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Carrier & Compliance Updates 3.13.18
by Rosa Tessandori » Thursday, March 15, 2018 12:13 PM


  • Life Insurance: Aetna has completed the sale of their U.S. Group Life and Disability Insurance business to The Hartford insurance company. Effective 4/1/18, Aetna Small Group will no longer sell life products to new business, click here to view a copy of the plan sponsor letter regarding the transfer of existing Aetna Life and Disability groups. For more information on the acquisition, click here.
  • Dental Rates: A 24-month Rate Guarantee is available for dental groups with effective dates now through June 15, 2018. In addition, effective April 1st, dental rates for the Metallic Dental plans have been reduced by 10%. Click here for more details.
  • Medical Prior Carrier Deductible Credit: Participants must submit a copy of their HIPAA Certificate reflecting their last day of coverage under the prior plan, a copy of the most recent Explanation of Benefits (EOB) for each enrolled family member and current group information (Group Name, Group #, Member ID# or Social Security#). 
  • My Anthem News: View the March issue, a copy will soon be emailed to your clients, view it before they do. 
  • EXPO - Save the Date: Join the Sacramento Association of Health Underwriters (SAHU) on April 17th, 7:30 AM - 3:00 PM, click here for additional details.
  • Adjusted 2018 limits for HSA, Adoption Assistance and MSA Accounts: Dollar amounts previously released for 2018 have been adjusted. Special note for HSA participants who have already funded the annual maximum contribution amount for 2018, those participants will need to initiate a correction for contributions made for 2018. Click here for a review of the new limits.
  • Commuter Benefits - IRS 2018 Publication 15-B Released: The 2018 release of Publication 15-B includes important information regarding changes to the tax treatment of commuter benefits and the suspension of qualified bicycle commuter benefits. Click here for more details.

View Document
Carrier & Compliance Updates 3.5.18
by Rosa Tessandori » Monday, March 05, 2018 6:53 PM


  • Life Insurance - What's it good for? Click here to share this info graphic.
  • Life Takeover Provision: Want to change carriers but think you have to wait until employees on disability return to work? Don't worry, UNUM's takeover provision will cover them, even if not actively at work. Click here for more information.


  • $400 Amazon Gift Card: Offer valid from March 1 - July 1, close 6 cases and earn the gift card! Contact your RBG Sac sales representative for more information on how employers benefit when providing Healthiest You and Best Doctors to help their employees save time and money.
  • Webinar: View the product/services overview.
  • Federal Law Alert: Second Circuit Rules Sexual Orientation is Protected by Title VII, click here to read more. 


View Document
Carrier & Compliance Updates 2.26.18
by Rosa Tessandori » Friday, March 02, 2018 4:38 PM


  • Reduced Participation:   Groups with 5 or more enrolling members are eligible for a reduced 30% participation requirement through June 15, 2018.  Download a copy of the Q2 presentation.


  • Small Broker Update: Broker Connection Resources, Account Management and Producer Services Support, Specialty Benefits, Reduced Participation for PPO/HMO groups, Waived Participation for Trio HMO Only Groups and 1095-Bs are in the mailclick here for details.


February Chronicle

  • South Bay Expansion Webinar:   Download a copy of the presentation.
  • Expansion Party:  RSVP to join the Expansion Party on March 8th.
  • Dignity Health:  Pending regulatory approval, Dignity Health will be part of the 2018 Expansion.
  • Cadillac Tax:  Congress delays implementation
  • Health Carrier Partners:  View details on Health Net, United Health Care and Western Health Advantage.


  • Harassment - Do We Need the Alleged Victim's Permission to Investigate? Click here to learn more. 


  • Newswire  Feb 21. 2018:  Short-Term Plans Expansion, ACA Fines, CMS Value-Based Payment for Medicare Delayed and more, click here to view the report.  

View Document
Carrier & Compliance Updates 2.20.18
by Rosa Tessandori » Tuesday, February 20, 2018 3:01 PM


Rogers Benefit Group  has partnered with UNUM, a highly reputable carrier offering quality products and service.  We are  now quoting life, disability, dental and vision products.  Click to learn more about UNUM and about the competitive advantage of their dental products.

  • February Webcast:  Join UHC on February 28, 2018 at 2:00 p.m. for Northern California Small Group underwriting and ancillary updates, click here to add to your calendar.  Registration is not required, but space is limited.
  • Webinar:  Learn more on  how to expand your product offerings and enter to win a $100 gift card February 22, 2018 at 11:00 CST, click here to register.  
  • 2018 Commuter Program Changes: The White House Chief Counsel's office confirmed that as of 1/1/18, that pretax salary reductions taken by an employee are NOT a deductible business expense for the employer.  For more details, click here.
  • ACA Individual Mandate Enforcement:  For Tax Year 2017, the IRS will not consider a return complete and accurate if the taxpayer does not report full-year coverage, claim a coverage exemption, or report a shared responsibility payment on the tax return, click here for more details.
February 28, 2018    Deadline to file 1094-C/1095-C schedules if paper filing
March 2, 2018
Deadline to furnish 1095-C schedules to employees
(extended from January 31)
April 2, 2018Deadline to file 1094-C/1095-C schedules if electronic filing
July 31, 2018
Form 720 (PCORI) due from self-insured plans
(includes self-insured employers)

View Document
Carrier & Compliance Updates 2.12.18
by Rosa Tessandori » Tuesday, February 20, 2018 2:56 PM


      Q2 Updates

  • Rate Changes & Marketing Update:   MC/PPO rate pass, HMO - So Cal 2.8% (areas 12-19) increase and HMO - Nor Cal 8% (Areas 1-11). 
  • 2018 Small Group Benefits and Plan Guide Toolkit:  Copy attached.
  • 2018 Underwriting Guidelines: Copy attached.
  • Employer Eligibility Underwriting Guideline Change:  The owner or officer signing the employer group application for the group must be a resident for tax purposes in the state in which the group is applying for medical coverage.
  • Plan Name Changes:  View the toolkit.
  • Reminders for Submission Deadlines


      Partner Alert
  • CCSB-Exclusive Certification Program: Licensed insurance agents interested in selling only CCSB will be eligible for an online licensing training program. More to come about this new certification program in the months ahead. 
  • Agent Bonus Program Now thru June 1, 2018
  • Partnership with EaseCentral:  CCSB is now included on EaseCentral’s integrated software platform.
  • 2018 Submission Deadlines and the Late Application Policy:  Both are available for viewing and downloading.
  • Enroll Faster and Expedite Access: Groups can now pay CCSB upon completion of their application, rather than waiting for the first month’s invoice .
  • CCSB Plans Offer Infertility Coverage if Elected 
  • Updated 2018 Forms are Available for Downloading 
  • View the Top 9 Reasons for Selling CCSB
  • View Upcoming Events
  • 2018 Metal Plans & Network Summary:  Both are available for downloading.

  •  2018 Large Group Broker Bonus Program:  To learn more, click here.  Up to $100 bonus per new member!

  • Need Aggregation Analysis for Common Ownership Groups?  ERISA Compliance Services provides Commonly Controlled Group analysis and ACA 1094 & 1095 Reporting Servicesclick here for more information.

E is for ERISA
  • Management Carve Outs in Group Health Plans:  View the top 10 questionsclick here.

View Document
ACOs Used To Make Me Yawn. Not So Much Now. 2.6.18
by Rosa Tessandori » Thursday, February 08, 2018 2:34 PM

From the desk of Craig Gandy,

My initial reaction to Accountable Care Organizations (ACOs) was “Let me know how that goes once you get it figured out.”  I can now say some data from Blue Shield of California (BSCA) has caused me to pause, as well as adopt a new perspective:
BSCA’s Trio HMO product has more than 200,000 members. In Large Group alone this product’s membership has grown by more than 300% in the last 12 months. 

