  • Zero $0 Consultations: Do you have employees with family members not enrolled in the group medical plan? Offer employees access to unlimited free phone consultations with HeatthiestYou (HY). Offer it on a voluntary basis or on a contributory basis, either way it's a great deal! View the Overview flier and Spring Fever flier.


Compliance Alert
  • Excepted Benefits: Discussion of new guidelines affecting Short-Term, Limited-Duration Insurance, Travel-Insurance and Similar-Supplemental-Health Coverage under Excepted Benefit Rules. Click here, to review.

View Document
Carrier Updates 3.20.17
by Rosa Tessandori » Friday, March 31, 2017 5:40 PM


Formulary Updates
  • 2017 Formulary Change Reminder: New groups in 2017 will be accessing the Aetna CA Small Group Value Formulary. Existing business will transition upon their 2017 renewal. To view the formularies, go to:
  • 2017 Quarterly Formulary Changes: Drug list updates will now occur January 1, April 1, July 1, and October 1. These changes will apply to all members on the date of the change. Impacted members will be notified of upcoming drug list changes by e-mail or letter, and updating will be posted on Aetna's web pages.


View Document
Carrier Updates 3.13.17 Part 2
by Rosa Tessandori » Tuesday, March 14, 2017 3:11 PM


Partner News
  • Directors Corner: Thanks from CCSB in increasing sales 26% over 2015 numbers. Expect a spring marketing campaign focused on the Small Business Federal Tax Credit designed to drive traffic to the CCSB website and increase engagement with small business owners. Reminder of the recent changes to the delinquency notice policy.
  • New Monthly Direct Client Communications: In February, CCSB kicked off a new communications initiative targeting active inforce groups. This month, clients will receive a message titled, “Navigating Your Company's Monthly Billing Statement” which educates employers on the most asked about sections of the invoice. For a preview of the March message, click here.
  • CCSB Spring Marketing Campaigns: To view a sample of the optimized Facebook, Twitter, and Google Search content as well as supporting research, reference the CCSB Spring 2017 Campaign Strategy Outline.
  • Tax Credit Postcards: The Covered California for Small Business SHOPWorks program has updated its tax credit postcards just in time for the 2017 tax season. Reference the SHOPWorks Flyer for information on how to order your customizable postcards to target small businesses in your area at little to no cost to you! Get leads by working with a tax professional, To search for a list of tax preparers in your area, visit the California Tax Education Council (CTEC) website.
  • Qualifying Life Event Matrix: If employees or their dependents experience a qualifying life event, they can enroll in a CCSB health insurance plan outside of your client’s normal open enrollment period.  For more information on qualifying life events, reference the Qualifying Life Event Matrix on the Covered California website. 
  • CCSB Responds to Concerns Regarding Delinquency Policy Change:   CCSB has revised the initial delinquency notification policy and will send employers the initial notice of delinquency, but not to employees. Read more here
  • Small Business Health Care Tax Credit: Covered California for Small Business is the only place where your small business clients could be eligible for a federal tax credit. For more information, please reference the CCSB Tax Credits Resources.
  • The Future of Technology in Small Group Health Insurance: In case you missed it, check out “The Future of Technology in Small Group Health Insurance,” an article in the February edition of California Broker by Kirk Whelan, Director of Outreach, Sales, and Small Business for Covered California.
  • 3rd Quarter Rate Update: Effective July 1, 2017 UHC will increase their HMO rates by 7.1% and PPO rates by 3.2%.  To read the full release, click here.
Broker Connection
  • Member Annual Dental Notice: UHC will mail a notice to California health maintenance organization dental subscribers in late March regarding of the procedure for processing and resolving grievances. This mailing is informational only. No action is required from subscribers. 
  • Website Update: Effective April 15, Employer eServices® will no longer support Internet Explorer® (IE) browsers 10 and lower. Newer browsers offer increased security and protection. Users should upgrade their browsers to IE 11 prior to this date. For more information, please contact your UHC representative.
  • New SBC Template Effective April 1: View guidelines for providing the applicability dates and details for the new 2017 Summary of Benefits and Coverage template and uniform glossary. 
  • Annual Privacy Notice: UHC's Financial Information Privacy Notice will be sent to fully insured dental and/or vision plan subscribers beginning late March, as required annually under the Gramm-Leach-Bliley Act. 
  • New "Step-up Preventive" Dental Benefit Design Now Available: A new progressive dental benefit design, "Step-up Preventive," is now available for Dental Preferred Provider Organization and Dental In-Network Only plans.
  • Specialty Medication Prior Authorization Requirement: UHC commercial plans are implementing new notification/Prior Authorization requirements for administration of Exondys-51, Xolair, and Inflectra.

View Document
Carrier Updates 3.13.17 Part 1
by Rosa Tessandori » Tuesday, March 14, 2017 2:23 PM


2nd Quarter 2017 Updates

  • Rate Impact Updates: View details regarding the medical quarterly and annual rate impact, as well as the dental rate changes.
  • Aetna Providence Network: In addition to Santa Clara County IPA and MemorialCare, Aetna is introducing a new collaboration between Aetna and Providence Health & Services that brings the triple aim of accountable care (better health, better care, and better cost) to more members in the greater Los Angeles area for May 1 effective dates.  
  • Open Access Managed Choice Network (OAMC/MC):  View the latest network additions in the Los Angeles area.
  • Underwriting: No current underwriting updates.
  • New Business Submission Deadlines:   The cut-off date is the 1st of the month, groups received after the 1st of the month are considered a late submission and will be moved to the next effective date. 


  • Anthem Broker News Sign-Up:  Sign up to receive any new or late breaking news via email by clicking on the below link and entering your name and email address.  Visit the Anthem Email Preference Center to sign up or update/change your email preferences at anytime.
  • Formulary Update:  Beginning March 1, Anthem individual and employer-sponsored health plans will cover the authorized generic (AG) form of EpiPen on Tier 1. This change applies to the National, Essential, Preferred, Generic Premium and Select Drug Lists.  Epinephrine coverage for emergency treatment of allergic reactions, including anaphylaxis.  For additional information,  click here to view the full Sales Call announcement.


Producer Alert

  • The Trio Qualification Tool:   Trio ACO HMO plans offer integrated care with lower premiums and out-of-pocket costs than most of their non-ACO plans. Also, you now have an easy way to check if the Trio service area is a fit for your clients – the Trio qualification tool. Watch the one-and-a-half minute video demo to see how quickly and easily the Trio qualification tool can match the Trio service area to your client's employee census. The tool also displays which medical groups would be assigned to employees based on their ZIP code.  Learn more about Blue Shield’s Trio plans and use the tool at

Producer Alert

  • Corporate Office is Moving:  Blue Shield will move its corporate headquarters from San Francisco to Oakland.   The move will take place in mid-2019, and nearly all executives and staff will move from 50 Beale Street in San Francisco to the new location at 601 12th Street in Oakland.   This move is designed to reduce administrative costs while we position ourselves to grow in membership. 

View Document
Carrier Updates 3.6.17
by Rosa Tessandori » Wednesday, March 08, 2017 10:53 AM


  • Easy Renew:    Visit, your one stop shop to access the 2017 Underwriting Guidelines and so much more.
  • Dual PPO Network Option:  Reminder that the promotion ends 3/15/17.
  • Renewing Groups:  Want to add or downgrade a medical plan?  Change the anniversary month? Want to know when the changes can be effective and what forms to use?  Refer to pages 19-22 of the January 2017 Underwriting Guidelines for general instructions.  Reminder, requests for anniversary changes must be received by Anthem generally no later than the 15th of the month prior to the requested effective date. 


Broker Update -Small Group

  • Message from the Senior Vice President
  • Bronze Plans Highlights:  The Bronze 5100 PPO now includes three office visits prior to the deductible, providing greater value for your clients. Previously the Bronze 5100 plan required members to meet their deductible for office visits (outside of preventive care). The Bronze Full PPO Savings 4500 & Bronze Full PPO Savings 5500 plans can be integrated with H.S.A. Administration services provided by Health Equity.
  • Sorela Health:  Lifestyle coaching  geared toward reducing the risk of type 2 diabetes. Blue Shield members can be referred by a physician and can also enroll in any program after completing a risk assessment at
  • New Palliative Care Program:  In January, Blue Shield of California began offering their fully insured Sacramento-area plan members a new, home-based palliative care program as a benefit.   For more information,  read the press release announcing the new program, available on Blue Shield’s Media Center.
  • Updated Broker Portal:   Producer Connection will now be Broker Connection and is being updated and upgraded. 
  • Post Enrollment Materials: Once your clients’ post-enrollment materials for any respective month are ready, they will be posted on Shield Renewals in our Renewal Center,
  • Updated Forms for Q2:  The Master Group Agreement (MGA), Employee Enrollment Form, Request for Contract Change and Subscriber Change Request forms have been revised for Q2 2017.  Submissions using outdated underwriting forms will pend until the updated forms are submitted. You can find all of the up-to-date materials at Producer Connection - Forms.
  • Teladoc Member Email Outreach: New and renewing groups members can save time and money by using the embedded Teladoc benefit.   View the Teladoc flyer for more information.   Members in groups with January and February 2017 renewal or effective dates will receive emails from Teladoc on how they can begin using this service.
  • BSC Vision Plans:  BSC offers one of the largest vision provider networks.  Click here, to access rates and plan information.
  • ID Monitoring: Blue Shield medical plan members can now get identity protection services such as identity repair assistance, identity theft insurance, and credit monitoring, offered at no charge. 


