What's Inside: Capital Blue Cross Producer Incentive+ Program rewards producers for renewals and new customers | Avalon Insurance Company Stop Loss Incentive+ Producer Rewards program | Medicare Sessions for retiring employer group members | 2024-2025 Peak schedule | Join the commercial group sales team for Peak Success webinar on October 24 | 2025 Capital Blue Cross health plans for small businesses | 2025 plans for individuals and families | 2025 Standard benefit update — Expanding nutritional counseling and education for obesity | Commercial group sales team | 2025 Medicare Advantage Star Ratings | eGEMs automatic renewal notification | 2025 Underwriting Compliance Guidelines for commercial group coverage | Consolidated Appropriations Act (CAA) Gag Clause Prohibition Compliance Attestation
Capital Blue Cross Producer Incentive+ Program rewards producers for renewals and new customers
The Block Management Bonus calculates incentives based on a comparison of active group account enrollment from January 31, 2024, to January 31, 2025.
The New Business incentive includes additional reward opportunities when you sell medical with a dental plan, tiered network medical plan, or ASO prescription drug plan.
The Renewal Business reward recognizes your ASO Medical & Rx, as well as adding a dental plan to your renewing group accounts.
Avalon Insurance Company Stop Loss Incentive+ Producer Rewards program
The Avalon Stop Loss Incentive+ Producer Incentive program began February 1, 2024, and runs through January 31, 2025, so there's still time to earn incentives for work with your Large group accounts (100+) only.
Persistency incentive — Receive up to 1.5% payout, based on retention.
Premium growth incentive — Receive an incentive of 0.5% of eligible premium for premium growth of 17% or greater.
New business incentive — Group premium tiers with increasing incentive.
High performing producer incentive — Sell six or more Large group stop loss accounts and earn a 10% enhancement to the final payout for new business incentives.
Medicare sessions for retiring employer group members
As employees begin to plan for retirement, they may have questions about their coverage options. Capital Blue Cross is committed to providing our members with more coverage and value for the life ahead. That’s why we make it easy for our members to stay with us after they retire. We offer a full suite of Medicare products, including Group Medicare plans, as well as plans for individuals.
We offer free educational sessions for members tailored to their needs, including group seminars and consultations on-site, virtually, and one-on-one. Sessions include Medicare education about the different parts of Medicare, enrollment periods, and the differences between Original Medicare, supplement plans, and Medicare Advantage.
To schedule a group seminar, employers can call Maria Laackman at 717.599.8926 or write to Maria.Laackman@capbluecross.com. Members looking for a one-on-one consultation can call our toll-free number at 833.201.8283 (TTY: 711).
2024-2025 Peak schedule
To give employer groups with December and January effective dates an optimal experience, and implement new and renewing group benefit changes by key target dates, refer to the 2024-2025 peak schedule.
Join the commercial group sales team for the Peak Success webinar on October 24
Register for the Peak Success webinar on Thursday, October 24, from 10:00-10:30AM ET, where Capital’s commercial group sales team will provide best practice tips to help you prepare for a successful year ahead.
Be prepared for the December and January effective dates.
Know what you need for new business and renewing employer groups in all business segments.
Be in the know and discover updates to the business process flow, YES tool reminders and tips, as well as expectations.
2025 Capital Blue Cross health plans for small businesses
Capital Blue Cross understands employers’ needs to provide quality coverage to employees while keeping an eye on their bottom line. Our suite of products and tools for employers and members give business leaders a way to offer important benefits as an investment in their well-being. Start the conversation about why Capital is your small groups' (1-100) trusted health plan partner by sharing this 2025 Health Plans for Your Small Business brochure.
2025 plans for individuals and families
Both the 2025 rate guide and product brochure are now available, including rates and benefits for on and off Pennie plans. As a reminder, we have two new off-Pennie plans for 2025.
Gold QHDHP PPO Choice 1700/0/10 will be available in Lancaster County; and
Gold QHDHP PPO 1700/0/10 will be available in all the counties in our service area, except for Lancaster County.
2025 Standard benefit update — Expanding nutritional counseling and education for obesity
Effective upon renewal on or after January 1, 2025, we are changing our standard benefit plans to offer members more nutritional visits with their healthcare provider. Members diagnosed "overweight" or "obese" will get 20 nutrition therapy counseling and education visits per benefit period.
