September 5 & 6, 2018

Small Business Broker

Online Roadshow

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Charting a steady course for success

Blue Shield’s commitment to California

Renewals made easier

New sales for Q4 and into 2019

Specialty: To complete members’ health

ACO: Worthy of our family and friends

Tools for the broker trade

Charting the course ahead

Welcome, our valued brokers and GA partners

Steve ShearerVP / GM

small business

Blue Shield delivers on its promises - 2017 Mission Report

Blue Shield procured approximately $28 million in goods and

services in 2017 from certified small businesses

The Blue Shield of California Foundation awarded more

than $25 million in grants in 2017 to improve the lives of

Californians most in need

• Blue Shield has contributed more than $500 million

since 2002 to the Foundation

• The Foundation is an independent organization funded

through contributions from Blue Shield

2%

We value the perspectives of our brokers, employers,

and members

Among Small Business Employers

• Brand my employees want

• Quality doctors and hospitals

• Great benefits1stAmong Small Business Brokers

•

•

•

Meets business needs

Trust

Sales Support

Forrester Customer Experience Index 2015 - 2018

Blue Shield of California

+1.9%

Healthcare industry

-1.8%

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for making Blue Shield the PPO small business carrier (#2 HMO) in California, #116%and helping us grow our membership by from 2017 to 2018.

Thank you

account management

Carol Soltero district manager

Susan Tatarian district manager

Renewal Resources – Broker Connection

Small Group Online Renewal (SGOR)

• Improved user-friendly experience

• Group level changes only in SGOR

• Member level changes can be made in EC+ one

month prior to the group renewal month

Quarterly renewals for Q2 and Q3

• December and January will each be a

single month renewal period

• Get ahead by working renewals early

January 2019 renewals will be available online in late-October

Renewal Resources – “Options” chart in renewal kits

“Options” chart included in Renewal Kits

• Increase plan benefits

• Decrease monthly premium

• Try a Trio HMO plan

• Try a Tandem PPO plan

Quick and easy way to see options

without running a new quote

New Business as usual

Design and functionality of EC+ after selecting a group Login and access - same site, login, password

Processes or steps to manage benefitsCapabilities - manage benefits such as adding a

dependent or changing a subscriber’s plan selection

Advanced reporting capabilities Self-service census reports

Optimized for mobile devices View transaction history

Billing, payment, invoice view is unchanged

EC+ benefits management enhancements

Some features and functionality used to manage employees’ benefits will be different from what you have

experienced using EC+.

However, your access to managing groups – the site and login information – will remain the same.

Who will use this and when?

EC+ benefits management enhancements

Where can I get help?

Renewal / effective Access

January - June July 29, 2018

July - August September 30, 2018

Sept - December February 2019

2019 groups tbd

NOTES:

• Groups missing a Tax ID Number will NOT be moved to the new tool.

• Employees missing a social security number will not appear in the new tool.

• BSC reaching out to collect missing info.

Broker Connection EC+ resource page

• Download FAQs

• Quick tips for employers

• “How to” videos for Brokers

• Register for an online guided tour

• Review a recorded webinar session

• Download Administrators Guide

Navigating the new features

(855) 589-7970

Eligibility and benefits questions, or logging in to EC+

(800) 559-5905

Access care for convenience and cost-savings

New ID cards with cost shares for

different points of service.

NurseHelp24/7SM

Primary Care Physician

$$

CVSMinuteClinicTM

$

HealTM

$$

Virtual Care$$

Emergency Room

$$$

BlueCard®$$

UrgentCare

$$

Teladoc$

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• 24/7/365 physician access

• 95% patient satisfaction

• 92% clinical resolution

• $5 HMO & PPO copay is

$40 HDHP until deductible is

met, then $5 copay

• Faster than going to a PCP

• Cheaper than going to urgent

care or ER

• Concierge medicine

8AM – 8PM, 365 days a year

• Primary, preventive, urgent

care

• Blue Shield PPO physicians

• Copay matches an office visit

• Scheduling

• On to Better Health

• Web-based, 24/7 self-help tool

• No additional cost

• Resources for common mental

health issues

Some valuable services are available but underutilized

Heal On to Better Health

2014 - 2018 annual trend medical rate actions have

been moderate and consistent

Customer specific compounded renewal rate actions will include

impact of four pricing cycles, as well as the impact due to aging,

and possible increase in billable members if a child ages to 21.

