00:24 — Introductions

01:51 — Spira Care Clincs

07:47 — Virtual Care / Telehealth

08:26 — Behavioral Health

09:20 — New Group ACA Census Enrollment

10:16 — Blues Enroll (System for On-going Support)

10:46 — Product Updates

16:44 — Transitional Relief Groups

17:30 — 2024 Rates and Commissions

18:24 — BCBSKS Strategy for Humana Exit

Jason Powers:

It is time for another carrier product update. Tune in as we talk directly to the carriers about their new plans, any new network options they have, or which plan designs offer the most savings and learn about the tools and resources they offer to help you generate more business. Visit our website to learn about all of the carriers we quote in our carrier product update series.

Hello and welcome [00:00:30] back to our carrier product update series. It’s our Q four kickoff summit for 20 23 20 24. I’m Jason Powers with Legacy Brokers and this is the carrier product update for Blue Cross Blue Shield of Kansas City. Our representative couldn’t be here today, so you get stuck with me today. That’s okay. We’ll get right into the updates from Blue Cross Blue Shield one. Probably one of the biggest things that Blue Cross Blue Shield talks [00:01:00] about in their updates and in their seminars with brokers is their commitment to customer service and this is not an uncommon award for Blue Cross Blue Shield to win. I can count over my career multiple times that the JD Power number one in member satisfaction award has been given to Blue Cross Blue Shield and they really do have a tremendous support team and support staff for not only members but [00:01:30] the broker community.

Some of the updates on their product. If you’re not familiar with Blue Cross Blue Shield of Kansas City, they do have products that serve the small group arena in that two to 50 space as well as large group 51 and above. Over the last nine years, they’ve really committed to the community to build out what are called s Spira Care clinics. These are advanced primary care clinics throughout the metro that are available inside the Blue Cross Blue [00:02:00] Shield product portfolio at no additional cost. So services rendered inside Spira Care Clinic are provided at no cost to members unless you’re at an H S A plan, and then there are some costs associated with that, but they started these back in 2015. They built a few of them around town integrated into their product portfolio and today in 2023 they have nine locations. Next slide. Those are listed there. Crossroads [00:02:30] Independence Leased Summit, Liberty Olathe, Overland Park, Shawnee, Tiffany Springs, and the Wyandot location. If you look at the map there, they’ve pretty much surrounded Kansas City with Aspire Care Clinic around every corner. They’re not walk-in clinics. These are clinics with hours of operation. Those are listed here on the screen. Appointments are required, but they do have after hours answering service. For [00:03:00] the most part.

These are clinics that can really tend to just about anything that’s going on outside of an emergency situation. Some of the most common services rendered at Aspire Care Clinic are listed there. Advanced Primary care, not only preventative medicine but also health coaching. You can get x-rays, you can have your labs done for kids. Everything under the sun on the pediatric side [00:03:30] and then just the convenience of the clinic itself and having multiple locations across the metro has really always been the blueprint for the S Spira Care Health solution. Again, no copay under most of the plans as long as they’re not H S A plans, they are no copay for the services rendered at those locations.

Taking a deeper dive into what happens inside the Spira Care Clinic, you can [00:04:00] set up for same day and next day sick appointments. You can schedule within generally about a week to get into those locations early morning and early evening appointments available. They do have four locations across the metro that are open on Saturdays you can do in-person and virtual, so all of that is available. Primary care services on call and again, keeping it with no copay gives no financial barrier for [00:04:30] individuals to access care. Coupled with the Spire Care and all plans across the Blue Cross Blue Shield portfolio is a smart shopper program that’s embedded into the Blue Cross app. This smart shopper program is designed to give transparency in the cost of care to members. This is something that they rolled out last year, maybe year before on some specific products, but this is now [00:05:00] rolled out across the portfolio for Blue Cross. This gives members the ability to look up common procedures, see what the cost is and what the cost variance might be from one provider to the other, and then they couple that with a reward or an incentive for a member to be a smart shopper, to be a better consumer of their healthcare and find lower cost care. These are same procedures, just [00:05:30] different locations where members can actually log in, compare costs, and get some reward along the way. To be a wiser consumer, the average incentive that they’ve seen earned per member is $92.

If you look at that on average across their book of business, I’d say you probably have quite a few people who aren’t taking of Smart Shopper, so when they’ve expanded that across [00:06:00] their portfolio, I anticipate that that incentive number will certainly climb. Give you an idea how those incentives work. Again, this is across the enterprise, fully insured 51 plus. Then you’ve got your level funded a s o, which is in that five to 50 space. A c A would be the fully insured small group product in that two to 50 space. Rewards kind of vary across the enterprise depending on the [00:06:30] type of service that’s being rendered. The average reward on the fully insured and level funded a s o side, fully insured being the large group side, $221 where the average reward in the A C A product is 19. Again, same sort of thread or theme throughout.