Here's some context: BSCA launched its first ACO in 2010 and has been expanding ever since. They now have more than 42 ACOs in 22 regions, serving 385,000 Californians. That’s an impressive track record. Since it began, Blue Shield's ACO program has:
  • Reduced hospital admissions by 21%
  • Decreased days that patients stay in the hospital by 19%
  • Saved more than $440 million in estimated healthcare costs

As Trio ACO enrollment continues to grow both in large and small group, so does the Trio Network.  View the Trio Network Guide for details.

This is just another topic to get your conversation away from pretty spreadsheets and a low number. Make sure you have this conversation with your client before another broker does.

For more information talk to your
 RBG Sales Representative:

 Valerie Loui │Cell: 916-425-9499
Greater Sacramento:  Sacramento, Placer, San Joaquin, Stanislaus, Solano, Nevada, El Dorado
Marcy McCulloch │ Cell: 916-634-3031
Greater Sacramento:  Sacramento, Placer, San Joaquin, Nevada, El Dorado
Steve Moore │Cell: 707-849-2709
Greater Bay Area:  Napa, Sonoma, Marin, San Francisco, Contra Costa, Alameda
Tom Zendarski │Cell: 925-285-7800
Greater Bay Area:  San Francisco, Contra Costa, Alameda

Ed Buck │Cell: 559-960-5066
Central Valley:  Fresno, Kings, Tulare, Madera, Merced

Susan Priddy │Cell: 530-518-4211
Northern California:  All Counties North of Sacramento

Carrier & Compliance Updates 2.5.18
by Rosa Tessandori » Thursday, February 08, 2018 1:29 PM

  • Tandem PPO Pairing with Full PPO BSC producer alert correctionthis option is not yet available. This option will be available beginning with April 2018 effective dates.

      Your Choice Updates
  • Kaiser Rate Parity
  • Continued Convenience of multiple carriers under one contract
  • Big Bonus = $$$
  • New Member Value Program (MVP) Discounts
  • Webinar -  Tax Reform Implications for Pre-Tax Benefits:  Thursday, February 8 at 1:00 pm ET, click here to register.

      Compliance Alerts
  • Cadillac Tax Delayed to 2022
  • Children’s Health Insurance Plans (CHIP):   Funding has been approved for the Next Six Years
  • Health Insurance Fee Waived for 2019
  • 2.3% Medical Device Excise Tax Delayed Until 2020

      Health Care Reform Update
  • CA SB 562 (Lara and Atkins) Universal Single Payer:  SB 562 bill still sits at the Assembly Desk.
  • CA Select Committee on Health Care Delivery Systems and Universal Coverage:  View statements made to the committee.
  • DOL Association Health Plans (AHP) Proposed Rule:  This rule will 1) Allow associations to be formed solely for the purpose of obtaining health insurance, 2) Expand the types of employers that are eligible to participate and 3) Expand the ability to offer insurance across state lines.
  • Reminder Individual Mandate Still Effect in 2018
  • CHIP Funding
  • Legislation Requesting Removal of Insurance Producers from MLR - H.R. 4575 

View Document
Carrier & Compliance Updates 1.29.18
by Rosa Tessandori » Wednesday, January 31, 2018 6:12 PM


Broker Update

  • More Flexibility With Tandem PPO: Small business groups now have the option to select Tandem PPO plans and Full PPO Network plans together.
  • BSC Continues To Make it Easier To Do Business In 2018: Relaxed participation guidelines are extended through March, requiring only 25% employee participation with a minimum of five enrolled employees for medical plans. View the Relaxed Participation flier. For groups selecting Trio plans only, take advantage of waived participation requirements.
  • View Q2 2018 product and rate cycle updates
  • Bonus Statements: You can now view, print, and download your bonus statements through ICM, same as you can with commission statements.
  • Determining Group Size: View notes to help you accurately complete new group submissions and reduce the possibility of pended applications.
  • "Select All": When renewing a group online, "select all" plans to continue offering all plans all year long.
  • CMS Reporting Requirements Renewal Form: To continue to comply with CMS requirements, remind groups to complete the CMS form enclosed in their renewal packet and return it to Blue Shield within 10 days.


  • Medicare Part D 2018 Creditable/Non-Creditable Plans: View by carrier a list of plans, click here.

View Document
Carrier & Compliance Updates 1.22.18
by Rosa Tessandori » Friday, January 26, 2018 8:07 PM

  • Specialty Bonus:  The more you sell the more you earn.  You have all of 2018 to sell dental, vision*, and life* insurance small business products from Blue Shield.  Download the  incentive program details.

  • New - Restaurant & Hospitality Association Benefit Trust:  UnitedHealthcare works with the National Restaurant Association (NRA) and the California Restaurant Association (CRA) in a strategic alliance, offering exclusive health care pricing and solutions for every size NRA/CRA member business — including small, midsize and large employers.  Contact your RBG Sales Representative for additional information.
  • January BrokerCast:  If you missed the January BrokerCast, click here for a copy of the presentation.
E is for ERISA
  • Tax Relief for Victims of Wildfires, Flooding, Mudflows and Debris Flows in California:    The IRS has announced tax deadline extensions to individuals and businesses affected by the Thomas fire and subsequent flooding, mud and debris flow in Santa Barbara and Ventura counties.  The same relief is extended to individuals and businesses in San Diego and Los Angeles counties affected by wildfires and related natural disasters occurring since December 4, 2017, and is triggered by President Trump’s disaster declaration for these areas.  Significantly for “Applicable Large Employers” as defined by the ACA, the relief does not extend to Forms 1094-C and 1095-C, which are due in the early months of 2018, as discussed in our earlier post.  Click here for additional details.
  • Federal Law Alert:  For employers with 10 or more employees, view the reminder to post your OSHA 300A form by February 1st and if applicable, submit your OSHA 300A report online by July 1st.  

View Document
Carrier Updates 1.16.18
by Rosa Tessandori » Wednesday, January 17, 2018 9:10 AM



  • Relaxed Participation: Blue Shield has extended their relax participation program through March 31, 2018, click here for more details.


Broker Update

  • Kaiser Rate and Benefit Parity: Whether you write Kaiser directly or through California Choice, you’ll see no change in premium or coverage.
  • February and March Bonus: California Choice will pay you an extra $50 bonus for every employee on all groups with a minimum of five employees.


Broker Connection

  • Vision Plan Satisfaction: J.D. Power study ranks UHC vision highest in customer satisfaction.
  • General Managers: New GMs were announced for Northern and Southern CA.
  • Real Appeal Webinar: The half-hour session helps engage employees in the Real Appeal weight loss program.
  • Broker Webcast 2/28/18 at 1 p.m. E.T.: The one-hour webcast provides an overview of the tools and resources on the United eServices site, click here to register. Note: Dial-in information will be sent via email 3-5 days prior the webcast.  
  • Technology Upgrade: The Employer eServices Customer Reporting (eCR) tool will undergo a technology upgrade to a new version of software at the end of the month. 

View Document
Carrier & Compliance Updates 1.8.18
by Rosa Tessandori » Monday, January 08, 2018 6:03 PM


  • CA Small Group Product Performance Guide: Refer to this guide when you have commission or bonus-related questions. Also, included are references to various resources available to assist agents in accessing tools and information, click here for a copy.
  • Cheat Sheet: For a quick one pag review of UHCs product offerings, underwriting, commissions, rate and network information, click here for a copy of the unofficial Cheat Sheet.


