Broker Plan Comparison Tool

choice, confidence, and coverage start here.

We have a wide range of health plan options

Choose the option that best suits your business

Portfolio plans

Blue Shield offers businesses a variety of plan designs to meet their needs. Use this tool to compare benefits from our standard portfolio plans. We’ll never stop working to find and pursue the best path forward for fulfilling our mission of making sure all Californians can access the care they deserve at a price they can afford.

Small business
Large group

Blue Shield offers two packages to small businesses outside of Covered California for Small Business. You can offer plans from the Off Exchange Package or the Mirror Package, but not both.

Off Exchange plans

The Blue Shield Off Exchange Package includes up to 43 plans, including PPO, HMO, and HSA-HDHP options. These plans are available at each metal level – Platinum, Gold, Silver, and Bronze – offering different levels of coverage.

Mirror plans

The Blue Shield Mirror Package includes a PPO plan at each metal level and our Trio HMO plans at Platinum, Gold, and Silver metal levels. The Mirror Package offers the same standardized plans that are offered on Covered California7 for Small Business.

Networks

PPO networks

  • Our Full PPO Network is among the largest in California and includes more than 75,000 physicians and over 380 hospitals8.
  • Our Tandem PPO Network is a subset of our Full PPO Network, available statewide, with 60% of Blue Shield providers included. Tandem PPO plans9 provide the same plan benefits as the Full PPO plans at a lower price.
  • We also offer high-deductible health plans (HDHP)10, which are available on the Full PPO Network only. HDHPs come with the option of opening a health savings account (HSA) to help pay for qualified medical expenses.

HMO networks

Our HMO plans include all specialties and levels of care, access to over 320 hospitals, and are each available with one of three HMO provider network options:

  • Access+ HMO® Network provides access to more than 40,000 doctors in California.
  • Local Access+ HMO® Network11 provides access to more than 17,000 doctors in California.
  • Trio ACO HMO® Network provides access to 10,000 doctors in 24 California counties. Trio HMO is a high-performance health plan that leverages ACO partnerships to deliver a community of care for members. The name “Trio” represents our ACO program alliance between the medical group, hospital, and Blue Shield – an integrated network model that creates a community of care to support improved health outcomes for Trio members. Visit blueshieldca.com/ACO.

Dental, vision, and life insurance

Bundling offers savings plans for any size group

Dental

Add dental and save on premiums for all size groups. Blue Shield's dental PPO network12 is the fifth largest in the state, our DHMO is the second largest in California. Many of our plans include orthodontia, including clear braces, implant coverage, extra cleanings for pregnant women, and additional treatment for children at risk for tooth decay.

Vision

Add vision and save on premiums for all size groups. We have the largest vision network in California with nearly 7,000 providers13. Additionally, members have access to major retail chains with convenient evening and weekend hours (did you know that 15% of retail eyewear is purchased on Sundays?). Our plans provide generous allowances for lens extras (antiglare, bifocals, etc.).

Life insurance

Add life and save on premiums for all size groups. We offer life insurance amounts between 15k and 200k. One-hundred percent employer paid14, flat amounts, multiples of salary, or graded class plans with guarantee issue amounts meaning no evidence of insurability is required. In addition, LifeReferrals 24/7SM offers care and support for family members who have suffered a recent loss of a loved one. Members have access to grief support, financial advice, and legal needs.

Benefit summaries:

Dental benefit summaries

Vision benefit summaries

Life insurance benefit summaries

New for 2019 plans

Value Drug Formulary

This new formulary option is available for your clients19 looking to adopt a lower-cost formulary option. Compared with the Plus Drug Formulary, the Value Drug Formulary is different in the following ways:

  • Some drugs are moved to a higher tier or removed from the formulary.
  • High-cost generics are placed on higher tiers.
  • Non-formulary drugs require a medical necessity exception.

These differences will encourage members to use the most cost-effective drugs when their clinical effectiveness and safety are similar to the clinical effectiveness and safety of other higher-cost drugs used to treat the same condition.

Effective January 1, 2019, new and existing clients19 will have the option to choose between the current Plus Drug Formulary and the new Value Drug Formulary for their outpatient prescription drug benefit.

Benefit Solutions

The more you add, the more you save. Your clients can save up to 1.75% on their medical rate by bundling dental, vision and life insurance† together with their medical benefits. Available to groups of 101-1,000, the savings are based on how many products are added.

  • Choose dental and save 1%.
  • Add minimum of $25,000 life insurance and save an additional .5%.
  • Add vision, save another .25%.

Dental

Access to extensive networks. The dental PPO network includes nearly 52,000 providers in California and 350,000 nationwide, and the dental HMO network includes more than 26,000 providers in California.21

Life

Travel Assistance Services. Provides Employees and their families services when traveling more than 100 miles from home (including international travel). Some examples of general services include:

  • Visas and passports information
  • Immunization requirements
  • Local customs
  • Lost document and lost article assistance
  • Legal referrals, emergency cash and bail assistance

Some examples of medical assistance services:

  • Immunization requirements
  • Medical and dental referrals
  • Coordinate hospital admission
  • Critical care monitoring and discharge planning
  • Dispatch of a prescription medication and eyewear

Some examples of Indemnified medical transportation services include:

  • Emergency medical evaluation
  • Medical Repatriation
  • Transport of family member
  • Return of mortal remains

Three-year rate guarantee. All new groups receive a three-year rate guarantee on their life insurance coverage, giving them added financial predictability for budgeting and planning.

