Oct 14, 2024
Minimal changes are expected for plan portfolios. Changes include improved deductibles and out-of-pocket maximums, added benefits, easier HMO pairing, and expanding access to care.
Medical Plan Updates
A list of impacted PPO plans with cost share and name changes (there are no name changes within the HMO portfolio) can be viewed here.
The Changes to page on Blue Shield's Broker Connection has a full list of 2025 plan changes and updates. To view exact terms and conditions of coverage for all 2025 plan offerings, refer to the Evidence of Coverage. You can also use the Plan Comparison tool to see plan updates across multiple years and compare plan benefits within the same plan family.
Making it easier to offer HMO to your groups
Effective January 1, 2025, you can now offer all three HMO (Access+, Local Access+, Trio) networks alongside each other, applicable to both new sales and renewals allowing for more simplification and growth.
Virtual providers now available in all Trio HMO areas through Accolade
Members in all Trio HMO counties can now access virtual health services including PCP visits, behavioral health appointments, and specialty care. Virtual services, provided by Accolade Care, mean members have a 24/7 care team available and the flexibility of making appointments seven days a week. Learn more about Trio HMO here. Virtual appointments can be used in combination with in-person care, and please note referrals are required for specialty visits.
Providing improved accessibility to at-home care with DispatchHealth
Through DispatchHealth Blue Shield is offering employers and their employees convenient and prompt at-home medical support post-hospitalization. Now available at $0 for all PPO members. A referral is needed by a case manager or a provider.
Commitment to equitable access to health care
Effective January 1, 2025, Blue Shield will expand travel reimbursements for other eligible Covered Services subject to bans or restrictions that make the services unavailable in a member’s state of residence. Coverage will include gender affirmation care services as an additional category of eligible Covered Services. This is to assist members with access to these services in other states where they remain legally available.
Important Pharmacy Updates
Learn more about Blue Shield’s first-of-its-kind pharmacy solution on the pharmacy care model resource page (authentication required). This page covers Blue Shield’s Pharmacy care model, Amazon Pharmacy for home delivery, new I.D cards, and more.
Updates to Member Pays Difference Penalty (MPD)
When the MPD penalty applies, your group’s employees will pay the difference in cost plus the applicable tier cost share of the brand drug. The MPD penalty will be expanded to brand drugs that have an available preferred biosimilar drug. An exception process continues to be available when the brand drug is medically necessary.
Changes to weight loss drug exclusions
Beginning January 1, 2025, upon group renewal the weight loss drug benefit exclusion will be reinstated to align with the market. Weight loss drugs will be excluded from coverage except when medically necessary. For exact plan coverage details please refer to the plan’s Evidence of Coverage.
Renewals
Groups renewing in January will be available to brokers through Shield Renewals on Tuesday, October 15* while group-level changes can be made using the newly launched Employer Enrollment tool for renewals starting Thursday, October 17.* Groups renewing in February and March will be available on Tuesday, November 12* while group-level changes will be available starting Thursday, November 14.* Dates are subject to change.
The employer enrollment tool now has the added functionality of managing your group-level changes. You can review this EET Renewals user guide for more information or visit the Employer Enrollment Tool resources page. To review exact renewal and enrollment dates, plus enrollment materials and updated rates books, visit the Renewal Center page.
The first-quarter 2025 rate action is a statewide average of 1.3%.
All Plans are quote ready. Reach out to your Amwins Connect team do discuss Blue Shield options for your groups.