There’s no cost to use Smart Shopper in the Blue Cross Blue Shield environment, 98% satisfaction score for employees that have used [00:07:00] it, which means they’re getting a lot of good traction and a lot of good feedback from the folks that are using Smart Shopper to look at procedures and the cost and what those incentives bring to them. Back up one more before me. So it’s just some common procedures, MRIs, mammograms, colonoscopies, preventative exams, joint replacements. Those are common procedures that you can generally shop obviously in the midst of an emergency. You don’t need to shop. You don’t need [00:07:30] to log into the app and find the lowest cost location for whatever services you need, but certainly for some of those planned procedures, this gives folks the opportunity to look at lower cost alternatives and then be rewarded for their choices.

Just like most products out there, since the pandemic, blue Cross Blue Shield has committed to offering virtual care and telehealth across their enterprise, you’ve got access to 24 hours a day. You’ve got [00:08:00] access to physicians and medical providers through their virtual care services and telehealth app. They also added behavioral health. That’s something that’s really come out in the telehealth space over the last couple of years. Blue Cross has added that to their virtual health services, all available at no cost share, no copay, no deductible, no co-insurance. Blue Cross is also committed [00:08:30] to services in the behavioral health space through their program called Mindful. This is to really help individuals who need sort of a gateway to therapy in some respect. Available 24 hours a day, one number to call for members that are in crisis, you can certainly expedite access to help, but for the most part what we see in this program is [00:09:00] just getting help locating the right type of provider for an individual who might need more long-term, long-term therapy, getting them referred out to someone who’s in network, but certainly available for those in crisis in the moment and available 24 hours a day.

Should be no surprise that the a a fully insured small group product that’s that guaranteed issue. Community rated [00:09:30] product for small groups, two to 50, that those plans are pretty easy to implement. The only thing that’s needed is an employer application, the census of the members that are to be insured. The employer size survey, which is a little unique to Blue Cross Blue Shield of Kansas City’s product. It’s a two pager that’s pretty simple to fill out. Just ask some questions about the type of group or the size of group that they are so that Blue Cross can set up the right compliance, [00:10:00] compliance components and then any additional information that might be needed on small group. Micro group being two life cases would be like the wage and tax or the W twos that prove that these are common law employees. Blue Cross has a wonderful system called Blues and Roll for ongoing support where you can add and pull employees off of coverage.

You can add dependents, you can take care of your open enrollment [00:10:30] selections, manage any COBRA benefits, access reporting. You can pull census files, midyear or at renewal. All of those things were available through their Blues Enroll system. Really easy to access, really easy to navigate. All right, so let’s get on to some product updates for 2024. Start with the A product portfolio. These are the small group, two to 50 community rated plans, not a lot of changes going on. There are two plans that [00:11:00] they’ve retired really just due to low enrollment, low activity in those plans. That is the traditional 69 50 blue select plus bronze option that’s now being replaced with the traditional Blue Select plus silver option. The other one that’s being replaced is the Spire Care H S A 37 50 Blue Select plus Silver, so that’s using that S Spira care clinic product inside an H S A plan design, but then wrapped with their E [00:11:30] P O Blue Select Plus network that’s being replaced with a Spira Care H SS A B S P bronze product.

They are adding a new E P O plan and this is the first time that they’ve, they’ve taken two different product lines and really mashed them together a hybrid of the two, and this is the first time they’ve done this with the first product and the Spire product. So first is that product in their [00:12:00] chart that gives a copay for the first four office visits and then everything after that four is subject to deductible. So this is combining that with the Spire Care portfolio and offering a silver level plan. It’s got a $5,000 deductible if you use Spire Care. There are no copays. If you go outside of Survivor Care, you can have access to a primary care physician outside of s Spira Care at four [00:12:30] visits at a $25 copay, and that’s primary care or specialist, it doesn’t matter. It is just a physician outside of the S Spira care environment. Everything else would be subject to deductible like most spira care plans. And then it’s got the prescription drug card, which has also changed a little bit for 2024.

Here’s a list of some other things that are going on across the enterprise in that a product portfolio, the max out-of-pocket limit due to some indexing [00:13:00] on the federal side has increased to $9,450 with the family rate at 18,900. So that’s the new maximum out of pocket on certain plans. Urgent Care in network is now treated the same as a specialist in network, so they’ve changed that copay structure and the way that benefit works to be treated just like a specialist, which I think matches up pretty well to some of the other products in the market. Emergency room and transportation in and out [00:13:30] of network is now the same as inpatient hospital in network. Again, no copay for telehealth or virtual care, and that applies to KC Virtual Care, their Primary care Physicians, specialists, urgent Care. All that applies in the space of virtual, no charge for vision exam under the pediatric vision benefit. That’s something new. And then deductible and co-insurance for eyeglasses and contacts, again applying only to that pediatric vision benefit on those plans. [00:14:00] And then they simplified cost sharing inside the prescription drug card. I mentioned that’s changed a little bit. They have lowered the copay tiers, changed the deductible and co-insurance for higher tier drugs and added oral chemo drugs, some cost sharing changes on oral chemo drugs.

