What's new for small businesses – Q1 2025
1-100 employees – Effective January 1, 2025
Medical plan updates
Minimal changes to plan that include improved deductibles and out-of-pocket maximums. You can visit the ‘Changes to your plan benefits’ section of your renewal packet and on your renewal website for more details.
Impacted plans with cost share and name changes:
PPO Plans
| 2024 plan name | 2025 plan name |
|---|---|
| Silver PPO 2000/60 | Silver PPO 1700/60 |
| Silver PPO 2350/65 | Silver PPO 2100/65 |
| Silver PPO 2550/70 | Silver PPO 2350/70 |
| Gold PPO 1000/35 | Gold PPO 1000/30 |
| Bronze PPO 5500/65 | Bronze PPO 4500/65 |
| Mirror Bronze 60 PPO 6300/60 | Mirror Bronze 60 PPO 5800/60 |
You can compare benefits by using our plan comparison tool where you can:
- Compare multiple plans across multiple years to see changes and updates to our plans.
- Compare cost shares across all of our available plans for 2025.
- Use the network comparison tool to see current and future providers in our network.
For exact terms and conditions of coverage for all 2025 plan offerings, refer to the Evidence of Coverage for the plan, or contact your Blue Shield sales representative.
Access to Care anywhere in California, via Accolade Care now available with Trio HMO plans
Transform your employee’s health journey with Trio, offering a combination of coordinated in-person and virtual care. A virtual provider option is now available in all counties that offer Trio HMO through Accolade Care offering primary, specialist, and behavioral care1.
Dental, Vision and Life2
Dental plan updates
Dental plan withdrawal effective January 1, 2025
Three dental PPO plans are to be withdrawn from our specialty portfolio beginning January 1, 2025, as part of our product transformation and portfolio simplification efforts. You can refer to the plan mapping grid (PDF, 61 KB) to see your new plan and available options. Plans being withdrawn:
- Smile℠ Deluxe 50/1500/Ortho/MAC
- Smile℠ Deluxe Gold 50/1500/Ortho/U85/NR
- Ultimate Dental Plus PPO for Small Business 50/2000/Ortho/MAC/NR
Updates to orthodontic services
The copayment or coinsurance for orthodontic services applies one course of treatment per lifetime. The course of treatment must be received in a 24 consecutive month period as long as the employee remains enrolled in the plan.
Limitations and exclusions for dental procedures
If an employee has questions or a need for a complete list of limitations and exclusions for specific dental procedures, please contact Dental Customer Service at (888) 271-4880.
Vision plan updates
Insight discount with EyeMed3 Doctors for 2025
Use your discount with these 3 easy steps:
- Locate an eye doctor – Select from a broad network of independent eye doctors. Visit Blueshieldca.com to find a provider near you.
- Schedule an appointment – Call ahead or stop by one of the many eye doctors that offer walk-in appointments.
- Use your discount – When you arrive, let the eye doctor know you have a discount plan through Blue Shield of California.
Please note your discount cannot be combined with any other discounts, coupons or promotional offers. Learn more about our vision discount here.
Life Plan Reminders
Get more out of your Blue Shield life insurance with these services:
- Beneficiary assistance services offers your employees care and support for family members who have suffered a recent loss of a loved one.
- Travel assistance services offers your employees and their families a broad range of worldwide travel and medical assistance services.
For exact terms and conditions of coverage refer to the Evidence of Coverage and the Plan Contract and to the Summary of Benefits for a comprehensive summary of plan benefits. You can access these plan documents here.
Pharmacy Updates
Price Check my RX
Employer group members now have a better way to manage their medication costs online. The Price Check My Rx tool creates a personalized experience with real-time information from the member’s formulary and benefits usage. Members can use the tool once logged into their Blue Shield account.
Prescription Savings Program
The SMS text-based Prescription Savings Program (PDF, 169 KB) offers discounts on member out-of-pocket costs for select medications and is designed to improve prescription drug affordability and medication adherence.
Member Pays Difference (MPD)
When the MPD penalty applies, your employee 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.
Billing and payments reminders
Signing up for automatic payments is a great way to save time and effort when it comes to monthly billing. We’ve made it easy for you to sign up for autopay through Employer Connection.
For more information regarding making payments you can refer to the Billing and Payment guide.
Please note: currently, Blue Shield of California does not have a paperless billing option. Therefore, groups enrolled in autopay will still receive a paper statement every month.
For assistance, please contact Group Administrative Services by calling (800) 325-5166.
1 A referral from your virtual PCP is required for any in-person or specialty care.
2 Underwritten by Blue Shield of California Life & Health Insurance Company.
3 EyeMed is independent of Blue Shield of California and is contracted by Blue Shield to provide vision services.