Partner Alert

  • Delinquency Policy:  Employees will no longer receive a CCSB delinquency notice when an employer has missed their initial payment deadline.   

View Document
CaliforniaChoice Retro 1/1-6/1 Benefit Changes
by Rosa Tessandori » Wednesday, March 08, 2017 10:04 AM


Benefit Changes Retroactive 1/1/17 - 6/1/17

To comply with California Department of Managed Health Care requirements, various plan benefits were retroactively revised. CaliforniaChoice emailed employers a list comparing the incorrect quoted benefits vs the final corrected benefits,
 click here to view the list.  Rates for these plans did not change.

Plans quoted through EBIX/HealthConnect prior to February 24, 2017 and plans quoted through the CaliforniaC The 1/1/17 – 3/1/17 SBCs, EOCs, Employee Enrollment Guides and Benefit Summary Guides previously available on the CaliforniaChoice website  may contain incorrect plan information. Corrected documents will be posted once received.  The 4/1/17 – 6/1/17 documents are not yet available, but will contain the correct plan information once posted on the CaliforniaChoice website. hoice quote system prior to 12:00 pm on Tuesday February 24, 2017, contain the incorrect benefit information.  

CaliforniaChoice and the applicable carriers, are not sending members a notification of the change.  Employers are responsible for notifying affected members.   Employees enrolling or renewing who are affected by the benefit changes and may have received a CaliforniaChoice quote, Enrollment Worksheet, SBC, EOC, Employee Enrollment Guide or Benefit Summary Guide containing the incorrect benefit information, should be provided the following two documents:

Members remaining enrolled in a plan affected by a benefit change, will automatically have their claims reprocessed and a revised Explanation of Benefits (EOB) will be mailed out to the member as applicable.

Members affected by a retro benefit change can request a plan change.  However, all requests are subject to review.  Requests should be submitted as soon as possible.  

For instructions on how to submit a plan change request, for a side by side comparison quote of the affected plans, or if you have any other questions or concerns regarding this matter, please contact your Rogers Benefit Group Sales Representative or email/call our main office. 

View Document
Carrier Updates 2.27.17
by Rosa Tessandori » Wednesday, March 01, 2017 9:49 AM


  • Health Net Off Cycle Rate Change:  Effective May 1, 2017, Health Net has issued off cycle second quarter rate changes that will impact Covered California for Small Business renewals and new business with effective dates of May 1, 2017 and June 1, 2017. April rates will not be affected.

  • Specialty Medications:  Effective Jan. 1, UHC requires prior authorization for the new specialty medications: Probuphine (buprenorphine) subdermal implants, Cinqair® (reslizumab) and Nucala® (mepolizumab), Ocrevus™ (ocrelizumab), and Gonadotropin-releasing hormone analogs.  For more information, visit UHC's Specialty Pharmacy Information Center or contact your UHC representative.
  • 2017 Specialty Product Bonus Program:  Earn bonuses on new and renewing sales of dental, vision, basic life, supplemental life, short-term and long-term disability, critical illness protection, accident protection, and hospital indemnity protection.  View the bonus brochure.
  • Broker Webinar Training: Learn more about UHC's quoting tools and other broker resources on United eServices®  Date:  Tuesday, Feb. 28.   Time:  11 am to Noon  ET.  Register here. 
  • Employer Webinar Training:   Your clients can better administer their benefit programs on Employer eServices® by attending a UHC informational webinars.  Groups 2-99 Thursday, March 9, 2017 at 11 a.m. ET.  Register here .  Groups 100+ Tuesday, March 14, 2017 at 11 a.m. ET.  Register here.  Note:  Dial-in information will be sent via email three to five days prior to the webcast.
  • Telemental Health:  To improve access to care, Optum Behavioral Health has expanded its telemental health network to over 3,000 behavioral providers including AmWell and Doctor on Demand psychologists and psychiatrists. For more information, click here.
   Webcast Invite
  • Webcast Wednesday, March 8th at 2:00 p.m. (Pacific):  UHC's Northern California 1-100 Sales Team will be hosting a 2017 Webcast for their GA and Broker partners.  Registration is not required but space is limited, so please join the webcast early. Please refer to the attached flyer for details. The following topics will be discussed during the Webcast:   2017 Portfolio Refresh, How to Submit a Renewal, How to Use United eServices, and Upcoming SBC Changes. 

    View Document
    Carrier Updates 2.21.17
    by Rosa Tessandori » Friday, February 24, 2017 1:48 PM


    • Updated CA SB Toolkit: The attached Benefit Grid Toolkit includes slight updates to the HMO plans approved by the Department of Insurance and the Department of Managed Care.


    Producer Online News

    • Oroville Dam Emergency: To assist members impacted by the Oroville Dam emergency, Anthem has relaxed some of their guidelines for; filling an Rx, time limits on prior authorizations/pre-certification/referral requirements, replacement of DME that is damaged or lost, and has extended claims filing deadlines. Refer to the announcement for applicable dates and a list of plans/coverages excluded from the relaxed guidelines. For additional information or support, members can call the Member Services number on their ID card or select Customer Support on the Anthem website.


    Producer Alert

    • 1099-INT Forms: In January 2017, Blue Shield of CA sent some members a 1099-INT form in error. The forms were meant for providers. Members will receive a letter next week, with a corrected 1099-INT form. Blue Shield did not send or report any information on the erroneous 1099-INT to the IRS, so members do not need to take any action.


    • New 4/1/17 Network Availability Grid: This new comparison provides a snapshot view of the CaliforniaChoice carriers with a listing of plans by tier and their network assignments. It’s a quick, easy way to see how the dozens of plan options under CaliforniaChoice break down by PPO, EPO, HSP, HMO, and carrier. View the announcement and access a link to the comparison.


    • 2017 DME List: All Kaiser Small Business plans cover “base” durable medical equipment items that are essential health benefits. View the attached flyer, for a list of plans that cover “supplemental” durable medical equipment.

    View Document
    Carrier & Compliance Updates 2.13.17
    by Rosa Tessandori » Monday, February 20, 2017 2:35 PM


    Producer News Online
    • Metallic Dental Complete PPO Plans: Sold only through California general agents effective April 1, 2017. For details, view the metallic dental plan details flier. Your RBG Quote team is ready to assist with requests for a Metallic Dental Complete PPO quote. Don't forget about Anthem's 5% bundling discount.
    • 2017 Commission Payment Schedule: The schedule shows the key dates in 2017 when your commission statements will be posted on your producer website, when electronic fund transfers (EFT) will take place (for those on direct deposit), and when commission checks will be mailed (for those not on direct deposit). View the schedule.
    • Blue View Vision: Reminder, quote using enrolled lives, not eligible lives. 
    • Dual PPO Network Option Promotion Ending Soon: Effective March 15, 2017, the Dual PPO Network Option Promotion* for new Small Groups will end. Submit forms for renewing or already renewed groups before the deadline. 


    Producer Alert
    • Employer Connection Plus (EC+): Tips, in case an employer is having trouble logging into the site.
    • 1095-B Forms: Members should have begun to receive their form as of February 6.


    Broker Notification
    • Network Availability by Carrier & Plan Summary: Download a copy and easily compare 4/1/17 plans, networks and metal tiers.

    Tailored Benefit Bundles 
    • Simply Smart: Bundles dental and vision for groups 10-99. View the pre-built MetLife simply Smart Bundles.
    • MetLaw: Simply Smart Bundles also gives you the exclusive option to offer a voluntary legal services plan for groups 10-99.
    • 2-year Rate Guarantees: Lock in pricing for your clients for 24 months across bundled products.
    • Multi-Product Bonus:  Sell a dental plan and at least two new coverages and earn an additional one-time payment of 1.5%.  View the details. 

    Compliance Notice
    • It's The Law: TASC can help you stay protected all year, every year with their wide selection of compliance services to handle the work and worry for you. Let TASC be the compliance expert so you don’t have to. View info on the eight different pre-packaged compliance bundles.