This grid is going to be impossible for you to read. We will have posted below this video on our website. We’ll have a link to the actual grid because it’s a really [00:14:30] printed out. It is an 11 by 17 place mat, but this grid will be posted below and if you need a copy of it, you can’t find it on our website, just make sure to ask. But they do a pretty good job of highlighting the changes in blue here on what’s going on. And most of those changes really down to, there’s not a lot, but most of ’em come down to some of the plans where they’ve increased out-of-pocket max. Some of the new products that are available inside that portfolio [00:15:00] are listed there as well. All right, so that’s a Moving on to their level funded a s o products and their fully insured 51 to 99 product.

There are two highlighted changes here, and that is the P C B Blue Saver 6,500 plan, which is a new plan being added to the portfolio and the B S P spi a 5,000 plan that’ll be added to their portfolio. Just giving a little [00:15:30] more depth in the kind of products that are available inside that a S O product. We’ve seen some success with agents using the P P O copay product combined with a Saver product on the H Ss a side and maybe offering a Aspire Care option for low cost alternatives to members who are looking for that.

One more back. There we go. And then one other update we’ve seen on [00:16:00] their A s O product and the 51 and 99 fully insured product is just relative to what’s happened with the I R S and indexing deductibles and out-of-pockets on the H S A qualified plans due to cost of living adjustments. So the three changes here really apply based on the increased index for minimum deductibles and minimum out-of-pockets for an H Ss a qualified plan. Those apply to that Blue Select plus Blue Saver 3,200. [00:16:30] The Preferred Care Blue, blue Saver, 3,200 and the Blue Select plus Spira Care H S A 3,200. It just increases that minimum deductible to 3,200. Essentially what they’re doing.

All right, now we’re getting ready to come up for Q four renewals and Blue Cross has looked at their block and they’ve got an estimated average increase in Kansas of 5.3%. This is that transitional [00:17:00] relief package that’ll come out January one. This is tentatively planned. It does not mean that these are the renewals you’ll see for any specific group, but on average in Kansas they’re looking at 5.3% and in Missouri 2.2% certainly you may see cases with higher increases than that. You also may see cases with lower increases. Back one more I think. Nope, you’re right. [00:17:30] And then the a. A filed rate adjustments in Kansas, Missouri, this applies to that small group fully insured community rated a c a plan. They’re actually seeing a decrease on average of 2.7% in Kansas and in Missouri. Nearly 7% decrease on average on that A c A product commissions stay at 5% across the board on their two to 99, whether it’s a c a or a s o or the fully insured 51 and 99 space. [00:18:00] And then on their dental and vision products, they’ll remain at 7%. As we’ve maybe discussed in the past. Blue Cross Blue Shield of Kansas City is a product where we don’t actually operate in the space of a general agency contract with Blue Cross Blue Shield of Kansas City. So if you have questions about any specific commission arrangements on those products, be sure to reach out to our team.

Now, the last thing that we kind of want to talk about here is really specific to [00:18:30] one particular product in the market that we don’t have an update for this year because they’re exiting the market, and that is Humana Blue Cross Blue Shield has put together a strategy on Humana business to really be of service and be an alternative for brokers that are looking to place their Humana business elsewhere. If you’re not familiar with what’s going on, Humana’s pulling their group commercial products, they’re pulling out of that space effective with November [00:19:00] one renewals and Blue Cross Blue Shield of Kansas City is committed to working with brokers. To make that transition a little bit easier, UnitedHealthcare is issuing an endorsed quote in the place of a Humana renewal. And Blue Cross Blue Shield has said since United is obviously having the ability to look at claims data issue renewals, that Blue Cross will review that information along with the normal [00:19:30] stuff they need.

The Group Master app, the census copy of the most recent invoice, the current current plan that they have, current rates as well as the United Healthcare Offer and last two years of claims. If they’re on that Humana level funded product and they’ve got two years worth of claims data, they’ll take that and underwrite based on that without applications. There is a broker incentive going based on size of case. Smaller groups, it’s $50 per enrolled employee, [00:20:00] 25 to 74 enrolled employees. It’s a hundred dollars per employee, and then 75 plus they go to one 50, and this is for effective dates going through January 1st. One other thing that they’re adding to the Humana transition for any cases onboard from Humana to Blue Cross is out-of-pocket maximum credit, and that’ll be available for any effective dates from May 1st, 2023 through January of 2024, where they’ll not only [00:20:30] issue deductible credit, but also out-of-pocket maximum credit. That’s the update from Blue Cross Blue Shield of Kansas City. If we can help you here at Legacy Brokers with any of your Blue Cross Blue Shield of Kansas City quotes, submissions, or renewals, please be sure to reach out to our team. They’re anxious and ready to help at any given time. That’s all the update we got for you here.

Happy selling to you in Q [00:21:00] four, and we’ll see you next time.

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