Dental Plan changes effective 3/1/08
PPO and HMO dental rates are increasing.
There will be no changes to dental benefits.
Term Life Plans
There will be no changes to the existing rates or benefits
for Individual term life coverage.
Rating area definitions changing
Medical and dental rating area definitions will change from
9 areas to 14, as of 3/1/08. Why? To help premiums more
accurately reflect health care costs in each community. (SmartSense
and Lumenos non-maternity plans launched with these new
definitions in December 2007.)
Rate and benefit guarantees
Members not in a rate guarantee on 3/1/08 will receive their
new rate on 3/1/08 or at their next premium due date, but no
later than 5/1/08. The following table illustrates current
and future guarantee periods and the mailing dates for
notifications. Weíll make every effort to notify you before
Coverage Effective Date
Rate and Medical Benefit Guarantee Ends
Agent Notification Mail Date
Member Notification Mail Date
Prior to 9/1/07
Tonik benefit changes effective 3/1/08
The office visit co-pay
will apply to the office visit charge. Any other services
done during that office visit (for example, lab work and
X-rays) will be subject to deductible and/or coinsurance.
Emergency room visits
will be subject to the deductible. To help control these
costs, Blue Cross is helping members learn when using the ER, seeing
their doctor, or visiting Urgent Care is most appropriate.
Please see enclosed Tonik benefit changes insert for
SmartSense, new Lumenosģ plans and Tonik
These new plans target Californians who donít want to use up
their health insurance budgets paying for benefits they
donít want ó or need.
Blue Cross has
added some fresh options that save money efficiently. Their SmartSense benefit designs and Lumenos without maternity
plans make it easier to find solutions to match your needs
while putting a few bucks back in your pocket.
Single-age rates on these plans soften rate increases,
making the plans even more budget-friendly.
The bottom line with SmartSense is that itís nice to your
bottom line. Itís solid protection that covers the
essentials of full medical at one of our lowest monthly
These new products will get the attention of couples and
retirees who donít want to pay for maternity benefits they
wonít use. And active people who lead a healthy lifestyle
will appreciate the incentives and free wellness programs
that help them reduce out-of-pocket expenses. Lumenos
already gives members an unprecedented amount of control
over how their health care dollars are spent. With three new
plan choices and a variety of deductible options, you can
have even more flexibility for any coverage needs and
Tonik Enhanced Dental
This comprehensive product is available to both existing
Tonik member and new applicants who want more than the basic
dental included in their medical benefits package.
Why are rates increasing? We are fortunate to live in a time
when medical knowledge and technology help us live longer
and better lives. We have more sophisticated tests and
procedures. We go to the doctor more often and receive more
prescriptions than ever before. As a result, todayís health
care services cost more and the demand for them is greater.
Therefore, premiums for health care coverage must keep pace
with these costs.
2. How can I review health care coverage online? You can take advantage of new resources at
(available in late January).
Can Tonik plan members change to another plan? If you have a
Tonik plan and would like to change to a higher deductible
Tonik plan, they just need to fill out a written request.
But to change to a lower deductible Tonik plan or a
different Blue Cross plan, theyíll need to complete a Tonik
Application or an Individual Enrollment Application, and it
will be reviewed by Underwriting.
4. What if you canít afford to keep their coverage? Blue
Cross offers a wide variety of plans for every stage of
life. They will work with you and your client to find the
plan that meets your health care needs and budget. Whatever
you choos, itís important to stay covered; without health
coverage, they could pay an average of $27,984 for just
three days in the hospital. Also, if you cancel coverage now
and become ill or injured later on, you may not qualify for
coverage ó or may be charged a much higher premium.
5. How often can members change benefit plans? Generally,
they can change plans once a year. A change in plan may only
be requested six months or more after their original
Why are rates increasing if a member hasnít used or barely
used their benefits? Benefit costs are increasing overall,
and these costs are spread over Blue Crossí membership base.
This practice allows Blue Cross to moderate rate increases
and share the risk. By having their risk spread over the
larger population, individuals donít find their premiums
increasing just because they used their health plan.
What is the cut-off date for new members to receive the
current March 1, 2007 rates? Applications for new business
with a signature date on or before February 28, 2008 will
receive the current March 1, 2007 rates.
Some of the main factors driving health care
coverage rate increases:
Growing need to keep pace with current health care costs
Expensive new technologies
Increased use of medical service and prescription drugs
An aging population
What Blue Cross is doing to control costs
Cost containment is key to reducing the frequency and
severity of rate increases. Blue Cross is working to control
costs by helping people stay as healthy as they can and by
helping to improve the quality of care delivered by our
health care system.