    Compliance Alert
    • FMLA and Benefits Plans: This article examines the rules for participants going on an unpaid Family and Medical Leave Act (FMLA) leave. Regulation 1.125-3 summarizes employees’ rights to continue or revoke coverage and cease payment for Healthcare flexible spending accounts (FSAs) when taking an unpaid FMLA leave and specifications for participants returning from leave.  

    View Document
    Carrier Updates 2.6.17
    by Rosa Tessandori » Tuesday, February 07, 2017 11:11 AM

    January Broker Update
    • Note of Thanks: Jim Elliott (VP & GM Core Accounts, Small Business Market, Producer & Channel Partner Relations) extends his thanks to the broker community.
    • Employer Connection Plus (EC+): The Blue Shield of CA online employer portal, is removing from the website the ability to submit enrollments that are due to loss of coverage or due to court orders. Instead, administrators will be required to submit these enrollments via paper. Blue Shield of CA will provide a notification when this change is implemented and reflected on EC+. 
    • SGOR Tool Online: The Small Group Online Renewal Tool is up and available for use to submit contract changes online.
    • 1095 Forms: BSC will mail members their copies of the 1095-B form by January 31, 2017. Employers may request a copy of the 1095-B forms to assist with filling out the employer 1095-C forms by calling Employer Services at (800) 325-5166.
    • Q2 - What’s New 4/1/17: View the guide for details. 
    • April Renewals: Visit the Renewal Page on Producer Connection to download your clients’ renewal kits.
    • Trio Network: Visit for a complete listing of Trio covered zip codes and ACO providers. Areas with recent network expansion include San Diego, Riverside, San Bernardino, San Mateo and Nevada Counties.
    • 2016 Medical Loss Ratio Rebate (MLR) - Employer Survey: In December 2016, Blue Shield emailed the 2016 Medical Loss Ratio (MLR) employer survey to fully insured client groups (small and large). On February 6, 2017, Blue Shield will resend a copy of the 2016 Medical Loss Ratio (MLR) employer survey letter to fully insured client groups that did not respond to the original survey request. Employers can provide the requested information by going to or by faxing the form back to (855) 895-3497. Survey information is required by February 24, 2017.
    • Teladoc: Is now included in all new 2017 plans and upon renewal for existing groups. Teladoc is a cost-saving service with $5 copays for most plans (except HSA's). Find out more about Teladoc.
    • Wellvolution: Is now included for groups effective and renewing as of November 1, 2016. This service is available for members 18 years of age and older. Wellvolution assists members with measuring their well being and in addressing specific health concerns such as preventing diabetes. Visit for more information (login required).
    • Diabetes Prevention Program (DPP): The DPP can help members lose weight, adopt healthier habits and reduce the risk of developing type-2 diabetes. This benefit is available at no cost to members and is included in all medical plans upon renewal, beginning November 2016. Visit for more information.
    • Quitnet: Effective January 1, 2017 for all groups, regardless of the renewal date, will include nicotine replacement therapy (NRT) at no additional charge.

    Quoting Updates
    • Two New Enhancements: You can now create a "New Hire" Worksheet and run table rates with contributions.

    View Document
    Carrier & HR Compliance Updates 1.30.17
    by Rosa Tessandori » Monday, January 30, 2017 2:53 PM

    Health Equity Employer Portal Webinars
    • Webinar Dates: Join Health Equity, Blue Shield of CA's HSA partner, for an introduction to their employer portal. Health Equity will demonstrate the key functions of the Employer Portal including the various options for making contributions. Please register for the date that best suits your schedule.

    4/1/17 New Plan Options
    • 5 New Plan Options: Effective April 1, 2017, the following new plans have been added to the California Choice portfolio: UnitedHealthcare (UHC) HMO C: Bronze Metal Tier, Alliance Network; in southern California Sharp Health Plans: HMO D: Bronze Metal Tier, Premier Network; Sharp Health Plan: HMO C: Silver Metal Tier, Premier Network; Sharp Health Plan: HMO C: Gold Metal Tier, Premier Network; Sharp Health Plan: HMO C: Platinum Metal Tier, Premier Network. View the Private Exchange Guide and Fast Facts Flyer.

    Program Highlights and Guidelines
    • Highlights: Choice Builder® offers employers with 2-199 employees the nation’s premier dental, vision, chiropractic, and life carriers: Ameritas, Anthem Assurity, Delta Dental, Eye Med, Landmark, MetLife and VSP. In addition, groups receive access to two value add services, the Cal Perks entertainment discounts and the HR AsnwerLink HR Support Center Library.
    • Guidelines: Employer eligibility at initial enrollment requirements, plan availability, new hire waiting rule options, orthodontia availability and plan comparison of plans.

    From the News Desk
    • Executive Order: President Trump signed an Executive over for minimizing the ACA’s fiscal burdens. For employers, the effects of the Executive Order will not be immediate. Employer obligations under the ACA, such as the employer mandate and reporting, cannot be undone without revising regulations. For now, the employer mandate and employer reporting requirements remain in effect and employers should continue to comply with all provisions of the ACA.

    Federal Law Alert
    • OSHA 300A Forms Must Be Posted by February 1: The Occupational Safety and Health Administration (OSHA) mandates that all employers who are required to maintain the OSHA 300 Log of Work-Related Injuries and Illnesses post a summary of the previous year’s log between February 1st and April 30th each year, even if no incidents occurred in the preceding calendar year.

    View Document
    Carrier & HR Compliance Updates 1.23.17
    by Rosa Tessandori » Monday, January 30, 2017 2:41 PM


    Agent Newsletters
    • Identity Protection Services Due to Expire Soon: Individuals impacted by the 2015 cyber attack against Anthem were offered two years of AllClear ID Credit and Identity Theft Monitoring Services (called PRO). That two-year time frame is coming to a close.
    • January MyAnthem News: The January issue of our employer newsletter is now ready for your Small Group clients.
    • California Medi-Cal,  What You Need to Know: California’s Medicaid program is called Medi-Cal. Medi-Cal is free or low-cost health benefits for children and adults with limited income resources. Find out more about how this program works and how it may help your Individual clients.


    Producer Alert - 2nd Quarter Product Cycle
    • Rate Action: PPO 0.8% increase and HMO 4.3% rate increase. 
    • Continued Easier New Group Installation: Through April 1, 2017, groups can choose either no forms for employees enrolling in an other carrier's HMO or no DE9C - for groups with 10 enrolling employees that complete an Eligibility/Participation Attestation form. 
    • Relaxed Participation Guidelines: Available through June effective dates. Requires only 25% employee participation (minimum of five enrolled employees for medical plans).
    • Renewals Online: April Renewal Kits are available online on the BSC Renewal Site. Submit member level changes through Employer Connection Plus. Kits will be mailed to clients January 20th. The Small Group Online Renewal (SGOR) tool will be available in mid-February for Q2 renewal changes.
    • Benefit Summaries: Benefit Summaries are being updated on Producer Connection to reflect some benefit changes pending regulatory approval. When approved, details of these endorsements will be sent to you soon in a separate communication. The Spanish versions of the 2017 Benefit Summaries have not yet been updated to reflect these changes, but we expect to have them also posted on Producer Connection by the end of January.
    • Trio ACO HMO: The Trio ACO HMO network continues to be expanded with new providers and in new regions. to see if your clients are in a Trio coverage area. The Trio ACO plans can be offered alongside the full Access+ HMO® network for greater member options.
    • Dental Network Expansion: BSC continues to expand their PPO provider network and has the second largest dental HMO network in California. Specialty rates remain steady making it the perfect time for employers to offer specialty benefits alongside Blue Shield medical plans or on a standalone basis.
    • Value Adds: Remember that clients have access to Teladoc, Wellvolution, ID protection, HealthEquity, and Blue Shield’s updated mobile app. Your clients can learn more about these programs and take advantage of them by visiting

    • Retro Changes - Extended Deadline: For new and renewing 12/1/16 and 1/1/17 groups, to ensure that all of their customers are set up correctly, UHC is extending the deadline for eligibility changes from 30 days to 60 days. The deadline for December 1, 2016 eligibility changes is January 31, 2017 and the deadline for January 1, 2017 eligibility changes is February 28, 2017. This opportunity is time sensitive and no further eligibility corrections will be made once the extended deadlines have passed. Outside of these two effective dates the normal 30 day limit will apply.

    HR ANSWERLINK - HR Support Center

    Federal Law Alert
    • New Form I-9: The new Form I-9, released November 14, must be used as of Sunday, January 22, 2017.

    View Document
    Carrier Updates 1.17.17
    by Rosa Tessandori » Friday, January 20, 2017 10:19 AM

    • Second Quarter Rates Available for Quoting: Rate pass for both PPO and HMO. For renewing groups, the average net rate effect for all regions combined will be 1.1% increase for PPO and on average a decrease of -3.0% for HMO.

