4/7/2025
We are pleased to announce that the Blue Shield Q3 2025 rates are now available for quoting in ProQuote.
Below are some important updates to make sure you have everything you need for a successful Q3 2025.
Rates and Quoting
Small Business Q3 Renewals
2025 medical and dental updates
Medical plan updates
See below list for impacted PPO plans with cost share and name changes. There are no name changes within our HMO portfolio. You can view the full list of 2025 plan name changes here.
You can expect minimal changes to their medical plan portfolios. Updates for Q3 include improved deductibles and out-of-pocket maximums, added benefits, easier HMO pairing, and expanding access to care.
Compliance with SB 729’s fertility service requirements
Blue Shield is working in good faith to implement the various requirements of SB 729 for fully-insured small employer groups to ensure that we provide fertility services consistent with the bill’s requirements by July 1, 2025.
Please see these FAQs for more information.
Dental PPO plan withdrawals
As part of Blue Shield’s product transformation and portfolio simplification efforts, three DPPO plans were withdrawn beginning January 1, 2025:
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
See this mapping grid for a list of withdrawn plans and corresponding recommended available plans. You can also use the Plan Comparison Tool to compare benefits between a withdrawn plan and an available plan by using the “Compare year over year” function.
Pharmacy updates
New 2025 pharmacy care model resources now available
You can now learn more about Blue Shield’s first-of-its-kind pharmacy solution by visiting this new pharmacy care mode resource page (authentication required). This page includes details about Blue Shield’s Pharmacy care model, Amazon Pharmacy for home delivery, new I.D cards and many more helpful information for you and your groups.
Updates to Member Pays Difference Penalty (MPD)
When the MPD penalty applies, your group’s employees 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.
Changes to weight loss drug exclusions
Beginning January 1, 2025, upon group renewal the weight loss drug benefit exclusion will be reinstated to align with the market. Weight loss drugs will be excluded from coverage except when medically necessary. For exact plan coverage details please refer to the plan’s Evidence of Coverage.
Additional resources
The Q3 2025 Sales Guides provides you with comprehensive information about selling Blue Shield of California products with added value propositions. Topics include ‘Why choose Blue Shield?’, understanding our plan offerings, eligibility and more. Download the medical and specialty sales guide for Q3 2025 now. The plan cheat sheet is a quick guide to all our 2025 medical plan offerings. You can use this guide to easily identify richer and leaner plans and compare plan benefits within a plan family. Please contact your Warner Pacific sales team if you have any questions.
Below are some important updates to make sure you have everything you need for a successful Q3 2025.
Rates and Quoting
- Blue Shield third-quarter 2025 rate action is a statewide average of 1.9%. View full rate tables for medical and specialty here.
- Q3 Rate books have been posted to Broker Connection (authentication required to download rate books).
- Closed Rate books including specialty for all regions can be accessed here.
Small Business Q3 Renewals
- Available resources for the Employer Enrollment Tool for renewals:
| July, August, and September 2025 renewals |
| Groups renewing in July will be available to brokers through Shield Renewals on Tuesday, April 8, while group-level changes can be made using the Employer Enrollment Tool starting Thursday, April 10. Groups renewing in August and September will be available to brokers through Shield Renewals on Thursday, April 25. Group-level changes can be made using the Employer Enrollment Tool for renewals starting Thursday, May 1, for August groups and Monday, June 2, for September groups. View all your group renewal information by visiting the Renewal Center page(Opens in a new window). Dates are subject to change. |
2025 medical and dental updates
Medical plan updates
See below list for impacted PPO plans with cost share and name changes. There are no name changes within our HMO portfolio. You can view the full list of 2025 plan name changes here.
You can expect minimal changes to their medical plan portfolios. Updates for Q3 include improved deductibles and out-of-pocket maximums, added benefits, easier HMO pairing, and expanding access to care.
Compliance with SB 729’s fertility service requirements
Blue Shield is working in good faith to implement the various requirements of SB 729 for fully-insured small employer groups to ensure that we provide fertility services consistent with the bill’s requirements by July 1, 2025.
Please see these FAQs for more information.
Dental PPO plan withdrawals
As part of Blue Shield’s product transformation and portfolio simplification efforts, three DPPO plans were withdrawn beginning January 1, 2025:
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
See this mapping grid for a list of withdrawn plans and corresponding recommended available plans. You can also use the Plan Comparison Tool to compare benefits between a withdrawn plan and an available plan by using the “Compare year over year” function.
Pharmacy updates
New 2025 pharmacy care model resources now available
You can now learn more about Blue Shield’s first-of-its-kind pharmacy solution by visiting this new pharmacy care mode resource page (authentication required). This page includes details about Blue Shield’s Pharmacy care model, Amazon Pharmacy for home delivery, new I.D cards and many more helpful information for you and your groups.
Updates to Member Pays Difference Penalty (MPD)
When the MPD penalty applies, your group’s employees 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.
Changes to weight loss drug exclusions
Beginning January 1, 2025, upon group renewal the weight loss drug benefit exclusion will be reinstated to align with the market. Weight loss drugs will be excluded from coverage except when medically necessary. For exact plan coverage details please refer to the plan’s Evidence of Coverage.
Additional resources
The Q3 2025 Sales Guides provides you with comprehensive information about selling Blue Shield of California products with added value propositions. Topics include ‘Why choose Blue Shield?’, understanding our plan offerings, eligibility and more. Download the medical and specialty sales guide for Q3 2025 now. The plan cheat sheet is a quick guide to all our 2025 medical plan offerings. You can use this guide to easily identify richer and leaner plans and compare plan benefits within a plan family. Please contact your Warner Pacific sales team if you have any questions.
Source: Blue Shield of California