Medium & Large Business Health Plans | Excellus BlueCross BlueShield

What’s New for 2024

ThriveWell^SM: ThriveWell is a digital home base dedicated to engaging teams in health and wellbeing. Our partnership with Virgin Pulse* will give employees the tools to make small, everyday changes to their wellbeing that are focused on the areas they want to improve the most. They’ll build healthy habits, have fun with friends, and experience the lifelong rewards of better health and wellbeing. ThriveWell will be embedded in all Fully Insured plans and available as a buy-up for Self-Funded and Minimum Premium plans. Our suite of rewards programs is designed to provide employees with helpful incentives for getting and staying healthy. Based on the incentives you’re looking to offer, we have several different reward options available for purchase.
Headspace for Meditation, Sleep, and Stress Relief:  Headspace, powered by Virgin Pulse, is a leading digital mindfulness-based mental health app that helps members take care of their minds. The Headspace app includes hundreds of exercises and meditations for stress relief, focus, productivity, and sleep. It is designed to bring wellbeing resources together into a seamless, personalized, and easy-to-use experience. The Headspace app provides an experience comparable to Calm® and will be replacing Calm beginning January 2024.
Virtual Physical Therapy for Musculoskeletal (MSK) Management**: Members receive virtual access to a holistic team of specialty medical doctors, physical therapists, health coaches, and nutritionists. Virtual physical therapy visits will be covered in full (subject to deductible, where applicable), and included as a telemedicine service.
REACH Kidney Care: Our Care Management Team is partnering with REACH Kidney Care, a kidney health management program designed to benefit members along the continuum of kidney disease, specifically targeting members with Stage 4 and 5 chronic kidney disease (CKD). At no cost to members, REACH will provide one-on-one, individualized care management, both in person and virtually, to help them navigate their health in a way that best fits their life.
Dental Preferred Packaging: To help make selecting the right plan easier, we’ve created four preferred package options. They are great places to start if you’re brand new to dental or need help navigating through some of our popular levels of coverage. The new packages vary, with coverage options that range from a focus on preventive care to more comprehensive coverage featuring orthodontia, and generous annual maximums.

* Virgin Pulse is a separate company and offers a digital wellbeing service on behalf of Excellus BlueCross BlueShield.
** Pending final contract between the parties.

Medical Plans

With three types of plans and multiple options, we have coverage that’s right for every group and every member. Our network gives you access to more of the best doctors, specialists, and hospitals in your neighborhood and around the globe than any other. We’ve also negotiated great rates with these providers, which means everyone pays less for a higher quality of care.

Local 31-County Network: 100% hospital participation, 99% physician participation and more than 98% participation of hospital-based providers
National Network: >1,700,000 providers, 96% hospital participation, and 95% doctor and specialist participation
Global Network: 7,400 hospitals (including the U.S.), thousands of hand-picked doctors and dentists fluent in English, and providers in 190 countries

Also, we know that going to the doctor’s office isn’t always an option, so our plans allow employees to access care and support right from home through telehealth, telemedicine, and the Wellframe^® app. Learn more about these convenient tools in Tools & Resources.

Blue Simplicity

The simplicity and predictability of a copay plan - without the higher premiums. Blue Simplicity is a new way for employers to offer an easy-to-understand copay plan at a lower price point. It works just like a traditional copay plan, only with additional copay levels that help businesses keep expenses in check while still providing a simple copay plan employees love.

Six copay levels so costs are always transparent and predictable.
No deductible or coinsurance to figure out.
Copays go toward the out-of-pocket max.
Preventive care is covered in full from day one.
All plans are FSA and HRA compatible.

Medicare Solutions

We can also help you with Medicare Advantage, Part D, and Supplement Plans for retirees and employees working past age 65. View Group Medicare Options.

Member Health Management

When your team is healthier, your business runs more smoothly. That’s why our comprehensive approach to Member Health Management is essential. With our system of clinical programs, reminders, and education, we surround your employees with the help they need to stay on track with their health goals, live better, and work harder.

Whether someone on your team is dealing with a chronic or complex condition, or just needs a reminder to go to the doctor once in a while, you can feel confident knowing someone is looking out for them—at no additional cost^*.

Some highlights of our comprehensive roster of Member Health Management services include:

Utilization management
Care management
Disease management
Behavioral health management
Wellbeing and incentive programs

^{*Included for Fully Insured. Buy-up for Self-Funded}

Tools & Resources

We’re dedicated to making health care more convenient for greater employee engagement. That’s why we offer free self-service support tools that make it easier than ever to get care.