    Producer Alert
    • Merger - New Comprehensive Health Info Exchange: The California Integrated Data Exchange (Cal INDEX, founded by Blue Shield of California and Anthem Blue Cross) and Inland Empire Health Information Exchange (IEHIE) today announced a planned merger that will create one of the nation’s most comprehensive nonprofit health information exchanges (HIEs). HIEs help improve the quality of the patient experience, support collaboration and coordination and improve efficiencies. HEIs will also make it easier for doctors, hospitals and other care providers to securely review, analyze and share medical information across the health care system.
    Producer Alert
    • Second Quarter Rates Available for Quoting: Rates for Q2 effective dates are available for quoting and downloading. PPO will experience a 0.8% across all regions. HMO will experience 4.3% increase across all regions. 
    • April Renewals: Kits are available for downloading on 1/13/17. Member level changes can be submitted through Employer Connection Plus starting 1/18/17. Printed renewal kits will be mailed out on 1/20/17.


    New Carrier
    • MetLife: If your new and renewing groups are considering Dental for 4/1/17 (or later), they now have a new option, Choice Builder. MetLife is joining Choice Builder with three Employer-sponsored Dental PPO plans and one Voluntary Dental PPO plan. View the Delta Dental and MetLife comparison.
    • Second Quarter Rates Available for Quoting: Great news, UHC CA Small Group 1-100 will be having a Rate Pass Q2 2017.

    View Document
    Carrier Updates 1.9.17
    by Rosa Tessandori » Wednesday, January 11, 2017 10:10 AM

    Producer Alert
    • Sutter Health Contract: New 3-year agreement signed effective January 1, 2017!

    Partner News 
    • Enhanced Agent Portal: Website improvements are expected for release in the first quarter of 2017. Expected enhancements will include processing client renewals, submitting eligibility changes, access commission information and other time saving capabilities.
    • .Enhanced Employer Portal: Later in the year, employers will be able to pay premiums online, update employee information, download side-by-side comparison worksheets of their benefit plan options and much more.
    • Nonpayment of Premiums - Policy Change: Effective January 1, 2017, the statement of consequences will be enclosed with the employer's invoice and serves as the first notice of delinquency.
    • Carrier ID Cards: Carrier partners of Covered California for Small Business are now given the option to either continue printing ID cards with the Covered CA logo or remove the logo altogether. Thus far, Blue Shield of California (PPO plans only) and Health Net have confirmed that they will remove the Covered CA logo from their ID cards in early 2017.
    • No Out-of-State Participation Requirements: Covered California for Small Business has eliminated membership participation requirements across states, so long as the business’s headquarters are registered in California.
    • General Agent Partners: GA's are here to help, readily available services include: prospecting, pre-screening, underwriting, quoting, pre and post-sales support, enrollment, customer service, renewal support and other resource materials.
    • PEO's: CCSB is a great place for placing your Professional Employer Organizations, read the alert and see why.
    • Updated Eligibility Guidelines: The Covered California for Small Business Enrollment & Eligibility Guidelines were recently updated and are now available for download under the Agent Sales Tool Kit.
    • 2017 Health Plan Change Summary Now Online: View a side-by-side comparison of the 2017 plan benefits, 2017 Health Plan Change Summary.
    • Customized New Hire Employee Worksheets: Receive a customized new hire worksheet within 48 hours of your request.

    View Document
    Carrier Deadlines for January 1, 2017 SG Contracts
    by Rosa Tessandori » Wednesday, January 04, 2017 9:36 AM

    If you have not yet submitted your 1/1/17 small group cases, please submit your case(s) as soon as possible. This will allow the RBG underwriting department the opportunity to scrub the group and request missing information prior to submission to the carrier.

    Several carriers now require us to submit groups via their carrier portal, which extends the amount of time needed for our office to meet the carriers' deadlines for submission of new groups.

    RBG must submit your January 1, 2017 Small Group Case(s) to the applicable carrier by the following due date and time*:

    Due January 9th by 12:00 p.m.
    o Blue Shield of California

    Due January 9th by 5:00 p.m.
    o Anthem Blue Cross of CA
    o California Choice
    o Kaiser Permanente
    o United HealthCare

    Due January 11th by 5:00 p.m.
    o Covered CA**

    Due January 13th by 5:00 p.m.
    o Choice Builder**

    *Aetna submission cut-off date was December 30, 2016
    ** Special Extension

    At the time of submission to the carrier, the group must be "complete". A "complete" submission must include all required documents such as: the employer application, reconciled DE-9C (when required), employee applications, ownership documents and a binder check (if required).

    Carriers are also expecting that the group will be "clean" and not require needing to obtain a long list of missing information. Any grace period for missing information will be determined by the carrier upon recipient and review of the case.

    We greatly appreciate your business during this busy time of year and your assistance in meeting the carrier deadlines.

    View Document
    Carrier Updates 1.3.17
    by Rosa Tessandori » Tuesday, January 03, 2017 8:37 PM


    • Annual Notifications: Insured subscribers (excludes Shared Advantage, ASO, Medicare, and FEP) will receive the annual notification notice (attached) by December 31, 2016. The annual notice helps Blue Shield to satisfy federal, state, and NCQA/HEDIS requirements for notification to subscribers. The communication covers the following topics: standards for timely access to care, personal benefits information, preventive health guidelines, member rights & responsibilities. It also includes information on programs to help manage chronic conditions, quality improvement and patient safety, utilization management, and case management as well as information on language assistance, privacy practices, filing grievances, becoming an organ donor and coverage for mastectomy-related services for breast cancer. 

    Producer Alert
    • Sutter Health Contract: Negotiations continue, but the existing contract has expired and Sutter Health is no longer a Blue Shield in-network provider as of January 1, 2017. In the interim, Blue Shield and Sutter Health have agreed to a six-month transition period (through June 30, 2017) to help ensure uninterrupted care for members. For members with questions about Sutter Health and their access to care, Blue Shield has set up a dedicated phone line (888) 852-5345 from 8:00 a.m. to 5:00 p.m. Monday through Friday to address their concerns. View the notice for additional transition details.   

    View Document
    Carrier & Compliance Updates 12.27.16
    by Rosa Tessandori » Friday, December 30, 2016 12:55 PM


    Online News
    • Limited Promotion - Dual PPO Network Option Effective 1/1/17 through 3/15/17: New, renewing and groups requesting an early renewal, can offer both the Prudent Buyer and Select PPO network plans for a limited time.


    From the President's Desk
    • Message to Brokers and Employers: Emails were sent to brokers and employers with a message reassuring them that despite any changes the Trump administration may bring to healthcare reform, that small group health insurance benefits through CaliforniaChoice are safe. In addition, the notice to brokers also included a notification that effective 4/1/17, Aetna will no longer be a contracted provider.


    Compliance Update
    • CA State Automatic-IRA Effective 1/1/17: The Automatic IRA has been proposed as a way for the roughly half of U.S. workers that are not offered a 401(k) or any other type of employer-sponsored plan to save for retirement. However, in California, enrollment is postponed until regulations governing the program are adopted. The California program, titled the California Secure Choice Retirement Savings Program, phases in participation based on employer size. In addition, the DOL safe harbor prohibits employer contributions to auto-IRAs and requires that employers fulfill only “ministerial” (clerical) tasks. Note, employers always have the option of maintaining their own plan. Noncompliance may result in penalties and voluntary participation in Auto-IRA Program may create an ERISA plan.

    Compliance Alert
    • New Type of HRA for Employers with less than 50 FT Employees: On November 13, 2016, President Obama signed the 21st Century Cures Act. Among a variety of healthcare provisions, this legislation establishes a new type of health reimbursement arrangement (HRA) called the Qualified Small Employer Health Reimbursement Arrangement (QSEHRA). The provisions for QSEHRAs are effective for plan years beginning on or after January 1, 2017. 

    View Document
    Carrier Updates 12.19.16
    by Rosa Tessandori » Thursday, December 22, 2016 10:15 AM


    Producer News Online
    • Small Group Q4 2016 Update - From the desk of Joe Greenberg:  Read a short synopsis on Anthem's success in Q4-2016 and 2016 overall, as well continued expansion of services and tools in 2017. Via the Anthem Educational Blog, you can keep up to date with Anthem's new communication outreach program for new group administrators and continued political updates and other news 
    • 2017 H.S.A. Plan Changes: The 2017 Silver H.S.A. plan will have a three tier deductible and three tier out-of-pocket maximum (OOP). In addition, the deductible and OOP will now be embedded. RBG side note: The current version of the benefit summary contains an error in the footnote section which is expected to be corrected in the coming weeks. The footnote erroneously indicates that for a family "one member must satisfy their individual deductible and one member, (either same or other family member) must satisfy the individual out of pocket amount. Click here to view the summary.
    • December Webinars: No RSVP required, just click to join the meeting at the scheduled time. Small Group updates 12/22 9:30 a.m. PST, click here and LiveHealth Online 12/28 9:30 a.m. PST, click here. Test the links before joining.
    • Online Small Group Renewals: Renewals are now available online, but groups must first register on EmployerAccess. View the flier.
    • Online Tool Enhancements: View reports to identify who is turning 26 or 65 up to one year in advance; Dental and vision quote updates; Enhancement to the Small Group Details screens; Bill History screen enhancements and more.

