A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

2020 Small Group (1-50) UpdatesTHIS PRESENTATION AND THE INFORMATION CONTAINED WITHIN IT, IS BEING SHARED FOR INFORMATIONAL PURPOSES ONLY AND IS CURRENT AS OF AUGUST, 2019. IT IS SUBJECT TO CHANGE BASED ON SUBSEQUENT FEDERAL AND STATE LAWS, REGULATIONS AND GUIDANCE. IT DOES NOT CONSTITUTE LEGAL, COMPLIANCE, OR TAX ADVICE. IF YOU HAVE QUESTIONS, PLEASE CONTACT YOUR LEGAL, COMPLIANCE, OR TAX PROFESSIONALS.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

2020 Medical UpdatesNOTE: 2020 products are not considered final and are still pending regulatory approvals

Discontinuing Plans

• ALL Blue Essentials Access (applicable for Small Group only, network remains available in mid/large segments)

• ALL Blue Premier Access (SG only)

• Discontinuation notices drop 90 days in advance of renewal

• No changes to Blue Choice PPO plans

• New Blue Advantage HMO Plans• G9E5ADT• G9E3ADT• S9E5ADT• G9E1ADT• S9E1ADT• B9E1ADT

2020 Small Group Medical Changes

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2020 Discontinuance Mapping

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2019 Discontinuing Plan

2020 Mapped Plan

G601HMO G9E5ADT

G610HMO G9E3ADT

S611HMO S9E5ADT

S604HMO S643ADT

S602HMO S9E5ADT

S601HMO S643ADT

S603HMO S9E1ADT

B601HMO B660ADT

G630HMH G663ADT

S623HMH S9E5ADT

S621HMH S641ADT

S620HMH S643ADT

S622HMH S9E1ADT

B640HMH B660ADT

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Virtual Visits

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Virtual Visits = PCP Copay

HSA plans = $44

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

2020 HSA Updates

Health Savings Accounts

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All small group products are embedded.

Embedded - Individual based

Once an individual reaches Limit (deductible or OOP) benefits apply.

When family limit is reached, benefits apply even to those that have not met individual deductible or OOP.

Embedded plans have both an individual limit that one person on the plan can meet, but not exceed prior to receiving benefits, as well as a family limit.

Once the family limit (accumulated from all members of the family) is met, all members of the family are eligible for benefits.

2019 to 2020 IRS Guideline Changes

2019 IRS HSA Guidelines

HSA Embedded Minimum Deductible

Individual/Self Only

Family (2X’s)

2019 $2,700 $5,400

2020 $2,800 $5,600HSA Embedded Out-of-Pocket Maximum

Individual/Self Only

Family (2X’s)

2019 $6,750 $13,5002020 $6,900 $13,800

Non-HSA Out-of-Pocket Maximum

Individual/Self Only

Family (2X’s)

2019 $7,900 $15,800

2020 $8,150 $16,300

HSA Contributions

Individual, self-only is $3,550 Family coverage is $7,100 No change to catch up contribution limits for individuals

ages 55 and older

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

2020 Dental Updates

2020 Small Group Dental Changes

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TypeCoinsurance (In-Network) Annual

Max

Ortho Lifetime

Max

Ded. In-Net. Implants

Class I Class II Class III Class IV

Contrib. 100% 100% 60% 50% $1,500 $1,500 $50 YesDTXHM27

TypeCoinsurance (In-Network) Annual

Max

Ortho Lifetime

Max

Ded. In-Net. Implants

Class I Class II Class III Class IV

Vol. 100% 100% 60% 50% $1,500 $1,500 $50 No

Contributory = 75% participation and 50% employee-only contribution

Voluntary = 25% participation and maximum of 50% contribution

2020 Small Group Dental Changes

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TypeCoinsurance (In-Network) Annual

Max

Ortho Lifetime

Max

Ded. In-Net. Implants

Class I Class II Class III Class IV

Contrib. 100% 80% 50% 50% $1,000 $1,000 $50 NoDTXHM28

TypeCoinsurance (In-Network) Annual

Max

Ortho Lifetime

Max

Ded. In-Net. Implants

Class I Class II Class III Class IV

Vol. 100% 80% 50% 50% $1,000 $1,000 $50 No

!!! Diagnostic and Preventive services do NOT count toward the annual max !!!

