The Affordable Care Act (ACA) expands the small group market to encompass all employers with 100 or fewer full-time equivalents (FTEs), as of January 1, 2016. This change will have significant impact on groups with 51-100 FTEs, as it will entail a shift into member level rating, metal level plans, and Custom Select prescription drugs. Blue Cross® Blue Shield® of Michigan and Blue Care Network (BCBSM and BCN) have devised strategies for this market segment designed to meet the needs of groups based on their unique demographics. These strategies are in line with the delays allowable by the ACA under Transition 2.0.
Action Benefits would like to remind agents of the multiple opportunities Transition 2.0 creates for both existing and new-to-Blue business. We have an extensive Transition 2.0 resource library available in the Documents Resources section of our agent website, www.actionbenefits.com. This section contains forms, marketing pieces, and news articles to guide you through this transition period with your groups.
The Group Transition Tool is expected to be available on June 15, 2015, on the BCBSM agent portal at www.bcbsm.com, and will offer specific insight as to which strategy will benefit each of your Transition 2.0 eligible groups. The Transition Tool will provide estimated premium changes associated with moving to small group status, and will be an instrumental tool in helping you make recommendations for each group.
In addition, Action Benefits will be sending agents a list of their impacted groups (if applicable) prior to June 15, 2015. Also, you should expect to be contacted by Action Benefits and BCBSM account representatives to offer assistance in the Transition 2.0 decision for each group.
Action Benefits has also created two helpful quick reference guides that outline the various scenarios for existing and new business, and highlight important deadlines. We strongly encourage you and your staff to review these job aids prior to discussions with your groups.
As a reminder, BCBSM and BCN have several options available to help customers through this transition:
• Transition 2.0: Allows groups to maintain large group products and rating. The Blues will renew all January 2016 to October 2016 groups as large groups unless notified by the agent.
• Renewal month shift: Allows groups to transition to the small group market sooner, or remain a large group status longer. More details about this option can be found in the Existing Business Transition 2.0 Job Aid.
• 2015 alternative product offering: Allows groups to modify current benefits today, as well as introduce a lower cost plan to be used as an offering at renewal in 2016 (details regarding adding an alternative plan are being developed).
• Self-funding: Allows groups to shift to self-funded coverage to avoid small group product and rating changes.
• Private exchange: Employers may choose a defined contribution approach on GlidePathSM.
Existing Business Transition 2.0 Job Aid
Click on the link above for extensive details and important deadlines regarding your existing business.
Remember, all groups of 51-100 FTEs must transition to small group rating and products by their renewal in 2017.
Questions regarding Transition 2.0 and your existing groups? Please contact the Action Benefits Agent Relations Team at 248-356-8585. Our team is well-informed and ready to assist you in determining the best strategy for your affected groups.
New-to-Blue groups interested in maintaining large group status and delaying the transition to small group rating and products will experience the greatest benefit (and delay) by renewing October 1, 2016. The Blues understand that not all groups will find enrolling October 1, 2015 viable, and have developed long and short rating options which will allow groups enrolling any month prior to the end of 2015 to set an October 1 renewal date at the time of enrollment.
Groups that delay their transition to small group rating and products via Transition 2.0 will receive 2016 renewal rate increases capped at or below 9.9 percent (not including taxes and fees). However, all groups must transition to small group rating and products at their renewal in 2017.
New Business Transition 2.0 Job Aid
Click on the link above for extensive details and important deadlines regarding new business opportunities.
Questions regarding Transition 2.0 and new business opportunities, including exciting new-to-Blue incentives for agents? Please contact the Action Benefits Service Representative at 866-501-8727.
Action Benefits is an Authorized Managing Agent for Blue Cross Blue Shield of Michigan and Blue Care Network. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.
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