    Broker Update
    • Client News: Responding to ACA questions following the presidential election.
    • Broker Tools: ABC's and 123's of HMO's and PPO's - Health care basics for your clients and the 2017 updated MGA.
    • Reminders: Broker of Record changes; CVS flyer - the sequel; Renew all of your Q1 clients now. 
    • Member Benefits: Find a doctor and holiday gifts with the Blue Shield mobile app; Viva la Wellvolution!; and Teleport to a physician with Teladoc.

    Broker News
    • 2017 Santa Cruz County - Small Group Bonus Program: Eligible groups need a physical headquarter address in Santa Cruz County. Note: Some groups headquartered in Monterey County that have employees living in Santa Cruz County also are eligible. The bonus program runs from January 1, 2017, to June 1, 2017. The bonus amount is $50 per Kaiser Permanente member (based on the member count as of the effective date for the new group). The bonus applies to all channels (including Covered California Small Business and California Choice).

    Broker Connection
    • Various Updates: View the Prescription Drug List (PCL) changes for 1/1/17-6/30/17; IRS Extends Deadline for form 1095, the new deadline is March 2, 2017, however the deadline for 10945 reporting has not changed; Learn about the UHC weight loss program for groups 51+; New Musculoskeletal value-based care payment program; Value-based Care report results; The Member Disclosure Notice was mailed the week of November 28; and read about the origination and prevention of opioid abuse.
    Important Billing Update 
    • Remittance Mailing Addresses Change for Non-Medical: Per the notification included in the July 2016 Invoice mailing, the mailing address for UnitedHealthcare Life, Disability, Critical Illness and/or Accident Coverage has been changed. View the update for the new mailing addresses for regular and overnight mail and handling of checks mailed to the old address.


    • Compliance Corner: COBRA Q&A; 2016 IRS instructions for reporting COBRA coverage on 1094 forms; 2017 FSA plan limits; and PCOR fees rise.
    • News & Trends: OCR pays closer attention to small HIPAA breaches; and Better informed employees make better benefit choices.
    • Behind the Scenes: WageWorks holiday supply drives for local charities

    View Document
    2016 Holiday Schedule
    by Rosa Tessandori » Thursday, December 22, 2016 9:57 AM

    View Document
    HR On-Demand by HRAnswerLink & RBG Discounts
    by Rosa Tessandori » Thursday, December 22, 2016 9:43 AM

    HR AnswerLink:  HR Support Center and HR On-Demand
    Looking to provide your clients an additional service that increases your value to them while having it pay for itself?

    Make yourself indispensable, offer your clients and prospects access to HRAnswerLinks' 24/7 HR Support Center Library, and then let it help pay for itself through subscriptions to HR On-Demand - which provides live HR consulting, or you can choose to pay for your clients' HR On-Demand subscription at a special broker discounted rate.
     Rogers Benefit Group offers agents an affordable discounted package: 
    • $99 HRAnswerLink Setup Fee - provides an HRAnswerLink site branded with your logo.
    • $100/month subscription - allows you to share the HRAnswerLink 24/7 library, the HR Support Center, with 100 users at no additional charge. It also provides broker access to the HRAnswerLink upgrade package which includes the: Analytics Dashboard, Website Marketing Tools and Prospect Communications Tools
    • Allow clients to upgrade their HRAnswerLink subscription to include HR On-Demand at a discounted rate of $39/month/user, while you earn a %15 revenue share per subscription, or provide HR On-Demand to your clients at the special broker discounted rate of $19.50/month/user.

    What does the HR AnswerLink 24/7 HR Support Center include?
    • Templates to create your own customizable employee handbook and job descriptions
    • Quick guides and checklists on common HR topics, including Health Care Reform, Hiring, Termination, and more
    • Extensive, easy-to-understand federal and state law libraries
    • Training videos and HR podcasts on various HR Topics
    • 3-minute HR audit to help quickly identify HR compliance gaps
    • Weekly HR Snapshot emails featuring a Q&A on trending HR topics.
    • Timely HR Articles

    What does HR On-Demand include?
    • Unlimited live “Ask the Pro” consulting
    • Employee handbook development
    • Custom job descriptions and HR documents
    • Free quarterly harassment prevention training
    Interested in learning more?
    • Watch this two-minute video, and
    • Reply to this email/RBG Tip Sheet, or email your RBG sales representative

    View Document
    Carrier Updates 12.12.16
    by Rosa Tessandori » Thursday, December 22, 2016 9:37 AM


    Broker Update
    • Secondary Contract Changes - To submit secondary changes during the same renewal period for groups already renewed online through (SGOR), email or fax a completed Request for Contract Change form with a note indicating “Unable to submit via SGOR”. Submit changes via email to or by fax to: 855-808-8598.
    • Pending Enrollment for New Members - Delays in processing applications may result in members incurring out-of-pocket expenses. Once installed, members can file a medical or Rx claim, view the Broker Update to access links to forms. Once members have registered, submitted claims can be tracked via the Blue Shield Mobile app.


    Partner News
    • Santa Cruz – CCSB is a winning combination in the Santa Cruz area.
    • 51-100 Group Segment – Read the article titled “The Evolution of ‘Large Group’ and Its Opportunities.”
    • 2017 Health Plan Change Summary – This summary provides a side-by-side comparison (year-to-year) of health plan benefits.
    • 2017 SBCs – Visit to download copies today. 
    • Employee Only Contracts – Offering an Employee Only contract allows family members who qualify, to continue qualifying, for and Advanced Premium Tax Credit (APTC). Groups with 50 or more FTEs, the contract must include coverage for the employee and child(ren). Note, no employer contribution is required for child(ren) coverage.
    • Customized New Hire Employee Worksheets – Receive a customized new hire worksheet within 48 hours of your request.
    • Payroll in Lieu of DE9C for New Businesses – Don’t have a DE9C because your group is too new? Not a problem, in lieu of a DE9C, submit 2 weeks of payroll.
    • Big Shifts in Plans Effective 1/1/17 – View what’s expanding and what’s going away.
    • Special Enrollment Period (SEP) – Deadline to submit an SEP group is December 15, 2016.
    • Broker Incentive Program -The fourth quarter Agent Incentive Program, combines sales for multiple agents from the same agency. The program ends January 1, 2017.

    Small Business Employer Briefing
    • Online Account Service Tool – View the new employer dashboard, it shows key account information at a glance. 
    • Retro Terminations – Kaiser will not retroactively terminate subscribers prior to the month the request to terminate is received. All subscriber terminations will be effective in the month Kaiser receives the termination request (i.e. if received by 8/31, the term can be retro to 8/1), or a future term date if requested.
    • Employer Identification Number (EIN) – View the MEC Reporting Guide to learn more about Kaisers’ ACA EIN and SSN/TIN data collection procedures.
    • Current Forms – Visit for the most current form and avoid processing delays when submitting enrollments or changes.
    Small Business Online Update
    • 2017 Renewal Packet Error – The Plan Highlights section at the end of the 2017 renewal package is incorrect. Please go to the Plan highlights and rates page to view the correct 2017 Plan Highlights.

    View Document
    Carrier & ACA Updates 12.5.16
    by Rosa Tessandori » Monday, December 12, 2016 7:44 PM

    What You Need to Know - Q4 2016 & Beyond
    • 2017 Portfolio & Marketing Materials: View the announcement or visit Easy Renew to download copies.
    • Q1 2017 Rates: Download a copy today.
    • Census Tool: Use it to get same-day turn-around approval on your groups.
    • Online Member Enrollment: This new feature will become available as soon as possible in the 1st Quarter of 2017.
    • EmployerAccess Enhancement: Soon groups will be able to provide their membership via a configured census that they download themselves, and then upload back into EmployerAccess once complete.
    Producer Alert
    • New Mobile App Sweepstakes: To encourage members to download the improved mobile app, letters are in the mail this week and the week of December 12th. Members will automatically be entered when they download the new mobile app and log in from any device. The sweepstakes will include weekly drawings for $100 Amazon gift cards, and a grand prize drawing of two $250 Amazon gift cards.
    Earn an Additional One-Time Payment of 1.5%
    • Multi-Product Advantage: Sell a dental plan and at least two new coverages from two or more of the different product groups, and you could earn an additional one-time payment of 1.5% of the annualized premium for each product sold. Groups with 10-99 employees are eligible for the Multi-Product Advantage discounts.
    E is for ERISA
    ACA Reminder
    • Form 1095 - Employee Statement: Deadline extended from January 31, 2017 to March 2, 2017.
    • Form 1094 - Transmittal and Accompanying Forms 1095: There is no extension to the filing deadline. The deadline to file with the IRS by paper is February 28, 2017, or by E-File on March 31, 2017.
    • Powerpoint: This brief presentation covers changes to transition relief, new reporting codes, "Good Faith Relief" and provides other helpful hints.