  • ACA reporting 1095-B and 1095-C Extension: IRS Notice 2017-209, released on December 22, 2017, provides an automatic 30-day extension for Health Plans and Large Group Employers to provide recipients with Form 1095-B (Minimum Essential Coverage Reporting) and Form 1095-C (Employer Shared Responsibility Reporting) for tax year 2017. Click here to view the due dates.  Employer groups filing 250 or more information returns during the calendar year must file the returns electronically.

View Document
CA Compliance Update 1.2.18
by Rosa Tessandori » Thursday, January 04, 2018 11:08 AM


      Compliance Update

  • CA Family and Medical Leave (SB-63):   Effective January 1, 2018, California is expanding CFRA baby bonding to cover employers with 20+ employees. This is an important policy update and should be added to employee handbooks by January 1, if possible.  To request more information on HR AnswerLink and HR On-Demand services to help your client HR Managers stay up to date and compliant with CA state law changes, email us at

View Document
Carrier & Compliance Updates 12.27.17
by Rosa Tessandori » Tuesday, January 02, 2018 3:03 PM


  • Elimination of Outside Sales Teams for (1-100 market): As of December 26, 2017, Aetna will no longer have an outside sales team for the small group segment. However, in addition to the Aetna inside support teams, you can continue to rely on your Rogers Benefit Group Sales and Service Teams for continued support when selling, renewing and servicing your Aetna groups. View the alert.


  • The Benefits Guide - Online ACA Resource Center: Anthem is retiring their Making Health Care Reform Work website in January. Refer to the new online Benefit Guide website for Affordable Care Act (ACA) resources as well as hundreds of articles and other content designed to help employers learn more about health benefits and ways to engage their employees.


  • 2018 Specialty Bonus: For groups of 1-100 with 1/1/18 effective dates and going forward, earn $10 per net new member for dental, vision, and/or life insurance subscriber throughout 2018. To be eligible, a broker/agency must sell a minimum of two new groups in 2018. Learn how to start earning more now!



      Compliance Alert

  • Tax Cuts and Jobs Act (H.R.1):  For a review of the consumer directed benefits affected by the new tax codes signed into law on December 22, 2017.  Learn more on how the tax law changes will affect Transit and Parking (commuter) programs, the Qualified Bicycle Reimbursement Program and the implementation of "Chain CPI".

E is for ERISA


       Benefit Guidance and Tools

View Document
Carrier & Compliance Updates 12.18.17
by Rosa Tessandori » Wednesday, December 20, 2017 10:04 AM


Broker Updates

  • Tandem PPO: Tandem is a statewide High Performing PPO Network Solution that leverages many of our ACO partnerships throughout the state, providing the same plan benefits as the full PPO plans but at a lower price. Learn more about the new Tandem PPO program and search for providers in your area today!
  • Broker Connection Updates: Brokers will be able to view, print and download bonus statements through ICM on Broker Connection.
  • Relaxed Participation: Take advantage of BSC's relaxed participation guidelines through March, 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 flier.
  • HMO Members Pharmacy Vaccines: Small business HMO members are now eligible to receive vaccinations at retail pharmacy locations, a benefit previously available only through PPO plans. Members enrolled in an eligible non-grandfathered plan with an outpatient prescription drug benefit can receive coverage of select vaccines at a participating pharmacy at no additional member cost. You can share this information with your clients using the Vaccines at Retail Pharmacies flier, and encourage them to help fight the flu this season.
  • March Renewal Kits: Log into Producer Services to download your March kits. In mid-January, BSC will make all second quarter renewals available on the Producer Services portal for April, May, and June.
  • Annual Mandated Member Reminders: Starting mid-December, BSC will send mandated annual reminders to all members except Medicare and FEP. The reminders will be sent via email. If an email is not available, the reminders will be sent via regular mail. Members can visit for more information on these topics.




  • Bonus Program:  Earn Extra on CCSB groups with 6 or more enrolling January 1 - June 1, 2018, view the Partner Alert  for details.



       Compliance Update

  • Relief Extension for Hurricanes and Wildfires: The Department of Labor (DOL) issued compliance guidance for employee benefit plans impacted by Hurricane Maria and the California wildfires of October 2017 (DOL news Release 17-1555-NAT, available here).   This guidance, in part, includes extensions of certain COBRA, HIPAA, and ERISA claims procedure requirements for participants, beneficiaries, and benefit plans located in Puerto Rico and the U.S. Virgin Islands identified for individual assistance by the Federal Emergency Management Agency following Hurricane Maria.

View Document
Carrier & Compliance Updates 12.11.17
by Rosa Tessandori » Monday, December 18, 2017 8:37 PM


      Small Group

  • Underwriting Promotions:  View updates on Relaxed Participation and more.
  • Southern Cal Wildfire Member Assistance:  Rx, prior authorization and DME relaxed guidelines are available for Anthem members December 5, 2017 through January 5, 2018, learn more.

      Large Group

  • Claims:  Anthem developed What’s My Status,  an enhancement to their claims process that sends automatic, real-time emails or text messages to members to let them know when a claim is received, and another when it’s approved or denied, learn more.

Large Group Update

  • New Marketing Campaign:  The campaign, "We care about here," features real Californians and their stories.
  • Pharmacy Updates -  Rx Tier Relabel:  Beginning January 1, 2018, select generic and brand name drugs will be placed on new tiers in accordance with the updated formulary tier definitions for Blue Shield's large group Commercial plans. 
  • Broker Connection Updates:  Brokers will be able to view, print and download bonus statements through ICM on Broker Connection.
  • 2018 Q1 Bonus: Earn $50 for every employee on all groups with a minimum of 5 employees, view the flier.


  • HR Advisor:  Preventing Sexual Harassment in the Workplace,  learn more.
  • HR Snapshot:  You received a complaint about harassment. How should you respond?  Learn more.
  • HR Snapshot:  Is serving alcohol a liability?  Learn more.


Compliance Update

  • State & Local Minimum Wage Increases for 2018
  • CA New Hiring Laws
  • New Harassment Training and Posting Requirements
  • New Immigration Law Responsibilities 


  • ACA Reporting and Deadline Charts:  HR360’s 2 attorney-developed charts provide 2018 reporting requirements and deadlines for IRS Forms 1094 and 1095. The IRS sent their first ACA reporting penalty letters out recently--make sure your clients comply with our free, easy-to-understand charts, click here to learn more.

View Document
Carrier & Compliance Updates 12.4.17
by Rosa Tessandori » Monday, December 18, 2017 8:11 PM


  • MLR Employer Survey:  Employer groups are receiving their annual Medical Loss Ratio (MLR) Employer Survey by email requesting confirmation of their 2016 employee count. Employers who do not respond by December 8, 2018 will be categorized based on their group size on record with Blue Shield of Ca., which could impact the MLR calculation and any possible rebate.  Click here for a copy of the MLR letter.


  • Broker Bonus:  Start the new year off with a BIG bonus for all new CaliforniaChoice groups with a January, February, and March effective date. You’ll earn $50 for every employee on all groups with a minimum of 5 employees.  Click here to view the flier.


       Carrier Partners 
  • United HealthCare (UHC):  As of 9/1/17, UHC offers Canopy Health as part of the Advantage Network under small and large group contracts and is only available directly through UHC. 
  • Western Health Advantage (WHA):  Starting January 1, 2018, Canopy Health with be available through small group direct through WHA or through California Choice. Large group will have access only directly through WHA.
  • Health Net:  Starting January 1, 2018,  Health Net Smart Care (101+) will offer Canopy Care within its SmartCare Network. 
  • Resources: For more information on Canopy Health, click here


Broker Connection

  • Preventive Care:  The United States Preventive Services Task Force (USPSTF) has revised its preventive recommendation for cholesterol screening and cardiovascular disease testing effective December 1, 2018.
  • Vision Network Updates: Effective immediately, all UHC vision groups will now have access to Target and Sears Optical centers as part of their standard network.