NEW! ThriveWell^SM: A digital home base for health and wellbeing. By partnering with Virgin Pulse, we help members make small everyday changes to their wellbeing that are focused on the areas they want to improve the most. Members will build healthy habits, have fun with friends, and experience the lifelong rewards of better health and wellbeing.
NEW! Headspace for Meditation, Sleep, and Stress Relief: Headspace, powered by Virgin Pulse, is a leading digital mindfulness-based mental health app that helps members take care of their minds. The Headspace app includes hundreds of exercises and meditations for stress relief, focus, productivity, and sleep. It is designed to bring wellbeing resources together into a seamless, personalized, and easy-to-use experience.
Online Member Accounts: From viewing their member card and benefits to viewing claims, tracking their deductible and out-of-pocket spending, and more, members have more visibility into their plan than ever before.
Telemedicine: For non-emergency conditions and emotional wellbeing needs, telemedicine gives members convenient access to medical and behavioral health care 24/7/365 from the comfort of their home. In-network telehealth services provided by a member’s physician or our partner, MDLIVE^®, are covered in full (subject to deductible where applicable).
Wellframe^® App: Wellframe is a convenient way for members to receive confidential, text-based, one-on-one outreach from our care managers using a smartphone or tablet. Members can receive guidance, support, and tips to help achieve their health care goals and reduce costs.
24/7 Nurse Call Line: Members can contact a nurse by phone anytime—24 hours a day, seven days a week—with general health questions. If ongoing support is needed, members may be referred to a member care manager so they’ll have the support that best fits their needs.
Find a Doctor & Estimate Medical Costs Tool: Members are more in control of their care with the ability to quickly and easily find their most affordable local, national, and global care options with our online tools.

Voluntary Benefit Services

When you integrate services like dental, administrative services and stop loss with medical benefits, Excellus BlueCross BlueShield can support employees with a more complete view of their health. Leading to more proactive support to help keep employees healthy and costs of care down.

Dental

Large Group Dental Packages (more than 50 eligible employees)

With Dental Blue Options, groups get comprehensive dental coverage with the flexibility of choosing from a variety of coinsurance, deductible, and annual maximum options. With an emphasis on preventive care, Dental Blue Options helps employees maintain their complete oral health, reducing the need for more costly dental care in the future.

With Excellus BCBS, members get:

One-stop shop for comprehensive medical and dental coverage
Flexible benefit options at competitive rates
Easy access to a broad network of providers
Large network of dental providers with plans including National Dental GRID+ DenteMax
100% employee-paid options available

Dental Annual Maximum Rollover: Regular dental visits can greatly reduce the occurrence of major oral health issues, saving money for both employers and employees. The Dental Annual Maximum Rollover incentivizes preventive care by rewarding employees with funds they can roll over to use as needed in the future.

Groups new to enrolling in our dental plan will be able to keep any accrued rollover account funds from another plan when they enroll in a dental plan that includes the annual maximum rollover benefit. We will match the funding members have with a competitor up to the Rollover Account Maximum.

NEW! Dental Preferred Packaging: To help make selecting the right plan easier, we’ve created four preferred package options. They are a great place to start for groups that are new to dental or need help navigating through some of our popular levels of coverage. The new packages vary, with coverage options that range from a focus on preventive care to more comprehensive coverage featuring orthodontia, and generous annual maximums.

Vision

Simply Vision Plans

Vision and eye health are essential to overall wellbeing. That’s why group vision plans with low out-of-pocket costs are now available from Excellus BCBS.

All Simply Vision plans include:

Low-cost eye exams
Fully covered and low-cost on-trend frame options through the Exclusive Collection
Competitively priced plan options and multiple contribution options
Access to great discounts on lens add-ons, additional pairs of eyeglasses, LASIK services and other great extras*

Through our partner, Davis Vision, members also enjoy convenient coverage, with access to a large network that includes nearly 900 provider locations in the local Excellus BCBS network area and 130,000+ points of access nationwide.

*Not all providers participate in Davis Vision Discounts, including the fixed lens option pricing. Members should contact their provider prior to scheduling an appointment to confirm if discount and fixed lens options are offered.

Davis Vision is an independent company providing vision benefit management services and access to their network.

Pharmacy Management

As the largest regional pharmacy benefits manager, we oversee every aspect of care on a member-by-member basis to keep costs low and keep businesses and their employees safe. Plus, we regularly connect with local physicians to stay current on new medications that can lower costs even further.

With integrated benefits from Excellus BCBS, you get the complete package:

One member card
Zero claims integration fees, hidden costs for utilization management, or reporting fees
Local, dedicated pharmacy, sales, and customer service team for more responsive service
Real-time formulary management to identify the most effective drugs at the lowest cost —based on real member data (not national statistics)
Access to 48 on-staff pharmacists and 17 medical directors
4-6% reduction in overall medical costs*

* Health Plan Data

Stop Loss Insurance

We’re in the business of protecting local businesses from catastrophic claims. We treat stop loss as an important part of our business, not a commodity. It’s a conviction that goes back more than 30 years and one we plan to keep. So you get the timely support and payments you need, when you need them most.

An Integrated Approach to Care: By rolling stop loss in with medical and pharmacy coverage, we can use real-time member data to help prevent catastrophic events. The result: pricing consistently below the industry’s average stop loss trend.
Reimbursements When They Matter Most: With wire transfer availability, we can make deposits directly into health plan accounts — with funds immediately available. We can also provide credit to claim billing for extraordinary, large reimbursements.
Administration Without the Frustration: One point of contact for billing and customer service. Direct access to underwriters. And one consolidated bill for ASO administrative fees and stop loss payments when you also have medical through us — with no need to verify enrollment between carriers.

Administrative Services

Health insurance administration is complicated. We can help connect you with workplace management solutions to help ensure regulatory compliance while improving efficiencies and bottom lines. Meaning your business can save more by focusing on other business priorities.

You can get administrative support for things like: