Marketing Paused on 2 Medical Plans, Introducing New Dental Plans & More

Marketing for Two Bronze PPO Plans Paused

The DMHC has required Blue Shield to pause active marketing for the plans below until benefit modifications are submitted and approved. While these plans were initially approved and are compliant with Federal Actuarial Value (AV) requirements, these plans exceed the maximum AV allowed at the California state level and Blue Shield must make changes to lower the AV to the allowed range.

  • Bronze PPO 4000/70 OffEx (Full and Tandem networks)
  • Bronze PPO 6000/65 OffEx (Full network)

New group submissions prior to February 8, 2019, will not be affected and current members will not have any immediate changes to benefits or access to care. Applications received after this date that includes these plans will be pended for the subscriber(s) to select another available plan. You can refer to these Frequently Asked Questions for more information.

Tiered Pharmacy Network for Tandem PPO and Trio HMO Off-Exchange Plans

Tandem PPO and OffEx Trio HMO plans utilize a tiered pharmacy network as follows:

  • Level A (preferred) pharmacies: CVS, CVS at Target, Costco and Safeway/Vons
  • Level B (non-preferred) pharmacies: All other pharmacies in Blue Shield’s national pharmacy network

Out-of-pocket costs are lower when using a Level A (preferred) pharmacy.


Trio HMO plans available On-Exchange or in the Mirror Package will continue to utilize the full national (Rx Ultra) pharmacy network.

Dental Portfolio Changes

All 12 current DPPO plans include the Rollover Rewards program. These plans will close as of 3/31/2019 and will no longer be available to market to new groups. The plans will remain open for:

  • Groups currently offering DPPO plans with Rollover Rewards will be allowed to renew.
  • New employees of groups offering DPPO plans with Rollover Rewards will be allowed to enroll.

Effective 4/1/2019 all current 12 DPPO plan designs will be offered without the Rollover Rewards program. The only difference in these plans will be the removal of Rollover Rewards.


Dental plans will be added for Q2 which include 1 new DHMO and 11 new DPPO plans which include 3 new Voluntary DPPO plans. This brings the total dental portfolio to 5 DHMO and 23 DPPO plan options to give your clients the ability to select plans that work best for their group. Get more information and plan design detail with the updated Dental Brochure For Brokers effective 4/1/2019.

Vision Plan Changes

The 2019 Vision portfolio replaced plans with a $15 eye exam copayment with updated plans with a $10 eye exam copay (all other benefits remain the same). Renewing groups with current $15 eye exam copay plans can elect to change to the corresponding $10 copay plan at renewal with no difference in premium by submitting the Request for Contract Change Form.

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