Blue Shield Announces Q1 2022 Updates

10/13/2021
California

Rate Action
Blue Shield's first-quarter 2022 rate action is a statewide average of 1.2%. 
  • Average HMO Rate Action: 1.3%
  • Average PPO Rate Action: 1.2% 
Medical plan updates
Heading into Q1, there are minimal changes to the existing medical portfolio. This is due to decreased out-of-pocket maximums in many plans, no actuarial value calculator changes resulting in minimal cost share changes, and the carrier's focus on providing more plan options with a greater value for their members.

A list of 2021 Small Business medical plans changed names for 2022 can be found here.
View the 2022 Plans at a Glance Document.

Trio HMO Network expansion into Santa Barbara County and Monterey County!
Starting in January 2022, the Trio ACO network will expand to include parts of Santa Barbara and Monterey.

Santa Barbara County
The following medical group will be added to the Trio ACO network in Santa Barbara (partial county):
  • Sansum Medical Clinic
The following hospital partners will be added to the Trio ACO network in Santa Barbara (partial county):
  • Santa Barbara Cottage Hospital
  • Santa Ynez Valley Cottage Hospital
  • Goleta Valley Cottage Hospital
Zip codes now in service area:
  • Carpinteria: 93013, 93014
  • Goleta: 93116, 93199, 93117, 93118
  • Oak View: 93022
  • Ojai: 93023, 93024
  • Santa Barbara: 93110, 93130, 93160, 93111, 93103, 93190, 93109, 93102, 93120, 93121, 93101, 93140, 93108, 93107, 93106, 93150, 93105
  • Santa Ynez: 93460
  • Solvang: 93463
  • Summerland: 93067
  • Ventura: 93001
Monterey County
The following medical group will be added to the Trio ACO network in Monterey (partial county):
  • Aspire Health Plan
With network medical groups consisting of:
  • Montage
  • Salinas Valley Health System
The following hospital partner will be added to the Trio ACO network in Monterey (partial county):
  • Community Hospital of the Monterey Peninsula (CHOMP)
  • Salinas Medical Center
Zip codes now in service area:
  • Marina: 93933
  • Monterey: 93940, 93942, 93943, 93944
  • Pacific Grove: 93950
  • Pebble Beach: 93953
  • Seaside: 93955
Important pharmacy update: copay card programs
Certain specialty drugs have copay card programs offered by drug manufacturers to help members lower their out-of-pocket costs. Currently, the portion of the member's copay or coinsurance paid for by the manufacturer's copay card is applies toward the member's deductible and out-of-pocket maximum.

What's changing
Starting January 1, 2022, for Individual and Family Plans (IFP) and upon group renewal after January 1, 2022, for Small Business and Large Group, only the amount members actually pay for their prescriptions (i.e., true out-of-pocket costs after using a copay card) will be applied toward their deductible and out-of-pocket maximum when using a copay card at a CVS Specialty Pharmacy. The portion of the member's copay or coinsurance paid for by the manufacturer's copay card will no longer be applied toward the member's deductible nor out-of-pocket maximum.

What's not changing
Members can continue to use copay cards to lower their out-of-pocket costs at a CVS Specialty Pharmacy. This change does not affect copay card programs provided by foundations or financial needs-based copay assistance.
Source: Blue Shield of California