Includes: Dental exams and cleanings (2x every 12 months); Bitewing, full mouth and panoramic X-rays (limits on how many and timeframes) and Fluoride treatments (up to age 19, 2x per plan year)

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

2020 Pharmacy Updates

2020: Pharmacy

Formulary Changes• Annual Drug List Review

• Adds, moves, removes eligibility, or included in utilization management programs

• bcbstx.com/member/prescription-drug-plan-information/drug-lists

2020 Preferred Pharmacies• Walgreens

• Walmart

• RETURNING! Sam’s Club

• Alberton's

• Brookshire

• HEB

• Health Mart Atlas

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Locating Preferred Pharmacies

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1. Log on to www.myprime.com2. Choose Pharmacy Network3. Search by ZIP Code or City4. Filter by Preferred Pharmacies

Blue Advantage = Preferred Network for HMO

Blue Choice = Preferred Choice Network

Out of State Preferred Pharmacy / MyPrime.com

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2020: Pharmacy Updates

Specialty Pharmacy Program• Limited to a 30-day supply

• Self-administered meds are standardly covered under pharmacy benefit; physician administered meds are covered under medical benefit

• 50% out-of-network penalty if In-Network Specialty Pharmacy Network is NOT used (applies to PPO plans only)

Member Pay the Difference Penalty • IF a member chooses to use a brand name prescription versus the EXACT generic

equivalent the member will be required to pay copay or coinsurance PLUS the difference in cost

• Penalty applies to OPX (once OPX is satisfied, penalties will cease)

• Waiver Request (submitted by the Provider): • MPTD Penalty Waiver Form • FDA MedWatch Form

90-Day Delivery Options• Only available at preferred pharmacies (3x copay) or,

• Mail ordered through Alliance Rx Walgreens Prime (3x copay)

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2020: Pharmacy Updates

Drug Coupons• Effective 1/1/20, or upon renewal, drug coupons used for brand name meds will

not count toward the annual deductible and OPX, IF the med has a generic equivalent

• If a brand med is required due to availability or medical requirements, the coupon WILL count toward the deductible and OPX

Out-of-Network Pharmacies (applies to PPO plans only)• Meds filled at an out-of-network pharmacy must be initially paid in full, by member

• Submit claim for out-of-network eligible reimbursement

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2020: Pharmacy Drug List Exclusions

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This is a list of the most common drugs being excluded in 2020. Members impacted will be mailed a letter with a link to the BCBSTX website where they can search for all the drug list changes

Drug Name* Generic Alternatives Brand Alternatives

RANEXAAntianginal Agents/Other

• nitroglycerin tablet• nitroglycerin transdermal

• NA

TROKENDI XRAnticonvulsants

• topiramate ER capsules• topiramate tablets

• N/A

REXULTIAntipsychotics

• aripiprazole• risperidone• ziprasidone

• N/A

XELJANZ XRBiologics: Rheumatoid & Other Arthritides

• N/A • ENBREL• HUMIRA• SIMPONI

SENSIPARCalcimimetic (Calcium Reducer)

• Generic equivalent available • N/A

*May not apply to all strengths/formulations.

2020: Pharmacy Drug List Exclusions

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This is a list of the most common drugs being excluded in 2020. Members impacted will be mailed a letter with a link to the BCBSTX website where they can search for all the drug list changes

Drug Name* Generic Alternatives Brand Alternatives

TRADJENTAAnti-Diabetic

• N/A • JANUVIA• ONGLYZA

MINIVELLEEstrogens, TD

• Generic equivalent available

• N/A

COLCHICINEGout

• N/A • MITIGARE

ULORICGout

• allopurinol • MITIGARE

COLCRYSGout

• N/A • MITIGARE

OMNITROPEGrowth Hormones & Somatomedins

• N/A • NORDITROPIN

CIALISImpotence Agents

• Generic equivalent available

• N/A

COPAXONEMultiple Sclerosis

• glatiramer • N/A

*May not apply to all strengths/formulations.

2020: Pharmacy Drug List Exclusions

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This is a list of the most common drugs being excluded in 2020. Members impacted will be mailed a letter with a link to the BCBSTX website where they can search for all the drug list changes

Drug Name* Generic Alternatives Brand Alternatives

METAXALONEMusculoskeletal Therapy Agents

• baclofen tablet• cyclobenzaprine hcl tablet• methocarbamol tablet

• N/A

CHLORZOXAZONEMusculoskeletal Therapy Agents

• cyclobenzaprine hcl tablet • N/A

AURYXIAPhosphate Binders

• OTC options available • N/A

SOOLANTRARosacea Agents

• N/A • SKLICE

FINACEARosacea Agents

• Generic equivalent available • N/A

SUBOXONESubstance Abuse

• Generic equivalent available • N/A

MUPIROCIN CREAMTopical Antibiotics

• mupirocin ointment • N/A

*May not apply to all strengths/formulations.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