Age sloping changes for under 21 complete in 2019.

Blue Shield 2014 2015 2016 2017 2018

PPO 3.0% 4.7% 6.2% 1.1% 3.7%

HMO 2.9% 9.3% 3.4% 3.4% 1.3%

Annual Average Rate Change 3.7% 5.9% 5.5% 1.6% 3.1%

Blue Shield’s average annual rate trend

since the implementation of the ACA

has been below the industry average*

* Compared against other major carriers: Aetna, Anthem,

Health Net, Kaiser, United Healthcare

4.0%

Blue Shield

of California

6.5%

Industry

average

Theresa Boudreau

Area Vice President

Small Business Account

Management

Your Blue Shield account management team

new sales

Brian Tuttle senior sales manager

Kenneth Leachsenior sales manager

• $100 per member when 75% of new business comes in direct

• $75 per member when 50% to 74% of new business comes in direct

• Program runs through January 2019 effective dates

• v3.0 coming in 2019 with more benefits for brokers

Check with your Blue Shield RSE for program details and status of your rewards

Relaxed participation requirements

• 25% of eligible employees enrolling, with a minimum of five, through Q1 2019

• Enroll just ONE employee with Trio plans only

Relaxed submission requirements

• No DE9C required for groups of five or more enrolling

• Coming soon: IFP waivers accepted as a valid refusal of coverage*

• Details, including start date, will be announced in an upcoming Broker Alert

Only 25% premium due at time of application

Underwriting updates

Use our Enrollment spreadsheet to reduce errors, pends and cycle times

• Electronic submissions include Employee Enrollment Applications and now the

Master Group Application

• We’ve partnered with EaseCentral to help you populate the enrollment spreadsheet

Status check

• 24/7 online access for status updates of

new group submissions

• Search by group name or broker

Contact your Blue Shield sales team or general agent partner for additional

information or questions.

Broker Tools

2019 Plan Changes

New plan offerings for 2019

• Offered on all 3

HMO Networks

-Access+

-Local Access

-Trio Network

• Lower price point in

Trio network vs. Full

network

• Now offered on the

Tandem PPO

network

• Lower price point

than full network

• Available on Full &

Tandem PPO

network

• Ideal for employers

with lower

contribution

offerings

Gold HMO 0/30Silver Savings

2000/20%Bronze PPO 6500/50%

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Additional plan enhancements for 2019 plans

Silver PPO 2000/45

• Deductible for medical and Rx

separated

• $2000 medical

• $250 pharmacy

Health & Wellness programs

www.blueshieldca.com/wellnessdiscounts

• New flexible gym membership program

with 10,000+ locations

• Alternative Care Discount Program• 25% off Massage, Chiro, Acupuncture

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Spectrum Rx (A) Preferred vendors

• CVS

• Target

• Costco

• Safeway / Vons

Ultra Rx (B)

