More flexibility with Tandem PPO

Blue Shield of California introduced Tandem PPO plans to the market for 2018, and is pleased to announce that you may now offer your small business groups the option to select Tandem PPO plans and Full PPO Network plans together, starting with 4-1-2018 effective dates. This allows groups to offer lower-cost Tandem plans for members whose doctors are in the Tandem network and allows flexibility for members who want to see a doctor who is available only through the Full PPO Network.

Blue Shield announced the Tandem PPO Network for 2018 last year with six plan options. The Tandem network is a subset of the Full PPO Network, with 60% of Blue Shield providers statewide, including access to doctors in all areas of specialty and access to all Blue Shield Full PPO Network hospitals.* Tandem PPO plans provide the same benefits as the Full PPO Network plans but are offered at a lower rate.

Switching to Tandem is an easy way to offset rising annual premiums.

* (Includes Sutter Health hospitals only where necessary to achieve minimum coverage requirements: Alameda and Del Norte counties.)

Bonus statements are available on Broker Connection

Blue Shield updated the bonus payment system, and statements are available online. You can view, print, and download your bonus statements through ICM, just like you do for your commissions.

Your bonus statement on Broker Connection includes more detail about how the bonus was calculated. Bonus flyers by line of business are posted on the line of business landing page for your easy reference.

The first bonus payout through the ICM system was January 10, 2018. As a reminder, all commission payments are now made on the 5th business day of the month.

Which heads to count when counting heads – notes to help you determine if your groups are eligible for Blue Shield of California small group coverage

Group size is important in determining small group eligibility. Below are a few notes to help you accurately complete new group submissions and reduce the possibility of pended applications.

FTE/FTE Equivalent Count Calculation:

  • Only common law employees, not owners, are included in the FTE/FTE Equivalent count for purposes of determining group size.
  • FTE/FTE Equivalent count information is provided by the group or broker submitting forms. However, if underwriting can see that the count includes owners, they must consider that in their final determination.

Out-of-State (OOS) Count when determining in-state compliance:

  • As owners are not included in the FTE/FTE Equivalent count, they are also not included in determining whether the group meets the California small employer requirement that the majority of FTE/FTE Equivalent employees are in California.


  • A group with one OOS full-time common law employee and two owners residing in California does not meet the requirement that the majority of employees are employed in California because the group’s one employee resides in another state.
  • A group with two OOS owners and one full-time common law employee residing in California does meet the requirement that the majority of employees are employed in California because the group’s one employee resides in California.

Continuing to make new business submissions easier in 2018

Updated Master Group Agreement

Blue Shield’s small group Master Group Agreement (MGA) forms for Q1 and Q2 2018 are updated and available on the RBG website. This latest version includes functionality requiring certain fields to be completed and a “Review” button at the end of the form that will identify any missing information. Be sure to use the Q2 Master Group Agreement and Employee Application for groups effective 4-1-2018 and later.

With these prechecks in place, there will be fewer incomplete new group submissions that are pended or returned to you, resulting in faster processing and installation times.

The new functionality does increase the file size of the PDF, so we recommend that you send it as a .ZIP file when emailing.

Relaxed Participation Extended through June 2018

All small business groups may continue to take advantage of Blue Shield’s Relaxed Participation Guidelines through June, requiring only 25% employee participation with a minimum of five enrolled employees for medical plans.

The relaxed participation requirements include vision and dental plans as well, when purchased with a medical plan. You can share this information with your clients using the Relaxed Participation Guidelines.

Blue Shield is continuing to encourage Trio sales by waiving minimum participation requirements for groups selecting Trio plans only, eliminating a barrier for your smallest of small groups.

Express Enrollment Continued

Express Enrollment continues in 2018 and streamlines the underwriting process for small groups with reduced participation requirements, waived DE9c requirements, flexibility in document requirements, earlier start dates for start-ups, waived participation requirements for Trio only groups. Get the details here and contact your RBG Representative to see if your group qualifies.

Your RBG Team is ready to help you grow your business with Blue Shield. Ask about expediting your Blue Shield groups with online enrollment.