2020 Behavioral Health Updates

• New Opioid / Substance Use Initiative• Risk Identification & Outreach + dedicated multi-disciplinary team to support

positive health outcomes

• Applied Behavior Analysis (ABA) / Autism• Leverages technology from the Cedar Group,

provides for improved consistency of ABA treatment by implementing an objective, evidence-based treatment decision support to guide authorization recommendations

• Behavioral Health Network Access• Improved user experience in identifying BH provider

specialties, including Medication Assisted Therapy (MAT) providers

• Advanced Analytics and Reporting• Continued focus on the cost of care for members and employers

2020: Enhanced Behavioral Health

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A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

2020 Blue Balance Funded

2020: Blue Balance Funded

Employer Size• 10-50

Participation Requirements• 75% employee participation

• Eligible employees w/valid waivers will be excluded from participation calculations

• 50% employee-only contribution

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A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Q4 Renewals

Renewal Timeframes

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January Renewals

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Release date dependent upon federal and state approvals of products AND rates

Paperwork due 30 days prior

Blue Advantage Network

• Covers all 254 Counties

• 8,626 Primary Care Physicians

• 28,815 Specialists

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January Renewals

Blue Advantage Education

• FAQs

• Network comparison charts based on region• Austin• DFW• Houston• San Antonio/Valley• West Texas

• Myth Buster Videos

• Employee communications

• Electronic communication directly to employers renewing in January w/out a Blue Advantage plan (est. release date 9/16)

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Blue Advantage Savings

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$551G652CHC (2019)

$619 (+12%)G652CHC (2020)

$396 (-28%)G663ADT (2020)

Age 40 Q1 rates for rating area 8 (Dallas) are used for comparison. Rate increases vary by plan and area.*Membership as of 6/30/2019

Dual Options

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$494G652CHC

(18 Members, 2019)

$572 (+16%)G652CHC

(18 Members, 2020)

$505 (+2%)G663ADT

(9 Members, 2020)G652CHC

(6 Members, 2020)P621CHC

(3 Members, 2020)

Age 40 Q1 rates for rating area 23 (Victoria) are used for comparison. Group of 18 – 9 moving to Blue Advantage; 3 on a Platinum Choice plan; 6 on a Gold Choice plan*Membership as of 6/30/2019

$572 (+16%)G652CHC

(6 Members, 2020)

$405 (-18%)G663ADT

(9 Members, 2020)

$673 (+36%)P621CHC

(3 Members, 2020)

Renewal Reminders

• Out-of-state employees and/or dependents –Blue Choice PPO is a must

• Employers can offer up to SIX benefit plans• 50% employer contribution is based upon the lowest plan offered

• Employee plan changes may be submitted with the BPA Amendment –OR – can be submitted later, if open enrollment has not occurred• Includes PCP selections:

• Family Practice• General Practice• Internal Medicine• Obstetrics & Gynecology (in some cases)

• Full BCBSTX portfolio is available in Section 5 of renewal exhibits

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A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Everything else, and….

Sales & Renewal Microsite

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Sales & Renewal Microsite

• Paperwork deadlines

• Forms• BPA Amendment• Membership application

• Contact listing

• Most requested marketing materials:

• Blue365• Pediatric vision• Virtual visits

• Dental SBCs

• 2019 Benefit booklets

• 2020 information added as available

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Sanitas Partnership

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BCBS of Texas & Sanitas are forming a joint venture in TX in order to enhance care delivery in Dallas and Harris counties, opening 10 clinics by January 1, 2020.

Details: This offerings allows us to create a unique product & partnerships with providers to be competitive in a dynamic market. Benefits: Both Medical Management and Customer Service will be

onsite at select clinics.

Future expansion concepts are being consideration for 2021 and beyond.

New Payment Address

• Beginning with premium payments due in Oct., 2019

Fully Insured

Blue Balance Funded / ASO

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Mailing Address Blue Cross and Blue Shield of TexasP. O. Box 650615 Dallas, TX 75265-0615

Overnight/Courier Address

Blue Cross and Blue Shield of TexasATTN: 6506151501 North Plano Rd., Suite 100Richardson, TX 75081

Mailing Address Blue Cross Blue Shield of TexasDept. 1134 (ASO)P.O. Box 121134Dallas, TX 75312-1134

Overnight/Courier Address

Blue Cross Blue Shield of <State>ASO BusinessBox 8911341501 North Plano Rd.Richardson, TX 75081

Ancillary

• Effective 1/1/20 Dearborn products will be re-branded as “Blue”• Life• Disability• Accident• Vision

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Looking to the future…

• New technology

• One-bill capabilities

• Data sharing

Deductible and OPX Credits

Small Employers (1-50)

• Deductible credit = Yes

• OPX = No

Mid Market Employers (51-150)

• Deductible credit = Yes

• OPX = Yes, IF reporting is provided with OPX amounts

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