    View Document
    Carrier & ACA Updates 11.28.16
    by Rosa Tessandori » Thursday, December 08, 2016 6:07 PM

    Missed the November 17, 2016 Webinar? View the "November Small Group Business Update Guide"
    • New Email Address  - Contact customer service at 
    • EOCs - Now online, no more mailed copies.
    • Special Open Enrollment (SEP) for Small Groups only for 1/1/17 Effective Date - Complete submission of all employer and employee forms are due 12/15/16. Employee minimum participation and employer contribution requirements are waived. All other underwriting requirements still apply.
    • 2017 Rx Changes - The Select Drug List will replace the National formulary and will apply to all plans in the 2017 portfolio. Members with an impacted drug will receive a notification in the mail.
    • SBCs - View instructions on how to download them.
    • Relaxed Participation Through 3/15/17 - Reduced to 30% participation when 5 or more enroll.
    • DE9C Not Required with 6 or More Enrolling Through 3/15/17 - Groups with prior carrier coverage must submit prior carrier bill. Excludes virgin groups. 
    • HMO Dual Network Selection Through 3/15/17 - Offer one or both HMO networks. All groups must select only one PPO Network.
    • Same Day Turnaround for New Business Enrollment - Case must use the Census Enrollment Tool, case must be clean with no missing information or documents.
    • 2017 New Plan Offerings - 4 new HMOs and 1 new PPO plan.
    • Discontinued Plans and Networks effective 1/1/17 - No more HRA plans and no Priority Select Network.
    • 2017 Pharmacy Changes - New 90 day retail benefit and copay changes.
    • 2017 ACA to ACA Mapping Grid - Now available on Easy Renew, click here.
    • 2016 Updated SG HMO Network Guide - Includes a list of participating medical groups and Independent Practice Associations for CaliforniaCare, Select HMO and Priority Select HMO, click here. Reminder, effective 1/1/17 contracts, there will only be two HMO networks, not three.
    • Renewal Reminders - view/download renewals through Producer Toolbox and utilize the Easy Renew website.
    • Groups 51-100 Renewing January 2017 – Large group renewals were automatically issued on October 4, 2016, which included a Renewal Acceptance/Attestation Notification. If the Acceptance/Attestation is not received, a small group renewal will generate and the transition to small group will automatically commence during the 1st week of December.
    • How to Make a Plan Change at Renewal - 1) Use the applicable plan change request form, 2) Get a letter on company letter head or 3) Complete the renewal packet forms and have the group sign it. Send requests to
    • Best Way to Submit Small Group Employee Changes and Enrollments - Submit changes 1) Using the E-Submit web portal, New to E-Submit? View the E-Submit Guide, 2) Fax forms to 855-750-2227 or 3) Email them to
    • 2017 Renewal Quote Enhancements - Several new features have been added or updated, making it easier to renew your group and submit plan change selections.
    • Early Renewal/Anniversary Date Change Cut-off Dates - View the cut-off dates for requesting an early renewal (only allowed once in a 12-month period).
    • LiveHealth - Board-certified doctors are available online 24/7 to assess your health condition and even provide a prescription. Prescription availability is defined by physician judgment and state regulations. View the LiveHealth flier. Currently available on all PPO plans. Available to new HMO contracts effective 1/1/17 or to existing HMO groups upon renewal. Want to "meet" a doctor to see how the service works? Email and ask for a coupon.
    • Anthem Connect Team - View contact information for the California Connect Team for new business and renewals.
    • 2017 Small Group Guide - Now available to order.
    Broker Alert
    •  ACA - Responding to ACA questions after the Presidential election.
    Federal Law Alert
    •  ACA Reporting - IRS extends the due date to distribute ACA form 1095-C/1095-B to employees from January 31, 2017 to March 2, 2017.
    Compliance Alert
    • PCORI Fees - For plan years ending on or after October 1, 2016 and before October 1, 2017, the fee is $2.26. Prior rate was $2.17. Fees are required for all group health plans including Health Reimbursement Arrangements (HRAs), but are not required for Healthcare flexible spending accounts (FSAs) that are considered excepted benefits.

    View Document
    Carrier Updates 11.21.16
    by Rosa Tessandori » Thursday, December 01, 2016 9:39 PM


    Diabetes Awareness Month  
    Anthem Whole Health Connection: Anthem Whole Health Connection is a no-cost, value-added service for clients with an Anthem medical, wellness and one or more of the following Anthem products: pharmacy, dental, vision and disability. 

    Small Group Business Updates-Webinar
    Technology Tools: Wednesday November 30, 2016 9:30 am PST – RSVP not required, space is limited. Join the meeting , Dial In: 1-866-308-0254, Conference Code: 8057135146.


    Broker Update

    CVS Pharmacy effective 1/1/17
    Relaxed Participation Requirements Extended through March 31, 2017
    New Year, New Forms: New 2017 MGA and Employee Enrollment forms.
    February and March Renewal Kits: Available for downloading through Producer Connection.
    • Nondiscrimination Notice: A new mandate as of October 16,2016 requires Blue Shield of California include a nondiscrimination notice in all significant communications and publications. Blue Shield will include the mandate in required publications so you do not need to try to determine which materials are “significant communications and publications.”
    • Age/Rate Calculation Correction for New Groups Only: For new groups enrolling on or after September 1, 2016 – new hires are rated using “age at time of enrollment”. Groups with prior effective dates, new hire enrollments continue to be rated using “age as of the renewal date”. Correction of the rating error for groups with effective dates prior to September 1, 2016 is expected by Q2 2017.
    • Sell Access+ HMO and Trio ACO HMO Side by Side
    Multiple ID Cards in December

    Preventive Care Outreach Campaign – PPO and Select PPO Members
    • Campaign Launched November 3rd 
    • Opt-out Options are available by email or phone
    Sutter Health Continued Negotiations
    Negotiations Still in Progress
    Portal Home Page and Find a Doctor Web Pages Updated
    1/1/17 New HMO Enrollees - Participants are being assigned an alternate in-network PCP.
    • Current HMO Members with Sutter prior to 1/1/16 - Notification of a contract termination has not yet been issued.

    Producer Alert

    • 2017 Producer Agreement: The new Producer Agreement and the 2017 Commission Schedule are now available on Producer Connection. 


    Compliance Update
    • Wellness Sample Notice: New sample notice effective January 1, 2017.
    • COBRA Tip: Employer options for tailoring the sample notice.

    View Document
    RBG Tip Sheet - Carrier Updates 11.14.16
    by Rosa Tessandori » Wednesday, November 16, 2016 7:06 PM

    Producer Alert
    • Sutter Health Negotiation Update: Blue Shield of CA and Sutter Health continue to engage in discussions to renew the existing contract which is set to expire 12/31/16. Customarily, Blue Shield issues a notice to HMO members of a change in their provider assignment due to the expiring contract 60 days prior to the change. However, at this time, Blue Shield has not yet issued letters to impacted members, this is subject to change based on the progress of the negotiations. All new Blue Shield HMO members who enroll with a Sutter-affiliated PCP with an effective date of January 1, 2017 or later, will manually be reassigned an alternate, in-network PCP and will receive their member ID cards reflecting the alternate doctor and not the Sutter Health provider they originally selected. A buck slip will be inserted into the ID card mailing to explain the reason for this change. If the contract is renewed, HMO members who were switched to a non-Sutter PCP must contact the Customer Service number on their ID card if they would like to switch back to a Sutter affiliated PCP.
    Employee Informational Flier
    • Teladoc: Effective 1/1/17 for new groups, and at renewal for existing groups, Members will have access to Teladoc services which provides unlimited access to U.S. board-certified doctors 24/7/365 to resolve non-emergency medical issues through phone or video consults. Small Business PPO Savings plans are a $40 copay prior to the deductible and once the deductible is met, a $5 copay will apply. For all other Small Business HMO and Full PPO Plans, visits are a $5 copay and are not subject to the deductible.

    Partner Alert
    • Our Work Continues - We Are Open for Business: Your client’s Covered California for Small Business coverage is not in jeopardy. We encourage them to renew into their existing plan or shop for a new plan that best fits their budget and the needs of their employees. Employers with more than 50 FTE employees shouldn’t risk a financial penalty by not providing affordable health coverage.