This commercial benefit expansion is for Small Group PPACA, Small Business ASO, Mid-Market, all Large Group, Children’s Health Insurance Program (CHIP), and Individual Accounts.
Commercial group sales team
Reach out to your sales team member to collaborate with you and your employer group customers and prospects.
CMS recently released Star Ratings for plan year 2025. We are pleased to announce that all of Capital’s Medicare Advantage HMO and PPO plans have received a 4.5 Star Rating.
For any 2025 enrollment kits that you have in inventory, please replace the Star Rating sheets. Be sure to include both HMO and PPO versions. You should begin using the 2025 Star Ratings in 2025 enrollment kits effective immediately.
If you need us to send you a printed supply of Star Rating sheets, email us at email us.
eGEMS automatic renewal notification
Starting November 1, Capital will be sending an email notification to our nonlarge groups and their producer's primary contact once their benefit changes or renewal has been processed. The notification will alert the group that eGEMS is available to process their group’s enrollment activity. Some groups may get the notification before submitting benefit change paperwork. We encourage you to inform groups that they will get another email when their changes are submitted and completed.
Below is an example of the notification email:
From: CBC AA Enrollment To: Policy Maker, Producer Subject: Test Group & 00555555 eGEMS is Available.
Your group’s benefit changes or renewal have been completed. Our eGEMS enrollment system is now available and you can process enrollment updates. Please email CBCAAENROLLMENT@Capbluecross.com. when you have completed your updates so we can order any ID cards needed. Please note that if you submit additional benefit changes, you will receive another email when we complete those changes.
Thank you in advance for your partnership in helping to ensure a smooth enrollment process for your members.
Sincerely, Capital Enrollment Team
2025 Underwriting Compliance Guidelines for commercial group coverage
The 2025 Underwriting Compliance Guidelines have been published, effective January 1, 2025. The guidelines apply to all commercial group health, dental, vision, and prescription drug coverages offered by Capital, as well as our wholly-owned subsidiaries.
There are no major changes to specific policies. Various updates and clarifications were added throughout the guidelines, including:
Added additional clarification for handling of religious waivers in section XII. Frequently Asked Questions #13.
Added details to handle court orders to add dependents. See section XII. Frequently Asked Questions #14.
Added Lancaster to eligible Performance PPO counties
The information contained within the guidelines is considered proprietary and is intended for the sole use by Capital’s agents for underwriting Capital business only.
Capital is preparing to submit the CAA Gag Clause Prohibition Compliance Attestation (GCPCA) on behalf of fully-insured and small business ASO group customers. Those groups do not have to take any action for this submission.
Self-funded ASO groups are also required to submit the GCPCA. However, Capital is offering an option for self-funded ASO group customers to elect to have Capital submit a GCPCA on their behalf. Self-funded ASO group customers will receive communications in the coming days with details about the opt-in process and deadline should they choose to have Capital submit an attestation on their behalf.
Self-funded ASO group customers electing to have Capital submit an attestation on their behalf will need to complete an online form to opt in and agree to certain terms and conditions by November 22, 2024. This deadline allows our teams time to prepare files and complete our submission to CMS prior to the December 31, 2024 deadline. There is no charge for this service, and we will issue an update on our CAA resource page when the submission is complete.
Thank you for your collaboration as we work through the complexities of this CAA requirement. We appreciate your business and working with you to help our respective clients and customers. Please direct any questions to your legal counsel or Account Executive.
Important notes: This form must be completed by an authorized employee of the group and cannot be completed by a producer. Capital’s reporting on behalf of our self-funded ASO group customers does not transfer those groups’ compliance obligations to Capital.
Your producer relations team
Capital Blue Cross has adopted a team approach to support you, as we collaborate to enhance business relationships, foster your growth through education and incentives, and actively support the communities we serve. The Producer Relations team thanks you for your commitment and hard work. Reach out whenever you need them.
If you have any questions about content in this email, please contact your account executive.
This is a marketing email for producer use only. Replies to this mailbox are unmonitored. Contact us.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association serving 21 counties in Central Pennsylvania and the Lehigh Valley. Communications issued by Capital Blue Cross in its capacity as administrator of programs.