     Compliance Reminder

  • When is a qualified health care expense eligible for reimbursement under an HSA account?  The answer to this question can vary depending on the state where the banking institution or the administrator is registered/domiciled.  Generally, only qualified expenses incurred after you have established your HSA account are considered eligible for reimbursement (IRS Notice 2004-50). However, for Health Equity HSA account holders, because Health Equity is a Utah based corporation, under Utah’s banking regulations, the HSA is considered established as of the effective date of a member’s QHDHP (PLAN) as long as the HSA account is opened by the federal income tax filing deadline (April 15th) of the subsequent year.  View the 2017 HSA Guidebook - Using and Growing Your HSA.  For more information on Health Equity Administration Services contact your RBG Representative.

View Document
Carrier & SEP Updates 11.27.17
by Rosa Tessandori » Monday, December 18, 2017 7:55 PM


  • Dental Prime and Dental Complete Plans: 24-month rate guarantee is available through March 2018 effective dates.


  • Underwriting Guidelines - Kaiser Restrictions:  Beginning 1/1/18, off-anniversary group movement between California Choice and Kaiser Permanente direct (or vice versa) will not be allowed.  Groups may only apply at their anniversary, there are no exceptions to this new rule.   View the 2018 Underwriting Guidelines.  


  • Deadline Reminder:  Small Groups (1-100) applying under the Special Enrollment Period (SEP) guidelines, must be submitted to the applicable carrier clean and complete by the carriers cut off date/time on December 15, 2017.  Please submit your SEP group(s) to RBG at prior to December 15th  to allow sufficient time to scrub and request any missing information.  View the attached for additional details on carrier deadlines 

View Document
Carrier & Compliance Updates 11.20.17
by Rosa Tessandori » Monday, November 20, 2017 3:07 PM

BLUE SHIELD OF CA Producer Alert
  • Updated Enrollment Spreadsheet: Updated versions of the 2017 and 2018 spreadsheets were posted on November 15 and are available under Employee Forms and Applications on Broker Connection. The updated forms automatically duplicate some information from section 3 to section 4 to help reduce potential pends.
  • 2018 New Case Submission Rules for Groups of 1-100: View the list of documents that are required at the time of new case submission, click here.
  • Bundling Bonus: Earn a bonus when placing new specialty lines of coverage with the same employer and initial effective dates of coverage between October 1, 2017 and January 31, 2018. For more information, click here.
  • Bonus for cases 51-999: Sell 51-999 eligible Humana dental cases with effective dates December 1, 2017 through January 31, 2018 and earn $40 per subscriber, for more information click here.
  • HR Complete: Offer your clients the premiere, full-service HR compliance and strategy solution, the industry’s most comprehensive HR protection and support service by partnering them with a certified HR professional. To learn more, click here.
  • IRS 2018 Plan Year Tax-Free Limits: The maximum annual limit for a Medical FSA will increase to $2,650. The maximum tax-free monthly mass transit and parking amounts will increase to $260 and the HSA contribution limits are $3,450, for single coverage, and $6,900, for family coverage. For full details, click here.
  • New Group Submission Deadlines: Groups with 12/1/2017 start date can be submitted no later than 12/14/2017 and groups with 1/1/2018 start date can be submitted no later than 1/14/2018. View the HealthiestYou flier.
  • ACA Reporting Training – Changes & Requirements: Join HR Service Inc, for training on Tuesday, Nov, 21st at 1:00 PM MT (12 PM PST). Click here to register
    and feel free in invite your employers.
  • ACA Penalty Enforcement: The IRS has started, “for the first time, to enforce one of the law’s most polarizing provisions: the employer mandate.” For more information, click here.

View Document
Carrier & Compliance Updates 11.6.17
by Rosa Tessandori » Tuesday, November 14, 2017 10:12 AM



  •    Changes to the New Group Initial Payment Process:  CCSB now has approval to accept checks before invoicing of new business. This new process will result in faster processing of member's carrier eligibility and ID cards.  Contact your local RBG sales rep for additional details.


      Small Group Broker Pulse

  •   COI and EOC Updates:  Plan Certificate of Insurance (COI) and Evidence of Coverage (EOC) booklets will contain the updates as shown in the "Notice of Changes to Coverage Terms" document(s),  for more information, click here.

       Large Group Broker Pulse

  •     Enhanced Choice Portfolio Updates:  Learn more about the new PPO-Only package, New PPO Lean Plan and more, for more information, click here.


  •  2018 Updated Materials:  View the updated HMO Network Comparison  and the UHC Overview.  Various other updated marketing pieces are available on
  • Real Appeal Webinars:  Real Appeal® is offering half-hour Employer and Broker Informational Sessions throughout November and December 2017.  Participants will learn more about the weight loss program and the benefits it offersregister for a session today.

 HR 360

  •  2018 updates for HSAs, FSAs, and HRAs:  View HR360's 2018 HSA/FSA/HRA Comparison Chartit features all the latest updates for next year. PLUS, you can easily compare key features of each tax-favored account in one convenient chart.


View Document
Carrier Updates 10.30.17
by Rosa Tessandori » Tuesday, November 14, 2017 9:39 AM



       Partner Alert

  • Commissions:  Beginning January 1, 2018, a 5% commission will apply to any new enrollment for groups with 1-50 enrolled employees. All 1-50 groups written from January 1, 2014 through December 1, 2017 will remain on the current 6 ½% down-graded commission schedule and will not be affected. For groups 51-100, no changes are being made.  For further details on the commission schedule changes going into effect January 1, 2018, please review the Agent Commission Structure found here >>


        Large Group 101+

  • Bonus Program:  Broker Cash Rewards for plans with effective dates 1/1/18-12/1/18.  Brokers earn a $50 bonus on each member enrolled in a newly sold plan.
  • Online Resources:  Visit for details on Health Net's Enhanced Choice and Starting Line-Up packages that offer flexible and cost savings choices.

View Document
Carrier Updates 10.23.17
by Rosa Tessandori » Monday, October 23, 2017 2:38 PM


 2018 Q1 Update

  • Rate Action:   The average difference for CA for the first quarter of 2018 is:  HMO increase of 2.5% and a decrease for MC/PPO  - 0%.  Child Age Rating Changes include a new single age band age 0 through age 14,  individual age band ages 15 through 63 and a single age band age 64+.
  • Portfolio Updates:  View the updated plan additions and changes.
  • Pharmacy Updates:   New single ACA formulary for SG plans.  Renewing plan members will transition to the new SG ACA formulary and will have a one-time Rx refill for up to a 30-day supply for medications requiring precertification, step therapy, or other utilization management review.
  • Network Name Changes:  Same networks,  just different names.
  • New Hire Effective Dates:   1st or 15th of the month option after meeting the required waiting period. 
  • Indemnity Plan Restrictions: The indemnity plan is no longer available for employees that don’t reside in an MC or PPO network area
  • Participation:  Stand alone is 60% and alongside Another Carrier's HMO is 40% with a minimum of 5 enrolling in Aetna.  
  • Special Open Enrollment for 1/1/18:  Aetna must be the sole carrier for groups enrolling under the special open enrollment period from 11/15/17 through 12/15/17, for a 1/1/18 effective date.  An attestation form will need to be submitted with the group confirming Aetna is the sole carrier.
  • New Business Submission Deadlines: A complete submission must be received by Aetna on 1st of the month for 1st of the month effective date and 15th of the month for the 15th of the month effective date. Groups submitted after the deadline are moved to the next effective date.
  • Renewals: Groups should submit their renewal confirmation in writing prior to the renewal date or make the renewal premium payment prior to the renewal date.  The plan change submission deadline is 10 days prior to the renewal or 5 days if using the eList tool.


Q1 2018 Resources



  • Paperless Update:  Reminder, BSC no longer accepts paper for many submissions.  January renewals are available online for downloading.  also, post enrollment materials are available online from the same renewal site.  Use Employer Connection Plus for open enrollment and ongoing member-level changes.  View the update.

Broker Update - Large Group


  • Trio Network Expansion: Effective January 1, 2018, 8 additional counties will be added making Trio available in 24 counties.
  • Vaccine at Retail Locations for HMO Membership: Effective October 1, 2017, members in select
  • non-grandfathered plans will be able to receive select vaccines at participating retail pharmacies.
  • SB17:  Is a new state law that provides transparency to prescription drug pricing in California and now applies to drug companies.
  • Assistance for Members Affected by CA Wildfires:  Services include immediate refill of prescriptions, even if they are not yet due for refills and more. 



CA 2018 SG Benefit and Rate Updates


  • Q1 Rate Action:  PPO & Enhanced Care PPO increase +3.3% and HMO & HSP decrease -0.2%.
  • Plan Updates:  New plans and plan change information
  • Medical Plan and Rate Resources:  Download rate tables, side by side comparisons and more.
  • Ancillary Rates:  Download the rate tables.
  • ACA Mandated Child Rate Age Factor Changes:  Learn more about the new age slop factor.

       Broker Pulse 

  • Assistance for CA Fire Victims:  RX Refill assistance and more.


  • Q4 Group Incentives:  For groups larger than 50 employer paid enrollments (HealthiestYou product), HealthiestYou is offering a 2-year rate guarantees and other incentives like 1 or 2 months free premiums.  For more information, contact your RBG Sales Representative.  Also, qualify to win an Apple Watch, a $400 Amazon Gift Card or the Grand Prizeclick here for more information.
  • Top Reasons Why Employers Want To Offer HealthiestYou:   $0 Copays, Prescription Savings Tool, Procedure Pricing Tool, Enhanced Provider Search Tool and the Claim Status tool. View their flier. 

View Document
Carrier Updates 10.16.17
by Rosa Tessandori » Monday, October 23, 2017 1:42 PM



  • 2018 Q1 Rate Action:  PPO Average decrease -0.4% and the HMO average increase +2.4%.  For more information on added or discontinued plans and other renewal resources, click here.
  • Age Band Rate Changes:  New age-band ruling impacts premiums for children ages 15 through 20 years of age effective January 1, 2018.  For more informationclick here.
  • Disabled Social Security Registration Option:  As of September 15, members can no longer use their social security number to complete their online member registration or to reset their username or password.  For more information, click here.
  • New Website Resource:  The Stronger Together website combines many resources in a single location for people touched by cancer.  For more information, click here.




  • Tips to Streamline New Group Installations:   To streamline group installation, all components must be submitted together to begin processing. Incomplete submissions will be returned to the writing producer or general agent rather than pending for later completion or rolled into the next effective date.   For more information, click here.



       Broker News

  •  2018-Q1 Rate Action:  PPO & Enhanced Care PPO increase of +3.3% and HMO & HSP decrease of -0.2%.  This update also includes details regarding new and canceled plans, plan enhancements like Teladoc for CommunityCare HMO members and EnhancedCare PPO plans, ancillary rate information, medical and ancillary rate tables and the Federal Standard Age Curve changes.





       Nor Cal SG Webcast Resources


  • Presentation Copy:  View a copy of the presentation, click here.  
  • 2018-Q1 Rate Action:  PPO rates increased by +2.5 % for all networks and HMO rates decreased by -0.6% for all networks.
  • Canopy Health Fliers:  View the flier launching Canopy Health and the overview flier on Canopy HealthCanopy Health is now available to members enrolled on HMO Advantage plans.  The 2017 HMO network comparison brochure is being revised to include this change and will be posted shortly on once finalized.
  • Real Appeal Flier:  Weight loss planning and support is available in 2018 to members enrolled on PPO plans.  To learn more, click here.
  • Heal Flier:  Services include on-demand doctor house calls and is now available to new groups and existing groups at renewal to members enrolled on a PPO Select Plus or Core plan designs (in applicable areas) . To learn moreclick here.

     Broker Connection

  • Digital On-boarding:  When conducting an open enrollment, be sure to use the Digital On-boarding tool to not only simplify the member enrollment process but better inform and engage the employees about their benefit plans.
  • Wellness Webinars:  Build and Retain Clients with UnitedHealthcare Motion.  Pick from three dates October 23rd, 24th and 30th.
  • Opioid Crisis:  UHC can help your clients with strategies to prevent and treat Opioid Use Disorders
  • Prescription Drug List (PDL):  View the latest updates.
  • 2018, Jan 1st Prescription Drug List (PDL):  View the latest updates.
  • Vision Network:  Beginning in 2018, UHC has added Warby Parker to it's vision network.
  • ®Employer eServices Upgrade:  The Customer Reporting Tool, will have a technology upgrade in November to enhance data security on Employer eServices.
  • Real Appeal:  Join one of UHC's broker information sessions throughout October, November, and December 2017.  

View Document
UHC Support for Those Affected by NorCal Fires
by Rosa Tessandori » Wednesday, October 18, 2017 4:46 PM


Broker Connection - Special Edition*

United Healthcare is taking action to help people affected by the wildfires in Northern California.

  • Contact customer service for assistance finding a network care provider
  • Prior-authorizations waived
  • Deadlines for claims and appeals filings extended
  • Durable medical equipment replacement
  • Early refills available
  • Replace lost medical ID cards, call 866-633-2446 8 a.m. - 8 p.m. Mon-Fri or download the app
  • Free Behavioral Health Help Line - this service is free of charge and open to anyone

*These measures apply to individuals insured through UnitedHealthcare and living in Napa, Sonoma or Yuba counties and are effective through Oct. 23, 2017. Other measures apply to all counties included in the Governor's disaster proclamation. 

View Document
Carrier Updates & Compliance 10.9.17
by Rosa Tessandori » Wednesday, October 18, 2017 4:23 PM


       Producer Alert
  • Expanding Trio Network: Coverage available in 24 counties. For more info visit
  • New Tandem PPO Network: Beginning in 2018, these plans are offered at a lower rate than the Full PPO Network plans with the same plan benefits.
  • 2018 Q1 Rate Action: Find full rate information and sheets on Broker Connection. Rate increases for Q1 2018 are 1.1% for PPO plans and 2.4% for HMO plans.
  • Enrollment Spreadsheet: Reduce errors and turnaround time on new group submissions by using the Enrollment Spreadsheet available on Broker Connection under
    Forms and Applications
  • 2018 PPO Savings Plans: Chiropractic services are embedded in all 2018 PPO Savings plans.
  • Healthy Equity H.S.A. Services: The Silver 2000/20% can now be paired with Health Equity H.S.A. Services.
  • HMO Infertility Rider: 2018 HMO plans can be offered with or without supplemental infertility (INF) coverage.
  • HMO Members: No Cost Vaccines are covered under the pharmacy benefit and provided at no extra charge through retailers.
  • Summary of Benefits (SOBs): Beginning in 2018, SOBs replace Benefit Summaries.