• All other pharmacies in Blue Shield’s

national network

• Tiered Pharmacy network will be included in

Trio and Tandem plans for 2019

• Tiered networks offer additional cost savings

• SHOP and Mirror plans will not have tiered

Rx

Tiered pharmacy network for Trio and Tandem plans, Off-Exchange only

Two-tiered pharmacy Trio & Tandem

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% differential

between

Tandem PPO

and Full PPO

Trio ACO HMO is available in the following

counties

% differential

between Trio

ACO HMO

and Access+

HMO

% differential

between Trio

ACO HMO and

Local Access+

HMO

1 Rural North/Sierra -3.1% Nevada -11.1% n/a

2 Wine Country -3.2% Marin, Solano -11.1% -9.5%

3 Greater Sacramento -3.2% Sacramento, El Dorado, Placer, Yolo -31.7% -30.7%

4 San Francisco -4.4% San Francisco -14.1% -12.4%

5 Contra Costa -3.2% Contra Costa -11.2% -10.0%

6 Alameda -3.2% Alameda -11.0% n/a

7 Santa Clara -11.9% Santa Clara -10.9% -6.0%

8 San Mateo -9.6% San Mateo -13.4% -11.8%

9 Monterey Bay -3.2% Santa Cruz -28.1% -24.2%

10 Central Valley North -5.2% San Joaquin, Stanislaus, Tulare -14.2% -12.4%

11 Central Valley South -3.1% n/a n/a n/a

12 South Coast -3.5% San Luis Obispo, Ventura -14.5% -13.0%

13 Southern Desert -8.3% n/a n/a n/a

14 Kern -3.1% Kern -19.9% -14.4%

15 Los Angeles North -3.6% LA zips beginning 906-912, 915, 917, 918, 935 -13.9% -11.1%

16 Los Angeles South -9.2% LA zip codes not in Rating Region 15 -18.3% -15.6%

17 Inland Empire -3.1% Riverside, San Bernardino -15.5% -13.3%

18 Orange -3.1% Orange -19.5% -16.8%

19 San Diego -3.1% San Diego -26.0% -24.7%

Tandem PPO is available in

all Small Business Employer

Rating Regions

Blue Shield of California Members $ave with Trio HMO and Tandem PPO

check Find a Provider for specific zip code availabilit y

o May be paired with full network plans to provide flexible options and premium savings

o Priced 3% to 12% below Full PPO plans

o Statewide coverage with Blue Card covering

out of state

Note: differentials between Full and Tandem can vary by plan due

to rounding, and may not exactly match the above percentages

Tandem PPO provides a low cost option in some regions

* Sutter Health hospitals included in Tandem network in Alameda

and Del Norte counties

Competitive small business rates throughout the state

4th Quarter

2018

PPO HMO

0.7% -2.1%

2019 Q1 rates

available

PPO rate action:

0.7% increase average statewide

HMO rate action:

-2.1% decrease average statewide

Rate actions vary by region and plan.

Rate tables are available now on

Broker Connection

Rates will be available through your

preferred quoting engine after 10/4/18

Your Blue Shield New Sales Team

Tom Marshall

Area Vice President

Small Business Sales

General Agent

Team

Sandi Eber

Tina Da Silva

Melinda Audiss

specialty benefits

Sue Brittonsenior sales executive

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Earn $10 per member

for dental, vision, and/or life insurance

net new subscriber sales

Specialty Broker Bonus continues in 2019

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• Increased discount to 10% beginning 2019

• Discount for Small Business Dental or Vision

premiums when added to medical

• Available for new dental or vision plans

Rate stability drives high retention

• 2-year rate guarantee for Specialty plans

• No rate action to Dental, Vision and Life

renewals Q1 2019

• Rate reductions for new business, Dental,

Vision and Life for 2019

Specialty plans for member health and financial health

Rate Stability 10% Bundled Savings

+ =

Extensive networks in CA and nationally for more choice

27,000 DHMOCalifornia Providers

52,000 DPPOCalifornia Providers

400,000 DPPOProviders nationally

7,200 CACalifornia Providers

31,000Providers nationally

Independent Retail

LensCrafters

Site for Sore Eyes

Target Optical

Sears Optical

JC Penny

Largest/most diverse network in CA

Wholesale

WalMart

Sam’s Club

Warehouse

Costco

Online

MESVisionOptics.com

2019 plan benefit and name changes

Dental In-Network Only (DINO) plans closing Q1

2019

• No longer available to add these plans

• Groups with DINO can keep these plans

Dental Rollover plans closing Q2 2019

• No longer available to add these plans

• Groups with Rollover can keep these plans

“Enhanced” “Basic”

• Name change for clarity

• Basic Vision plans available starting Q1 for

new sales

• Groups with Enhanced Vision plans will be

renewed into Basic Vision plans starting Q2

$10 Eye Exam copays for all 2019 Basic, Preferred,

and Ultimate vision plans

Travel assistance services to include:

