Digital enrollments are the future of doing business together
The Employer Enrollment Tool (EET) resource page has all the materials you need to learn and stay current with the #1 broker preferred enrollment channel. The page features our continually updated user guide, helpful checklists, renewal resources, and an extensive library of video tutorials so you can master every aspect of digital enrollments.
Brokers serving large and small businesses: Calculate member effective dates before you start an enrollment submission with the new My Calculator capability available in the tool now. Located in the top navigation bar, My Calculator offers new hire, newborn, and cancelation effective dates so you and your clients can know before you submit.
Brokers serving small businesses: Bulk enrollments, a highly anticipated capability for the EET, will be added soon as part of our continued efforts to enhance your digital experience. Bulk enrollments let you enroll multiple new members to a client’s renewal policy in one transaction.
Compliance with SB 729’s fertility services requirements
We are working in good faith to implement the various requirements of SB 729 for fully-insured small and large employer groups. We have engaged our clinical and legal teams to ensure we provide fertility services consistent with the bill’s requirements and intend to comply by July 1, 2025.
Coverage details are currently being reviewed by the Department of Managed Health Care (DMHC). Once the DMHC approves our implementation approach, plan documents such as EOCs and SOBs will be updated accordingly for all fully-insured small and large employer groups that offer fertility service in accordance with SB 729.
We will continue to provide additional information as it becomes available. Please see these FAQs for more information.
Annual Medical Loss Ratio employer survey due 3/31/25
The Blue Shield of California Annual Medical Loss Ratio (MLR) Employer Survey is now open. To access the survey, please visit this website and enter the Group ID with the web key: #44n50c
The deadline to submit information is March 31, 2025. Please review the MLR FAQs for more information and we appreciate your support in collecting the information needed to help us meet the MLR requirement. If you have any questions, contact your Blue Shield representative or contact us at (800) 559-5905.
Understanding prescription medication costs in 2025
While our new pharmacy model is designed to drive down overall costs, some members may be experiencing cost increases for their individual prescription medications since 1/1/2025.
There are several possible reasons why this may be the case, including:
- At the start of each year members are in their deductible period and therefore prescription costs will be higher than at the end of the calendar year. While this may seem obvious, it’s important members compare prices in this context.
- Generally, if the cost of a drug is lower than the cost share in a benefit summary, then the member will pay the lesser of the two prices (cost share in benefits summary vs. cost of the drug). For plans with deductibles:
- If a member has not met their deductible, they will pay the full cost of the drug.
- If a member has met their deductible for the plan year, they will not be charged more than the cost share in their benefit summary.
- Prescription medication costs are subject to price fluctuation just like other products and services.
- Prescriptions filled at CVS may see price changes as the company recently launched their CostVantage model which, in some cases, includes dispensing fees as part of the pharmacy’s reimbursement. (CostVantage impacts commercial members while Medicare is not impacted.)
- Most Blue Shield plan designs do not require home delivery. In some cases, prescription prices through Amazon Pharmacy (our new home delivery pharmacy as of 2025) may differ from our previous home delivery pharmacy.
- Lower co-pays may be available at different pharmacies or through mail delivery. Members should compare prices at nearby pharmacies to find the lowest price. The Our Pharmacy Network page can help locate nearby pharmacy options.
- There may also be lower cost alternatives available for prescriptions such as generic or biosimilar medications.
- We encourage the use of the member app Price Check My Rx to review medication options and guide informed decisions. Members can also learn more with this short Pharmacy Care Reimagined video.
Rx healthcare spending survey available now
Blue Shield of California is collecting D1 Premium Contribution data as part of the Consolidated Appropriations Act, Section 204 (2021)–Prescription Drug Cost Reporting regulation, on behalf of our employer groups.
Groups or their brokers with access to an Employer Connection account are encouraged to complete the survey by logging in to Employer Connection.
Groups or their brokers without access to an Employer Connection account can submit required information via the Prescription Drug & Healthcare Spending Survey using their group ID and following web key: #25yr24
The deadline to submit information is April 19, 2025.
Groups that miss the deadline will not be included in Blue Shield’s filing and may be subject to non-compliance if they do not report the required data directly to the CMS on their own. To prepare for submission, refer to the tips and reminders included in the original alert on this topic.