       Partner News – September
  • 2018 Rate Action: The weighted average rate change for 2018 is 5.6%. Rates are now available for quoting.
  • 2018 Carriers: Blue Shield, Health Net, Kaiser, Sharp Health Plan and Chinese Community Health Plan in San Francisco will continue to be participating carriers.
  • Discontinued Carrier effective 1/1/2018: CCSB will not be offering Western Health Advantage in 2018, a move that will affect approximately 350 consumers.
  • Agency Contract: Register your agency to allow office staff and account managers to help service CCSB groups. Contact for more information.
  • Group Submission Deadlines: October cases are due 9/25, November are due 10/25 and December are due on 11/27. Due dates can be extended for those groups signing the late submission form. Click here to view the form and contact our office for specific deadlines.
  • Dental Only Enrollment: With a valid waiver (through another employer, union, the military, or Medicaid or Medicare), CCSB allows your clients’ eligible employees to enroll in a dental-only plan without electing a health plan.
  • Reference Plan Educational Video: View the educational video which clarifies the importance of a reference plan and ways to best leverage the exchange to benefit both small business owners and their employees. Click here to view the video.
  • Promotional Video: This video outlines the benefits of prospective clients partnering with CCSB.
  • CCSB Website Updates: View the alert to see a list of updated web pages.


       RBG Tip Sheet Reminder

       Medicare Part D Creditable Coverage: Annual notices are due by October 15, 2017.

View Document
Carrier & Compliance Updates 10.2.17
by Rosa Tessandori » Monday, October 02, 2017 6:06 PM


Small Business Broker Update
  • New PPO Network Tandem PPO: Blue Shield has collaborated with select providers to create the Tandem PPO Network available for effective dates starting January 1, 2018. Members will be matched with a primary care physician (PCP) in the Tandem PPO Network. Like all PPO plans, members have the flexibility to see any health care professional, including specialists or access any facility in the Tandem PPO Network, without a referral.
  • Top Ten Underwriting Issues: View the Blue Shield lists of the top 10 most commonly missed fields which result in pending applications.
  • 2018 Q1 Rate Action: PPO average rate increase is +1.1%, HMO +2.4% and Trio +2.4%. The cumulative rate impact for the last four quarters is an average of PPO +2.4, HMO +5.8% and for Trio +0.9%.
  • Trio Rates: On average, Trio rates are 12% below the full Access+ HMO rates.
  • Tandem PPO: Blue Shield introduces a statewide network of choice providers, with plan benefits matching their Full PPO plans, but at a lower cost. Tandem PPO rates are on average 4% below the full network plan rates, and as much as 8% lower in some regions.
  • Ancillary Rates: On average, rates for dental, vision and life insurance remain flat.
  • Bundling Discount: For groups with a Blue Shield Medical Plan, a 5% discount is applied directly to the total dental or vision premium.
  • Changes to the Child Rate Tables: Due to ACA mandated new age slope requirements, for 2017 to 2018, members turning age 15 to 21 will have additional rate impacts from +20.5% to +57.5%.
      Producer Alert
  • New Hire Rate at Enrollment Clarification: For groups renewing on 10/1/17 or thereafter, the rate charged for new hires will based on the age at the time of enrollment rather than the age as of the group’s last renewal.
  • 2018 Q1 Rate Action: Rates are valid January-March 2018 effective dates. PPO rates are increasing +2.5% across all networks and HMO rates are decreasing -0.6% across all networks. Note, the optional infertility coverage is not factored in the above rates.
  • New Value-Add program: Real Appeal is a no-cost value add program including tools and support to help employees lose weight, feel good and prevent weight-related health conditions. Real Appeal is included in the CA small group PPO plans, click here to view the flier.
  • Vision Network Update: Earlier this year UHC announced the addition of Target and Sears Optical to their network. Starting in 2018, UHC is also adding online retailer Warby Parker as an in-network provider.
  • October Webcast: Join UHC on 10/11/17 @ 2:00 p.m., which will include their 2018 rollout. Click here to view the PDF & the outlook calendar invite.
      Broker Connection
  • SAM Enhancements: The census and enrollment templates are now combined. In addition, you are now able to change an effective date and drop a plan while you are in enrollment.
  • SAM Trainings: Several dates are available, register early.
  • New Medicare ID Cards: The new cards will no longer include the members social security number.
  • Prescription Drug List: View the latest updates.
  • Specialty Medications: Prior pre-authorization is required starting Oct. 1st for Radicava, Brineura and Soliris.

E is for ERISA

      Compliance Update
  • ACA Cheat Sheet: View the cheat sheet with affordability safe harbor thresholds, applicable large employer penalty tax amounts, and out-of-pocket maximums for 2017 and for fast-approaching 2018. Click here to view.

Carrier & Compliance Updates 9.27.17
by Rosa Tessandori » Wednesday, September 27, 2017 11:12 AM


Small Group
  • New Hire Age at Enrollment: Blue Shield has corrected the age attainment calculation for new and existing groups. All existing small business groups will see the fix applied starting October 1, 2017. View the alert, click here.
  • Relaxed Participation: This program has been extended through the end of 2017. View the update, click here.
Large Group
  • DPPO Network: Additional providers have been added increasing the network to nearly 45,000 providers.
  • Prenatal Support: At no additional cost to members, this program offers support before, during and after childbirth.
  • Trio Momentum: Membership is growing steadily and the network continues to expand, which means you can offer high-value health care to more people, in more places.
  • Product Mandates: Changes have been made based on current California and federal laws affecting the Alpha-Fetoprotein (AFP) Genetic Testing Program, contraceptives and the Diabetes Prevention Program.
  • SoFi: Is a new financial wellness benefit. An example of the services provided include student loan refinancing and employer student loan contribution administration.
  • Hurricane Victim Services: Blue Shield has implemented services to help ensure continuity of care for affected members.
  • Palliative Care Program: This program was introduced in Sacramento earlier this year and it has recently been made available in the San Francisco area. With time, the goal is to expand services through California.

  • Bundling Bonus: A Humana Agent Bonus is available for groups sold October 1, 2017 - January 31, 2018. View the flier, click here.


Broker Connection - September
  • MLR Rebates: Groups eligible for a rebate should receive them by September 30, 2017 deadline.
  • Child Age Band Rating Change: Effective January 1, 2018, a new age band structure will apply due to ACA requirements.
  • Preventive Care: Learn more about which preventive care services have been updated.
  • Pregnancy App: This new phone application is designed to improve pregnancy outcomes and to lower costs.
  • Pharmacy Updates: View the updated Prescription Drug List.
  • Specialty Product Promotion: UHC will send direct mail advertisements to groups 2-50 from September 2017 – August 2018. View samples of the Specialty product materials that will be sent to clients:

  • Winning with an HSA: Learn how to financially leverage your H.S.A., to download a copy, click here.
  • The Complete H.S.A. Guidebook - 10th edition: Includes health care reform and tax change updates, to download a copy, click here.


Federal Law Alert
  • New I-9 Form: As of Monday, September 18, 2017 employers should be using the I-9 with revision date of 7/17/17.

View Document
Carrier & Compliance Updates 9.11.17
by Rosa Tessandori » Tuesday, September 12, 2017 11:06 AM


       Partner Alert

  • Membership Growth: 25% growth over prior year.
  • 2018 Rate Action: The weighted average rate change for 2018 is 5.6%. 
  • 2018 Carriers: Blue Shield, Health Net, Kaiser, Sharp Health Plan and Chinese Community Health Plan in San Francisco will continue to be participating carriers.
  • Discontinued Carrier effective 1/1/2018: CCSB will not be offering Western Health Advantage in 2018, a move that will affect approximately 350 consumers.