• Visas, passports, immunizations requirements, local customs

• 24 hour pre-departure information on weather and currency

• Lost document and lost article assistance

• Legal referrals and bail assistance, emergency cash

Medical Assistance Services:

• Medical and Dental referrals, Coordinate Hospital Admission, Critical

Care monitoring, Dispatch of a Prescription Medication & Eyewear

Indemnified Medical Transportation Services:

• Emergency Medical Evacuation, Medical Repatriation, Transport of

Family Member, Return of Mortal Remains

Enhancements to Life Plans value added services

Provides services for members traveling more than 100 miles from home –

including internationally

Life Insurance Quick Match – starting at 10 lives

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Upsells 10 – 100

and extended through Q1 2019

Q1 Q2 Q3 Q4Q3

2018 2019

New Business 10- 100

extended through Q2 2019

Q4 Q1 Q2

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Earn $10 per member

for dental, vision, and/or life insurance

net new subscriber sales

Specialty Broker Bonus continues in 2019

shield concierge

Amy Ramirezprogram manager

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42ACOs in 23

regions

nearly

440KACO members

today

2019 Trio HMO covers 24 California Counties

Q4 rates

11% - 32%below

Blue Shield

Access+ HMO

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Concierge Member Service

Co-located clinical and

customer service team

Employer

Resources

Customer Care

Representatives

Medical

Directors

HomeVisits

Provider

Coordination

Personalized

Care Plan

PharmacistsSocial

Workers

Online

Tools

Community

Resources

Registered

Nurses

Condition

Management

• Single point of contact

• Seamless end-to-end issue resolution

• Personalized, employer-specific experience

• Proactive coordination with clinical team

Integrated Care Management

• Holistic member care management for medical, pharmacy and

social support

• Increased member engagement levels due to connection with customer service team

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Employer

Resources

Customer

Care

Representatives

Medical

Directors

HomeVisits

Provider

Coordination

Personalized

Care Plan

PharmacistsSocial

Workers

Online

Tools

Community

Resources

Registered

Nurses

Condition

Management

Getting “home” and starting care

Shield Concierge enables health care worthy of our family and friends.

• Member’s employer contacts Shield

Concierge

• Shield Concierge Program Manager

engages a Medical Director

• Social Worker reached out to member to

for out of country coordination of care

• The CCR and Registered Nurse Case

Manager coordinates with the ACO

provider hospital and physicians in

preparation for the member’s arrival

• The RN Case Manager and CCR

coordinates transport from the airport

directly to the hospital

Getting home and continuing care

• A Registered Nurse woks with the Hospital

Case Manager to develop a Personalized

Care Plan

• A pharmacist ensures that prescriptions

are sent to the correct pharmacy for the

member

• When released from the hospital, Shield

Concierge RN may coordinate Home

Visits for the implementation of the

Personalized Care Plan

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in actionA Blue Shield member is injured while in Brazil and hospitalized. Shield Concierge begins coordinating care.

marketing

Tom Kloossmall business strategy

Plan comparison tool: blueshieldca.com/employerplans

Quickly compare plan benefits

• Medical, dental, vision

• Multiple plans from same year

• Same plan year over year

2019 plans coming early October

blueshieldca.com/

employerplans

Request online enrollment materials for new & renewing groups

Unique site for each

of your groups

Request online enrollment materials for new & renewing groups

Plan overview and Summary of

Benefits for each plan the group

offers, including Specialty

Request online enrollment materials for new & renewing groups

www.blueshieldca.com/FAD

Improved search and user experience

• Exact address location search

• Multiple specialty selection

• Each doctor/provider has a single profile page including all locations

• Make PCP selection directly from a doctor’s profile page

• Optimized for mobile

Enhancements for Find A Doctor - Search

Enhancements for Find A Doctor - Provider Directories

• Anyone can submit an update

• BSC follows up on every submission

Broker Connection has all your resources, now easier to find

Alpha-numeric list of all fliers,

forms, documents included in

Broker Connection

Thank You

Steve Shearer

VP / GM

small business

Never stop