    View Document
    Carrier Updates 11.7.16
    by Rosa Tessandori » Wednesday, November 16, 2016 7:01 PM

    Producer Alert
    • CVS - Pharmacy Management Program & Mail Order Change (revised)
    Partner News
    • 4th Quarter Agent Incentive Program
    • Online Broker Renewal Function
    • Sales Tip: No Participation requirements among carriers.
    • Account Management Team
    • Special Enrollment Period
    • Two Full Network PPO Carrier Options Effective 1/1/17
    • Out-of-State PPO Coverage
    • Blue Shield of CA HMO Plan and Networks Changes
    • Kaiser Expands into Santa Cruz and the surrounding area effective 1/1/17.
    • California Dental Network: New carrier effective 1/1/17
    • Discontinued Dental Plans
    • Discontinued Blue Shield Medical Plans
    Broker Briefing
    • 2017 Small Group Commissions:
    • KPIF Open Enrollment Materials
    • Updated Underwriting Guidelines 
    • Small Business Service Contracts
    • Small Business Service Tips

    View Document
    RBG Tip Sheet - Aetna Quoting Tool Webinars
    by Rosa Tessandori » Friday, November 04, 2016 12:28 PM

    Learn different ways to quote in Producer WorldSM

    Don't miss this webinar

    Are you a broker who sells Small Group ACA new business? We've moved to a broker self-serve model for new illustrative quotes with January 1, 2017, effective dates.

    Join us for an important webinar and learn several ways to get an ACA quote.

    You'll learn to:
    • Access Quoting and Renewal System (QRS) through Producer World to get a quote
    • Find our quoting tool, QRS, in different ways
    • Find ACA rate sheets on Producer World 
    We're offering webinars for three weeks in the hope you can find a convenient day to attend. Just view the attached to register.

    View Document
    Carrier Updates 10.31.16
    by Rosa Tessandori » Monday, October 31, 2016 5:50 PM

    • LiveHealth Online: Currently available on all PPO plans. Available to new HMO contracts effective 1/1/17 or to existing HMO groups upon renewal. LiveHealth includes 24/7 online physician consultations and psychology consultations 7 a.m. to 11 p.m., 7 days week.

    Producer Alert
    • Sutter Health Negotiations – Current contract expires 12/31/16. Negotiations are under way to try to renew for a 1/1/17 contract.
    Broker Update
    • MLR Rebates
    • First Month Rate Flexibility
    • BSC & CVS
    • Census Tool – Employer Connection Plus Report is back!
    • Trio Digital Campaign
    • No HMO for out of state – Employer Connection Plus Error
    • Relaxed Participation – Extended (updated notice coming soon, new extension through 3/31/17)
    • 4th quarter flexibility – Cut-off dates are Nov 7th by noon and Dec 7th by noon (RBG must receive submission with enough time to review prior to submitting to BSC)
    • Web launch online user tool – new tools
    • ACA-26 rule
    • Seeing HMO Specialist – self refer for a consultation (not services)
    • Expanding Specialty Benefits- increased PPO network, Rollover Rewards, 2-year life guarantee for new groups
    • Sutter Health Plus Network Map: View the map and the Bay Area Provider Directory (directories change frequently, always remind participants to verify a provider is contracted before receiving services).
    • List of Annual Limits: The IRS has released some of its 2017 limits, a few are still pending. View the list.  View FSA & HSA 2017 Limits.

    View Document
    RBG Tip Sheet - Carrier Updates 10.25.16
    by Rosa Tessandori » Thursday, October 27, 2016 9:00 AM


    Easy Renew
    • 2017 Documents now available on Easy Renew: Our 2017 Small Group Guide, along with other helpful 2017 materials, can be found on Easy Renew. We are also working to upload these materials to Producer Toolbox, and to CustomPoint to make them available for ordering.


    Producer Alert
    • CVS - Pharmacy Management Program & Mail Order Change: Starting January 1, 2017 for new and current members, CVS Health will manage Blue Shield's national retail pharmacy network, and become our exclusive mail order pharmacy for Commercial and Medicare plans and our specialty pharmacy for Commercial plans, The Blue Shield network retail pharmacies will be nearly unchanged and will continue to include all key chains such as CVS, Walgreens, Rite-Aid, Costco and many others. Members currently using the mail order service can expect to receive notification 60 days in advance of the changes by mail and telephone.

    PCA Instructions and Form
    • Prior Carrier Accumulation - Deductible Credit: For new groups with prior group coverage moving to Blue Shield of CA, members can complete the attached form to request credit for their prior medical deductible. Members must complete the form and submit a copy of their most recent Explanation of Benefits (EOB). Credit can be given for members going from PPO to PPO (H.S.A. to H.S.A.) or HMO to HMO. We do not give credit for members moving from HMO to PPO or PPO to HMO. Credit for separate pharmacy deductible is not given. Credit for Maximum Out of Pocket met is not given. Refer to the Blue Shield of CA Evidence of Coverage (EOC) for additional details.


    Broker Announcement
    • Ameritas Voluntary PPO - Takeover on Major Wait: New groups effective 11/1/16 electing Ameritas Voluntary PPO with 10 or more enrolling and have had their prior plan for 12 months or more are eligible to have the 6-month wait on major services waived for all enrolling. View the notice.
    • New - Anthem Blue Cross PPO Dental: Effective 12/1/16 effective dates, Choice Builder is now offering Anthem Blue Cross PPO dental - Platinum, Gold and Silver/Voluntary options. View the notice.

    View Document
    Carrier Updates 10.17.16
    by Rosa Tessandori » Tuesday, October 18, 2016 1:35 PM


    Producer Online News

    • 2017 Small Group Portfolio Changes 
    • Silver HSA Plan Modifications 
    • Discontinued Plans: Gold HSA, HRA Plans and Priority Select HMO Network Plans


    Making it Easier To Do Business Through March 15, 2017:
    • Participation: For groups of 5+ enrolled reduced to 30%.
    • DE9-C: Not required for groups of 6+ enrolled.
    • HMO Network Option: Dual option now available.
    • Valid waiver: Individual covered is considered a valid waiver
    • Anniversary Date Changes: January anniversary date changes are due 12/28/16.
    Broker Blast
    • 2017 Q1 Rate Action: PPO -1.2% & HMO -4.6%. Also view the Annual Rate Change and Quarterly Rate Action 18-month history.
    • Renewal Package Changes: Small Group renewals have been refreshed and easier to understand including plan names alongside plan codes and easier alternative plans selections.
    • Broker Reference Materials: 2016 Rate Guide and 2016 Plan/Package Guide
    • New Plan Offerings: (1) HMO Plan, (1) PPO Gold Plan, (2) Silver HMO Plans and (1) Silver PPO Plan.
    • ACA Fees suspended for 2017: ACA fees have been suspended for 2017 so you will see them zeroed out on renewals.
    • Pharmacy Changes: New 90 day retail benefit & tiered generic drug copays.
    • Electronic EOC's: Starting 12/1/2016, members will receive electronic EOCs that they can access online under "My Plan Documents". The group administrator will continue to receive paper copies.


    Producer Alerts:
    • 1/1/17 Rates Available for Quoting!
    • Q4 New Business "Cut Off" Times: November and December new business submissions due no later than noon on the 5th business day of the respective month.
    • Digital Roadshow Link: Listen to it today!
    • ACO Digital Campaigns: Launches Tuesday, October 18, 2016, is statewide, with an additional focus in Southern California.
    • Member App and Portal: Launches October 16, 2016, includes a redesigned online experience and new mobile apps for Apple and Android users and more.
    Small Business Rate Cycle January
    • 2017 Rate Action: PPO Plans from -0.3% to +0.5% (including HSA-compatible plans); HMO Plans from -1.8%to +0.9%. Varies by plan (not by rating region).January 2017 Renewal Packets: Available for download October 18th.
    • Average Quarterly Rate Increase: View a list of factors on the product cycle home page.
    • Annual Customer Rate of Change: Will vary significantly by customer.
    • Covered CA: New Full PPO Network Blue Shield Plans will be offered for each metal level beginning 1/1/17. Consequently, the Narrow Network PPO Bronze 60 plan is being withdrawn from the market.
    • Commissions: 5% First Year and 5% Renewal Years.
    • Start-Ups: Groups that have been in business for less than four weeks, are now eligible if at least five (5) or more employees are enrolling and the business has been operating for at least one pay period. All other small group underwriting requirements still apply, refer to the "New Guidelines" for details. For start-ups with less than five (5) enrolling, refer to the "Underwriting Guidelines" .