       Broker Briefing
  • Mobile Bill Pay: Now available for paying bills and viewing payment history.
  • Optical Plans: Four new plans are being added for large group in 2018.
  • Q4 Service Tips: Avoid common mistakes, click here.
  • Current Email Addresses: Update client email addresses, click here for instructions.


      1-Minute Sales Tip
  • Job Descriptions: Help your clients and prospects by taking a large project off of their plates – job descriptions.

      Federal Law Alerts
  • EEO-1 Pay Data Reporting: The Office of Management and Budget put an indefinite hold on the pay data collection portion of the EEO-1 form. 
  • Overtime Rule for White Collar Workers: A federal judge ruled that the DOL overstepped its authority. 
  • Predictive Scheduling Laws: The states of Oregon and New York City have joined San Francisco, Emeryville, and Seattle in passing predictive scheduling laws, which require certain employers to give employees a minimum amount of advance notice of their work schedule.



View Document
Carrier & Compliance Updates 9.5.17
by Rosa Tessandori » Tuesday, September 12, 2017 10:46 AM

  • Express Enrollment: View the simplified underwriting guidelines, click here.

  • Multi-Product Advantage: Sell a dental plan and at least two new coverages from two or more of the different product groups, verify the group meets the qualifying criteria and earn an additional one-time payment of 1.5% of the annualized premium for each product sold. For more information, click here.


COBRA Compliance
  • Webinar: "Pitfalls to Avoid with COBRA" on Sept. 14, 2017 at 1:00 EDT. This event will help you: (1) understand COBRA rules and regulations, (2) recognize the pitfalls and consequences of improper COBRA management and (3) identify key questions you should be asking regarding COBRA services. Register now.
  • eBook: What makes a great COBRA partner?" The eBook outlines several items to consider when evaluating COBRA services and what really differentiates partners that truly excel at COBRA services. Download a copy.

View Document
Carrier & Compliance Updates 8.21.17
by Rosa Tessandori » Thursday, August 24, 2017 8:31 AM


Producer Alert

  • New - Enrollment Spreadsheet: For groups effective September 1, 2017, and later, the new Enrollment Spreadsheet is available to all brokers enrolling new groups in medical and/or specialty benefits.  Download the spreadsheet on Broker Connection and it will also soon be available through EaseCentral.

Partner News - August

  • IFP Open Enrollment:  Join Covered CA at one of their scheduled “In It, To Win It” kickoff tour meetings, which start on Wednesday, September 6th and run throughout the state, ending on Tuesday, October 3rd in Sacramento.
  • Revised Agency Agreement:  When completing your new agreement, keep in mind that the designated Agency Manager will act in an administrative and operational role for your Agency within the CalHEERS Agency Portal.
  • Agency Portal Update:  Learn More about the two phase process of the portal rollout. CCSB anticipates launching the 1st phase of the rollout for use with fourth quarter renewals.
  • Q4 Update:  New plans and rates are available for quoting.  The Blue Shield HMO Trio plans are experiencing a rate reduction.  Health Net has added their Value PPO plans on the Silver and Gold levels and a Health Net HSA PPO plan at the Bronze level.
  • Website:  Visit their updated pages.
  • Educational Video:   View the, “CCSB Health Plan Budget Control | Reference Plan Strategy.”  This video clarifies the importance of a reference plan and ways to best leverage the exchange.



Broker Briefing

  • Website Resources:  Visit for information that helps make deductible plans easier for your clients to understand.
  • Facility Updates:  The Santa Cruz facility is now open, click here to view a list of future sites.
  • Large Group Deductibles: Effective January 1, 2018, the IRS is raising minimum deductible levels and allowable out-of-pocket maximums for large group health savings account (HSA)–qualified plans.
  • Webcast Invite:  1-100 Northern CA August Webcast 8/23/17 2PM PST.  Updates from UHC on how they are serving you and your clients in 2017 – and far beyond.  For more information, click here.


  • Opt-Out Payments:  In the 2016 opinion in Flores v. City of San Gabriel, the Ninth Circuit court held that opt-out payments had to be included in the regular rate of pay used to calculate overtime payments under the federal Fair Labor Standards Act (FLSA). For more information, click here.


HR Snapshot -  Provide your clients with a real time look at trending HR Topics through HR AndswerLink.


  • How Do We Calculate Whether We’re Covered Under FMLA?  For more information, click here,


Compliance Alert

  • Who is a Dependent?  The IRS issued proposed regulations 26 CFR Parts 1 and 301 in January 2017 regarding the definition of a dependent. These proposed regulations provide guidance and clarification for the current definitions under Internal Revenue Code (IRC) IRC Section 152 plus other conditions introduced by the Working Families Tax Relief Act of 2004 (WFTERA) and by the Fostering Connections to Success and Increasing Adoptions Act of 2008 (FCSIAA). To learn more, click here.

View Document
Carrier Updates 8.14.17
by Rosa Tessandori » Thursday, August 24, 2017 8:20 AM


Producer News Online

  • Q4 Underwriting Promotions:  Relaxed Participation - 30% for 5 or more enrolled, DE9C - not required for groups with existing coverage with 6 or more enrolling, individual coverage counts as a valid waiver, dual HMO network option, same day approval is available for groups submitted by 8.a.m. Mon-Fri that are complete and have utilized the census enrollment tool, 9/1 anniversary date changes are available once in a 12-month period and must be submitted by 8/24 for a 9/1 effective date.
  • 2018 Plan Offerings:  Anthem CA Small Group Plans will continue in all 19 rating regions for 2018. The recent CA Individual announcement does not impact CA Small Group business or regional footprint.


Producer Alert

  • Underwriting Updates:   BSC is increasing access to affordable health care by streamlining the underwriting process for small groups and for brokers with reduced participation requirements, waived DE9C requirements,  flexibility in document requirements, earlier start dates for start-ups and waived participation requirements for Trio.

Large Group Broker Update

  • Earned Rewards:  Double your rewards for Trio.
  • Trio Network:  Effective July 1, 2017, Allied Pacific IPA joins the Trio ACO HMO Network in Los Angeles County
  • Narcotics Safety Initiative:  View the 2nd-year report results.



  • Bundling Bonuses:  To earn a bonus, place new specialty lines of coverage with the same employer and initial effective dates of coverage between August 1, 2017 and January 31, 2018.  Click here to learn more.


  • Simply Smart Bundles and Bonuses:  MetLife has expanded the flexibility of its small business bundles. Any Dental-plus bundle combination comes with exclusive value-adds to help you close the sale. Bundles with 3+ products can qualify for MetLife's Small Business Multi-Product Advantage, earning you additional one-time broker compensation. Click here to learn more.


Broker Connection

  • Methadone Coverage:  Beginning Jan. 1, 2018, UHC will introduce the Methadone maintenance program for the treatment of opioid use disorder to self-funded plans.
  • Flu Shot Program:  Preventive services, including immunizations, are provided under the standard, fully insured UnitedHealthcare Certificate of Coverage (COC).  Access to flu shots are available through a variety of providers including retailers like CVS, Safeway, Rite-Aid and more; offering a range of convenient options.  
  • Prescription Drug List (PDL) Updates:  View the latest PDL Tracker.


  • Webinar - Solving the Unsolvable in Health Care:  Thursday August 17, 2017 @ 10:00 AM PST.  In July, HealthiestYou joined forces with Best Doctors. Best Doctors solves the unsolvable in healthcare, by identifying and providing solutions to the most complex health conditions.  Click here to learn more.


  • HR On-Demand - Document Customization Feature:   Save your clients and prospects time and money by introducing them to the Document Customization feature included with HR On-Demand, the live consulting feature that provides access to certified HR Pros.  Click here to learn more. 

View Document
Carrier Updates 8.7.17
by Rosa Tessandori » Tuesday, August 08, 2017 6:45 PM


4th Quarter Updates

  • Rate Action:  Rate Pass for HMO, MC, and PPO medical plans for all rating areas
  • Network Updates: Who's new and who's going away.   Access Heal providers for on-demand house calls. Take advantage of Teladoc providers that available for phone or video consultations 24/7/365 days a year.  View the updated CA HMO comparison.  Click here for more information.
  • Springboard:  Aetna's online enrollment platform is available free of charge.
  • Renewal and Plan Changes:  Allow enough time for processing, submit renewal and plan changes no later than the last day of the month prior to the renewal.
  • Sold Case Submissions:  Aetna's underwriting team must receive sold case submissions by the requested effective date: the 1st or the 15th of the month.


Producer News Online - Small Group

  • 8/23/17 Webinar:  Reduce tobacco use in the workplace.
  • Employer Access:  The portal has been updated and is now available.
  • Form and Flyers:  The updated 2017 Anniversary Month and Plan Change request forms, and the New "Top 10 Reasons to Sell Anthem" flyer, are now available for Small Groups.

      Producer News Online - Large Group

  • Specialty Account Management:   Michele Bodie has been promoted to Director of Specialty Sales Account Management for California, Colorado, and Nevada.
  • 8/23/17 Webinar:  Reduce tobacco use in the workplace.
  • Online Billing and Payment Effective 9/1:  Anthem is moving Large Groups in California to electronic billing and online payment, starting September 1, 2017.


  • Trio ACO HMO:  BSC is waiving their participation requirements for groups of 1 to 100 eligible employees with Trio-only membership!  Click here for additional details.


  • Q4 Rate Action:  HMO/HSP Rate pass through December 15, 2017.  PPO/EPO insurance medical plan rates were given a 0.0% quarterly increase . While this is not a rate pass per se, you will find that most of the PPO/EPO Q4 rates are identical to Q3 rates.  Click here for additional details.


  • Covered CA:  Rates are available for quoting.

View Document
Carrier Updates 7.31.17
by Rosa Tessandori » Tuesday, August 08, 2017 6:26 PM

  • CA AB7:  Benefit updates have been implemented to meet new guidelines, click here to learn more for individual and small group contracts, click here.  For large group contracts, click here.  

  • Nivano Physician IPA:  Blue Shield of California has issued a termination notice to Nivano Physicians IPA (formerly Sierra Nevada Medical Associates IPA) effective August 10, 2017. Blue Shield is notifying affected HMO/POS members that they are being reassigned to alternate network IPAs in the area to help ensure uninterrupted access to care, effective August 10, 2017.  Members can call the Member Services number on their ID card to self-select a PCP or IPA.  Click here for more details.  
  • Digital Roadshow:  The invitation is coming soon, save the date - Wednesday, August 30th. or Thursday, August 31st., click here for more details.

  • Q4 Revised Health Net Rates:   Rates effective 7/1/17 will hold through 12/1/17 effective dates.  Please replace the previously published Rate Guide with the revised Rate Guide, click hereto download a copy.  Quotes processed prior to 7/20/17 will need to be requoted.

  • Choice Pharmacy Network:  Health Net is introducing their new, tailored pharmacy network designed for cost control.  Learn more, click here.

  • Northern CA SG 1-100 Webcast:  If you missed the webcast, click here for a copy of the presentation 7.21.17.  Get up to speed on UHC4Me, click here.  Check out the ancillary plan recommendations, in particular the dental $5K Max DPPO plan, click here.
  • CAHU SB 562  Tool Kit:  SB 562 would establish a state-run single-payer health care system.  Please review the CAHU Tool Kit for resources to use in your discussions with clients, colleagues and friendsClick here for more information.

  • Earn a Reward and Win A Trip:  Any broker that brings in 6 or more new clients (or 2 or more clients with >2500 lives) between 8/1 and 12/1, will get either an Apple Watch or $400 Amazon gift certificate,  plus a plaque as HY Top Performer and you could also win the Grand Prize! Click here for more details.   

View Document
Carrier & Compliance Updates 7.24.17 - part 1
by Rosa Tessandori » Monday, August 07, 2017 11:29 AM


      Producer Online News  - Small Group

  •  Q4 Rate Action:  The average quarterly rate increase for medical plans are PPO 3.2% and HMO 2.2%.  Dental, vision and life products, no rate increase. 

        Producer Online News  - Large Group

  •  Whole Health Savings Guarantee:  Some ASO large group clients that choose to combine Anthem medical, pharmacy, dental, vision, and behavioral health products,  may be eligible up to $30 PMPM savings guarantee.  
  • Vivity Broker Bonus Program:  Anthem brokers are eligible to receive a $100 bonus per subscriber for each new Vivity case sold!
  • Employer Access Enhancements: With the introduction of the new enhanced Employer Access benefit management resource tool will result in changes to Plansource arrangements for Large Groups effective 10/1/2017.


  •  Q4 Master Application:  Download a copy of the revised Master Group Application effective 10/1/17.   
  • Q4 Employee Enrollment Form:  Download a copy of the revised Employee Enrollment Form effective 10/1/17.


  •  Q4 Revised Health Net Rates:   Rates effective 7/1/17 will hold through 12/1/17 effective dates.  Please replace the previously published Rate Guide with the revised Rate Guide, click here to download a copy.  Quotes processed prior to 7/20/17 will need to be requoted.


       Partner News - July

  •  Agent Portal Access:  Via DocuSign, CCSB will reach out to all agencies to obtain a new signed Agency Agreement and/or Non-Monetary Agreement, this will be required to be able to sign in to the new Agency Portal.       
  • LinkedIn:  Use LinkedIn to gain immediate access to informational articles and education posting to share with your clients and followers.
  • First Month's Payment:  Please inform new groups to only submit the first month's payment after receipt of their first invoice.
  • Redesigned Invoice:   For details on the changes, see the CCSB Employer Invoice Redesign Tutorial.
  • 2017 Employer Guide:  The CCSB Employer Guide has been updated and is now available on the Resources for Participating Employers page on the CCSB website.
  •  Late Submissions:  If a new group is submitted after the 25th of the month prior to the effective date, a late submission form must be completed. Late submissions are accepted up to the 5th day of the requested effective month and are subject to management approval.

View Document
Carrier & Compliance Updates 7.24.17 - part 2
by Rosa Tessandori » Monday, August 07, 2017 11:19 AM


  • 7/26 Webcast - Q4 updates and more:   Registration is not required but space is limited so join early!  July webcast on 7/26/17 at 2:00 p.m.  Click here to learn more.  Add it to your calendar, click here.

     Broker Connection - July
  • Digital Onboarding Webinars: For new and renewing groups with 101+ employees, Join a UHC webinar on July 26, 28 and August 1. For more details about Digital Onboarding and to register for a webinar, go to
  • Wellness Program:  Employers Honored by UnitedHealthcare for Creating a Culture of Wellness.
  • Prescription Drug List Changes:  View the latesPDL Tracker for a recap of changes outside the Jan. 1 and July 1 pharmacy benefit updates.
  • Prior Authorization Required for Renflexis and Brineura: For dates of service on or after Aug. 1, 2017, UHC require notification/prior authorization for Renflexis and Oct. 1, 2017 for Brineura.
  • Premium (Physician) Program:  This program evaluates physicians in 16 specialties for quality and cost efficiency.  UHC is changing the timing of the UnitedHealth Premium designation release from the end of the year to September. The ability to identify Physicians with Tier 1 status designation will be availabl