Vision

Large vision provider network. With nearly 7,000 provider locations in California,20 Blue Shield has one of the largest networks in the state. Our national network gives members a wide choice of providers including private-practice optometrists, retail locations like LensCrafters,22 Sears Optical22 and Target Optical,22 wholesalers like Walmart and Sam’s Club, and warehouse chains such as Costco. Multiple options make it easier for members to see an eye doctor of their choice and purchase frames, lenses and contacts more conveniently.

Networks

PPO networks

Our PPO plans offer flexibility for members to see non-network providers. These PPO plans come with a wide range of deductible and cost-share options.

  • Our Full PPO Network is among the largest in California and includes more than 75,000 physicians and over 380 hospitals8.
  • Our Tandem PPO Network is a subset of our Full PPO Network, available statewide, with 60% of Blue Shield providers included. Tandem PPO9 plans provide the same plan benefits as the Full PPO plans at a lower price.
  • Our PPO Savings plans are ideal for individuals who want to be actively in control of their healthcare expenses by saving tax-advantaged dollars for future medical expenses. These high-deductible health plans (HDHPs) can be paired with an HSA, HRA, HIA, FSA, LPFSA, or other financial accounts and are offered with full network coverage15. Each plan includes prescription drug coverage.
  • Our Active Choice® plans16 offer flexibility and greater management over routine health coverage spending. These plans are good, options for those who want comprehensive coverage but have low annual utilization.
  • Point-of-service (POS) plans are a great option for employers who would like the flexibility of having HMO and PPO benefits combined under one plan. With our Added Advantage POSSM Plan, members can decide at the time they receive service whether they would like to take advantage of using the HMO network, higher and less predictable out-of-pocket costs using the larger PPO network, or even higher out-of-pocket costs using any licensed provider who is not contracted with Blue Shield of California.

HMO networks

Our HMO plans include all specialties and levels of care, access to over 320 hospitals, and are each available with one of three HMO provider network options: Our Full PPO Network is among the largest in California and includes more than 75,000 physicians and over 380 hospitals.

  • Access+ HMO® Network provides access to more than 40,000 doctors in California.
  • Local Access+ HMO® / SaveNetSM Network17 provides access to more than 17,000 doctors in California.
  • Trio ACO HMO® Network provides access to 10,000 doctors in 24 California counties. Trio HMO is a high-performance health plan that leverages ACO partnerships to deliver a community of care for members. The name “Trio” represents our ACO program alliance between the medical group, hospital, and Blue Shield – an integrated network model that creates a community of care to support improved health outcomes for Trio members. Visit blueshieldca.com/ACO.

Self-funded options

Blue Shield also offers customizable and self-funded health plan options for businesses with 300 or more employees. Contact your Blue Shield representative for more information.

Access to care through large PPO networks in California

Blue Shield has one of the most expansive and diverse networks in California, offering access to hospitals, physicians, and specialty providers. Our PPO network includes more than 75,000 physicians and 380 hospitals8.

Network cost advantage

Blue Shield can help your clients with 300 or more employees customize a health plan, based on utilization and experience, to fit the needs of their workforce.

Custom plan designs, high-value stop-loss coverage18

  • Broad deductible range
  • Advanced funding when the deductible is reached – not waiting for reimbursements
  • Run-in and Run-out contracts
  • Renewal rate cap options
  • Aggregate specific arrangements
  • No employer disclosure and renewals
  • Top administrative partners to manage benefits and handle billings and claims
  • Care management, which we provide via Shield Advocate, through effective clinical programs and a mix of digital healthcare.

To learn more about our self-funding options, please contact your Sales Executive.

Dental, vision, and life insurance

Bundling offers savings plans for any size group

Dental

Add dental and save on premiums for all size groups. Blue Shield's dental PPO network12 is the fifth largest in the state, our DHMO is the second largest in California. Many of our plans include orthodontia, including clear braces, implant coverage, extra cleanings for pregnant women, and additional treatment for children at risk for tooth decay.

Vision

Add vision and save on premiums for all size groups. We have the largest vision network in California with nearly 7,000 providers13. Additionally, members have access to major retail chains with convenient evening and weekend hours (did you know that 15% of retail eyewear is purchased on Sundays?). Our plans provide generous allowances for lens extras (antiglare, bifocals, etc.).

Life insurance

Add life and save on premiums for all size groups. We offer life insurance amounts between 15k and 200k. One-hundred percent employer paid14, flat amounts, multiples of salary, or graded class plans with guarantee issue amounts meaning no evidence of insurability is required. In addition, LifeReferrals 24/7SM offers care and support for family members who have suffered a recent loss of a loved one. Members have access to grief support, financial advice, and legal needs.

Benefit summaries:

Dental benefit summaries

Vision benefit summaries

Life insurance benefit summaries

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