    What’s New for Small Businesses in 2017
    • New HMO Pairing Options: Customers may purchase both Trio ACO HMO plans and Access+ HMO plans side by side.
    • Teladoc: Access board-certified doctors 24/7/365 a year. Teladoc offers unlimited visits and is not subject to the deductible with all Small Business HMO and Full PPO Plans with a $5 copay. Small Business PPO Savings plans are a $40 copay prior to the deductible and once the deductible is met the $5 copay will apply. 
    • Dental PPO: Network expansion by 40%.
    • Wellvolution: The Blue Shield of CA Online wellness program.
    • HealthEquity: Is the preferred Blue Shield of CA HSA administrator.
    • Identity Protection Service: Free to active BSC members.

    2017 Packages for Small Business
    • Participation Requirements
    • Rating Information
    • View Package Options for Medical and Ancillary
    • New Group Submission Checklist
    • Helpful Hints For A Complete Submission

    HMO Network and Plan Package Guide
    • Access+ HMO: Blue Shield’s largest HMO Network
    • Local Access+: Subset of Access+
    • Trio ACO HMO: Most Narrow Network, now available in 22 counties.

    View Document
    HealthiestYou - "Premium Holiday"
    by Rosa Tessandori » Thursday, October 13, 2016 4:27 PM


    Help employees save time and money!

    With HealthiestYou, you can connect to a doctor for treatment, diagnosis and
    prescriptions, 24 hours a day, 7 days a week over the phone or via the mobile app.

    Receive 2 months free if booked for a November 1st effective date or 1 month free if booked in December!

    See attached:
    • Overview Flier
    • Holiday Premium Flier
    • Price Sheet
    Have questions? Contact your RBG sales representative today!

    View Document
    Tip Sheet - Blue Shield MLR Rebates
    by Rosa Tessandori » Tuesday, October 11, 2016 11:27 AM

    Blue Shield of California owes rebates to approximately 30,000 small business policyholders in plans regulated by the Department of Managed Health Care (DMHC). As required by law, rebates will be paid by September 30, 2016 to Small Business contract holders (businesses, not individuals) in those plans with the rebates based on their premiums paid in 2015. A list of your impacted clients will be available in the next 2 weeks.
    Contact Producer Services (800) 559-5905 for details on your impacted clients. 
    View the attached PDF for:
    • Links to Blue Shield MLR fliers
    • Employer Compliance Tips

    View Document
    RBG Tip Sheet - Medicare Part D Creditable Coverage Notice Due 10/15
    by Rosa Tessandori » Tuesday, October 11, 2016 11:19 AM
    Center for Medicare & Medicaid Services 
    Creditable Coverage:
    The Medicare Modernization Act (MMA) requires entities (whose policies include prescription drug coverage) to notify Medicare eligible policyholders whether their prescription drug coverage is creditable coverage, which means that the coverage is expected to pay on average as much as the standard Medicare prescription drug coverage. For these entities, there are two disclosure requirements:

    1- Written disclosure notice to all Medicare eligible individuals annually who are covered under its prescription drug plan, prior to October 15th each year and at various times as stated in the regulations, including to a Medicare eligible individual when he/she joins the plan. This disclosure must be provided to Medicare eligible active working individuals and their dependents, Medicare eligible COBRA individuals and their dependents, Medicare eligible disabled individuals covered under your prescription drug plan and any retirees and their dependents. In addition, if it is known that a spouse or dependent that is Medicare eligible resides at a different address from where the participant/policyholder resides, a separate notice must be mailed directly to that spouse or dependent.

    2 - Entities should complete the Online Disclosure to CMS Form to report the creditable coverage status of their prescription drug plan. The Disclosure should be completed annually no later than 60 days from the beginning of a plan year (contract year, renewal year), within 30 days after termination of a prescription drug plan, or within 30 days after any change in creditable coverage status.

    To comply with the first requirement, many employers provide this notice as part of the annual open enrollment and new hire packets, and then provide a reminder letter in October. Employers should keep a copy of the letter as well as a record as to whom the letter was provided, when it was provided and the method of delivery. For additional compliance details, refer to the 2007_2.15 Guidance - Disclosure of CC to Medicare Part D Eligible Individuals (pages 12-13) provided below.
    View attached PDF for:
    Links to additional resources
    Links to 2016 & 2015 Carrier Lists of Medicare Creditable Coverage Status 

    View Document
    Carrier Updates 10.10.16
    by Rosa Tessandori » Tuesday, October 11, 2016 10:54 AM

    • 2016 Online Roadshow: If you missed this year's Blue Shield small business webinar, listen now! 
    • New Hire Rating: Effective 9/1/16, new groups with Blue Shield will have their new hires rated based on their age at time of enrollment. Existing groups will continue to have their new hires rated based on their age as of the groups last renewal. View PDF for details.


    Partner Alert
    • January 1/1/2017 Rates: Now available for quoting.
    • Blue Shield PPO: Full-Network plans now available effective 1/1/2017. Includes all metal tiers and also available to out-of-state employees.
    • Blue Shield Trio HMO: Available effective 1/1/17.
    • Kaiser: Coverage expanded to Santa Cruz and the surrounding area.
    • California Dental Network: New carrier effective 1/1/17.

    • Start-up Groups: Effective immediately in the 4th quarter, UHC will now accept a start-up with at least six weeks of payroll. View PDF for details.

    View Document
    Carrier Updates 10.3.16
    by Rosa Tessandori » Tuesday, October 04, 2016 8:22 AM


    • Producer Online Tools: October 5th, 2016, 9:30 am PST
    • Census Enrollment & Employer Access: October 19th, 2016, 9:30 am PST

    Producer Online News
    • Mail and Email Campaigns: Renewing Groups will receive a mail campaign to contact their agent and an email quiz to tailor campaigns to a group's interest. 
    • Transformation Central: Access resources to help with your renewal such as the Plan Comparison Tool, SBC's and SOB's
    • Online Therapy Visits: Starting October 1, 2016, employees in our groups who have Anthem’s Employee Assistance Program (EAP) as part of their medical benefit can get free online therapy visits through LiveHealth Online. 
    • Producer Toolbox Videos: How to Create Delegate Users, How to set up Quick Links on your Toolbox home page How to default the setting on the "Current Business Tab" to Small Group. Renewal Packet Enhancements: Starting with December small group renewals with 51 to 100 employees, you will find the Medical Benefit Selection form. For January renewals and beyond, you will continue to see additional enhancements, including the ability for you to click directly on your electronic copy to get more detail on a specific plan. 
    • Updated 2016 Small Group HMO Network Guide: The HMO Network Guide for small businesses with 1 to100 employees shows the participating medical groups and independent practice associations (PMGs/IPAs) that are part of these networks. 


    Small Business 4th Quarter Update

    • Relaxed Participation: Extended through December 31, 2016. For medical contracts, only one carrier is allowed to be written alongside a Blue Shield of CA plan. Promotion requires a minimum of 5 enrolled or 25% of the total number of eligible employees, whichever is greater. Ancillary (alongside medical or standalone) is also reduced to 25%, but Blue Shield must be the sole carrier.
    • Extended Signature Dates: A completed application will be good for three months from the date of signature for effective dates of Oct. 1 through Dec. 15, 2016.
    • Initial Premium Flexibility: For the fourth quarter, only 25% of the first month's rate is due upon the application with the remaining balance due upon the groups’ first month's billing date (i.e., a Dec.1 effective date group will be billed in mid-November for the unpaid dues).
    • Groups 10+ Enrolling: DE9C not required, in lieu of the DE9C, groups must submit an attestation form, download the form. Underwriting reserves the right to request a DE9C at any time. Groups 1-9 enrolling, DE9C is still required.
    • Refusal of Coverage Forms: For groups alongside another carrier, the other carrier's bill will be accepted in lieu of a completed Refusal of Coverage form. If the other carrier has not yet issued a bill, a copy of the employee applications for the other carrier will be accepted.
    • Special Enrollment Period (SEP): New group applications received between Nov.15 and Dec. 15, 2016, requesting a Jan. 1, 2017 effective date, are eligible for coverage without meeting the minimum participation and contribution requirements. All other underwriting requirements apply. The group must meet the minimum participation requirements upon renewal to continue coverage.


    Additional Updates

    • Fourth Quarter Master Group Application - Revised: The original fourth quarter 2016 Master Group Application didn’t include the option of selecting up to 19 Off-Exchange plans. The revised Q4 MGA is posted on Producer Connection. If you have a version of the application without this option listed, and your clients want to choose up to 19 plans, simply write in “Selected plans” where the Off-Exchange plans are listed and then mark each of the plans the group is selecting.
    •  Flier - Keep your Blue Shield Coverage: Educational flier for small businesses to use with any employees who may be losing their employer-sponsored Blue Shield coverage. The flier explains options under the Affordable Care Act and how members can remain covered with Blue Shield of California if they wish. We encourage you to download the flier.
    •  Medical Loss Rebate Checks: