Medium & Large Business Health Plans | Excellus BlueCross BlueShield

Here’s what’s new for 2021:

Expanded wellbeing program choices give greater choice and flexibility based on desired financial and engagement levels, as well as the features your employees want most from a wellbeing program.
Telemedicine and telehealth services are covered in full* in 2021, making care more accessible and affordable for members.
Blue Simplicity plans** offer self-funded groups a budget-friendly copay option while giving employees an easy-to-understand plan with predictable health care costs.
The ability to cover additional medical preventive services before the deductible on HDHPs gives businesses the ability to provide increased value to employees. Additional services include blood pressure monitors for individuals with hypertension, retinopathy screenings and glucometers for individuals with diabetes, peak flow meters for individuals with asthma, and more.

* Subject to in-network deductible where applicable

** Available to self-funded groups only

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: >1,300,000 providers, 96% hospital participation, and 93% 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.

New! Introducing Blue Simplicity*

The simplicity and predictability of a copay plan—without the higher premiums. Blue Simplicity is a new way for self-funded 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.

*Available to self-funded groups only.

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.

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 Programs

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.

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.
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.
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. And NEW for 2021 plans, in-network telehealth services provided by a member’s physician or our partner, MDLIVE, are covered in full (subject to deductible where applicable).
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.

When you integrate services like dental, administrative services and stop loss with medical benefits, Excellus BCBS 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. Emphasizing 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
National network options through 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 from Excellus BCBS incentivizes preventive care by rewarding employees with funds they can roll over to use as needed in the future.

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 28 on-staff pharmacists and 16 medical directors
Up to 44% savings on medical costs for common conditions like diabetes*

* 2018 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: