Statewide PPO Plans Discontinued for Individual / Families in 2016

October 14, 2015

bcbsaz logo
Maricopa County, AZ ~ Blue Cross® Blue Shield® of AZ (BCBSAZ) has announced the Statewide PPO network will be discontinued at the end of 2015 for all Non-Grandfathered Individual & Family plans.  In Maricopa County, BCBSAZ will offer two exclusive HMO networks only, Alliance and Select.

Although open enrollment doesn’t begin until November 1st this year, there are a few things you can do to prepare if you are one of the many members required to make a new plan selection for 2016:

  1. Check the new networks to find out which network has the doctors you desire, if any.
  2. If you do not find your desired doctors on either the Select or Alliance network, you will want to check available networks from other insurance companies.
  3. If you purchased your insurance directly from BCBSAZ, your agent can help you make a plan change with them now.
  4. If you purchased your insurance on the Marketplace, you can reapply here (After November 1st)

Auto-renewal WILL NOT be available for all plans, which means some members will be required to select a new health plan by December 15th to avoid a lapse in coverage.  You can view the 2016 plan options with BCBSAZ here.

If you travel out of state on a regular basis, you will most likely want to select a carrier and plan with a PPO network.

L & A Services is prepared and certified to assist with 2016 health plan selections and enrollment on or off the federal marketplace under National Producer Number 6747133.


BCBSAZ 2016 Individual/Family Plan Renewal

August 27, 2015

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This week, Blue Cross Blue Shield of AZ (BCBSAZ) unveiled their new proposed plan and premium information for individuals and families in 2016.

There are many changes, and many customers will be required to take action to avoid losing coverage at the end of the year.  We are prepared to assist these customers with this process as early as September 9th.

Although BCBSAZ will be sending written notification to all affected members in the coming months, we wanted to provide the information in advance to help better prepare these customers for this year’s renewal.

These are the most important changes to know for 2016:

  1. Metal level plans (Platinum, Gold, Silver, Bronze) are considered ACA-compliant plans, since these were plans purchased and effective from January 2014 to now.
  • In 2015, these plans included three networks:  Statewide PPO, Alliance HMO, and Select HMO.   For 2016, BCBSAZ will only offer the two HMO networks in Maricopa County…the Statewide PPO plan is being deleted.   If you have an ACA-compliant plan with the Statewide PPO network, either purchased through the federal marketplace or directly from BCBSAZ, you MUST select a new plan by December 15th to avoid losing coverage on January 1st.  Customers living in all other counties will have access to the Statewide PPO network, as well as another regional network.  Note: the HMO plans do NOT require a primary care physician assignment, NOR do they require a referral to see a specialist.  However, it is important to check the list to make sure desired doctors participate in the network or else they are not covered.
  • The BlueEssential & Copay Complete plans have been deleted, so these customers will need to move to a new plan, as well.
  • For customers on a plan with either the Alliance or Select network, BCBSAZ will automatically enroll in the next closest available plan available for 2016.  This does not preclude you from changing your plan during open enrollment (November 1 – January 31), so contact our office if alternative choices are desired.
  • BCBSAZ ACA-compliant plans experienced an average rate increase of 21.4%.

2.  Grandmothered Plans are those plans purchased and effective between 2010-2013, and will include the word ‘Plus’ in the name of the plan.

  • All of these plans are being renewed without any changes to benefits or to the PPO network.
  • The average rate increase on these plans is 21.2%, however, the new rate will be guaranteed until April 30, 2017.  This will lock in the rates for a full 16 months.
  • Despite the increase, these plans continue to offer greater premium savings over the ACA-compliant plans.  Most customers in these plans will want to keep what they have.
  • Nothing is required to keep these plans, but customers still have the ability to either 1) change the deductible to lower the premium, or 2) consider moving to an ACA-plan during open enrollment (November 1 – January 31) if desired.  If a member moves away from a Grandmothered plan, they cannot get it back later.  We are able to assist with customers with this evaluation.
  • BCBSAZ will be sending a letter to each affected customer on October 12th.

3.  New Dental Plan

  • BCBSAZ is now offering their group BluePreferred Dental plans to individuals and families.
  • Contact our office if interested in private PPO dental coverage from BCBSAZ

We suspect there will be many changes in 2016 from all of our carrier partners.  We know there will be many questions, and we are here to answer them.  Please keep in mind that this is an extremely high-volume time of the year, so time is of the essence…the sooner you take action, the smoother the process will go for you.

Thank you to all 266 of our individual BCBSAZ customers.  We look forward to serving you during this time of change.


BCBSAZ Announces Oct 2015 Rates for Individual Grandfathered Health Plans

July 28, 2015

Blue Cross Blue Shield of Arizona (BCBSAZ) recently mailed individual grandfathered renewal letters.  Individual members with Suite A grandfathered plans with October 2015 renewal dates will be the first to receive their letters and renewal information.

The rate increase for these plans will be 18.5% (average, not including age adjustments.)  Some affected members will be able to increase their deductible within their product to help mitigate the rate increase, however they cannot move to a different grandfathered plan. BCBSAZ is discontinuing the BluePreferred Original individual product effective December 31, 2015.

For Members with Plans Continuing in 2016

Though they will have the option to renew their current plan, some members may consider switching to a non-grandfathered individual plan. Before doing so, they should be aware of the benefits grandfathered plans offer.  Grandfathered plans provide access to a large network of providers, out-of-state coverage, and, in most cases, lower monthly premiums than those found with a non-grandfathered plans.

For Members with Plans Scheduled to be Discontinued

Members enrolled in BluePreferred Original can stay in their plans until December 31, 2015. While this only affects a small number of members, these members must select a new plan by December 15th to ensure a January 1, 2016 effective date.

All Affordable Care Act compliant plans renew on January 1st.  This year, open enrollment for every individual begins on November 1st, and ends on January 31st. Watch for more information on renewal communications, including those to members enrolled in grandmothered and non-grandfathered plans, coming soon.

If you have any questions or help considering your options, please contact your insurance broker, L & A Services at 602-996-6010.

BCBSAZ Renewal for Individual ‘PLUS’ Plans

October 30, 2014





Blue Cross Blue Shield of Arizona (BCBSAZ) announces details of this year’s renewal for Non-Grandfathered (Suite C) individual plans.  These are plans that were purchased between April 2010 & December 2013, and are easily identified by the name, which will include the word ‘PLUS’.

Renewal mailings for these individual members are scheduled to begin the week of October 20th. The letter you will receive will include your plan information, current and renewal premiums, along with your broker’s contact information.

For members who wish to keep the plan they have, there is no further action you need to take…it will renew automatically.

For those who wish to review alternate health plan choices, we will be able to help you compare all 2015 plan options starting in November.  2015 plan enrollment begins November 15th and ends February 15th.

Overview-  Here’s What’s Happening!

For most, staying in your existing Suite C individual plan will provide coverage at a lower premium than the new, 2015 individual plans.  Exceptions may include those who are subsidy eligible, need maternity coverage, are 65 or older, or were rated up in the Suite C individual due to medical underwriting.

Many of our clients will experience a percentage rate increase this year in the double-digits.  Not everyone will be affected, but these are the factors that will lead to the greatest increases:

  1. Rate Pass in 2014 – Suite C individual customers did not receive a rate increase in 2014
  2. Age – members may face up to two years’ worth of age-related rate increases
  3. New ACA fees – The Affordable Care Act (ACA) mandates certain fees be added to rates

Discontinued Plans– Two existing Suite C individual plans will be discontinued on January 1, 2015.  All discontinued Suite C individual plan members will be mapped to comparable 2015 individual plans. You will also have the right to purchase any individual plan currently sold by BCBSAZ.

Discontinued Plan Mapped To
BlueSecure HMO Plus  —-> CopayComplete 40 PPO
Comp One Plus           —-> EverydayHealth 1000 PPO

Changes in Benefits– The following changes apply to: BlueOptimum Plus, BlueValue Plus, BlueBasic Plus, BlueEssential Plus, and BluePortfolio Plus:

Behavioral and Mental Health Services

  • Plans will now cover behavioral and mental health partial hospitalization services. (Precertification is required.)
  • Coverage for inpatient admissions to behavioral health subacute facilities will be expanded.
  • Care coordination will no longer be required for services provided through the behavioral services administrator (BSA).

Emergency Services

  • Reimbursement for emergency services provided by non-contracted providers will be based on billed charges.

Preventive Services

  • Additional preventive care services will be covered. (A list of covered services will be included in the Preventive Services section of the member’s benefit plan booklet, and available from BCBSAZ.)


  • Plans will cover telemedicine services delivered by an in-network provider through interactive audio-video electronic media to treat burns, cardiologic conditions, dermatologic conditions, infectious diseases, mental health disorders, neurologic diseases, and trauma.
  • Benefits are also available for emergency or urgent telemedicine services provided by out-of-network providers to treat these conditions.


  • Currently, services are denied or members pay a $300 charge if the member’s in-network or out-of-network provider fails to obtain precertification for covered services that require precertification. Except for medications that require precertification, services will no longer be denied and members will no longer pay a $300 charge if an in-network provider fails to obtain precertification for a service that requires it.

Depending on the type of service, services will continue to be denied or members will continue to pay a $300 charge if the member’s out-of-network provider fails to obtain precertification

Pre-Existing Conditions

  • Plans will no longer exclude pre-existing conditions for members of any age (currently 19 and older).

The following changes apply only to BlueOptimum Plus, BlueValue Plus, BlueBasic Plus, and BlueEssential Plus:

Office-Visit Copays

  • The in-network copay for a primary care physician visit will increase to $35, the in-network copay for a specialist office visit will increase to $60*, and the in-network copay for an urgent care visit will increase to $75.

* Specialist office visit cost-sharing for BlueBasic Plus will remain at 20% member coinsurance after deductible is met.

Out-of-Pocket Coinsurance Maximums

  • The in-network per-member out-of-pocket coinsurance maximum will increase by $500. The out-of-network per-member out-of-pocket coinsurance maximum will increase by $1,000.
Plan 2014 Out-of-pocket Coinsurance Maximum  (per member)  2015 Out-of-pocket Coinsurance Maximum (per member)
In-network Out-of-network In-network Out-of-network
BlueOptimum Plus $2,500 $5,000 $3,000 $6,000
BlueValue Plus $3,000 $6,000 $3,500 $7,000
BlueBasic Plus $4,000 $8,000 $4,500 $9,000
BlueEssential Plus $5,000 $10,000 $5,500 $11,000

The following changes apply only to BluePortfolio Plus:


  • The in-network deductible on the BluePortfolio Plus $2000 deductible plan option will increase to a $2,600 deductible for individuals and a $5,200 deductible for families.

All plan changes effective December 31, 2014. All benefits covered by benefit plans, including the benefits discussed in this notice, are subject to applicable law, BCBSAZ medical coverage guidelines and benefit plan limitations and exclusions.

Remember, if you are happy with your plan and the new rate, you don’t need to do anything. The Suite C individual plans will automatically renew. (This option will be noted in the renewal letter, along with notice of any benefit changes to the current plan.)

For more information, please contact your Broker Service Representative, L&A Services, Inc.