About Small Group Plans

2016 plans

2016 Medical Benefits Guide

Medical plan summaries

• Balance Gold 500
• Balance Gold 750
• Balance Gold 1000
• Balance Gold 1500

• Balance Gold PCP 500
• Balance Gold PCP 750
• Balance Gold PCP 1000
• Balance Gold PCP 1500

• Balance Gold PCP HRA 2000

• Balance Gold PCP 500 Employee Only
• Balance Gold PCP 750 Employee Only
• Balance Gold PCP 1000 Employee Only
• Balance Gold PCP 1500 Employee Only

• Balance Silver 2000

• Balance Silver PCP 2000
• Balance Silver PCP 2500
• Balance Silver PCP 3000

• Balance Silver HSA 3000
• Balance Silver HSA 5000

• Balance Bronze PCP 5500
• Balance Bronze PCP 6350

• Balance Bronze HSA 6000

• Choice Gold 500 PCP
• Choice Gold 750 PCP
• Choice Gold 1000 PCP

• PersonalCare Gold 750
• PersonalCare Silver 2500
• PersonalCare Bronze 4500

2015 plans

2015 Medical Benefits Guide

Medical plan summaries

• Choice Gold 500-750-1000
• Balance Gold PCP Employee Only 500-750-1000-1500
• Balance Gold PCP 500-750-1000-1500
• Balance Gold 500-750-1000-1500
• Balance Gold HRA PCP 2000
• Balance Gold HSA 1300-1500

• Balance Silver PCP 1700-2000
• Balance Silver 2000
• Silver HSA 1700

• Balance Bronze HSA 5250
• Balance Bronze PCP 6350 - 5500

Additional information

The provider network you choose is just as important as your health plan selection. Networks are a key driver in cost control and employee satisfaction. Check out our Heritage Signature network flyer to learn more. Look at our hospital list to see which facilities are in the network.

Small group supplemental guide

Medical plan definitions

Medical + dental

2016 Small group creditable coverage status

Dental Benefits Guide*

2016 DentalBlue benefit guide

2015 DentalBlue benefit guide

Dental plan summaries*

• Dental Optima™ - Coinsurance for covered services remains constant, regardless of whether the service is provided in-network or out-of-network.
• Dental Preference™ - Offers plan members choice and control over their out-of-pocket spending.
• Dental Copay Select™ - Offers predictable costs on more than 200 dental procedures. An affordable option for employers looking to provide full benefits, but with a reduced benefits budget.
• Dental Essentials™ - This plan can be funded 100 percent by employees, or employers can voluntarily choose to fund a portion of employee premiums (up to 50 percent).
• Dental Preventive™ - Coinsurance for covered services remains constant regardless of whether the service is provided in-network or out-of-network.

*Dental plans available for groups of 5-50 employees

An Adult Vision Plan can be pared with any small group medical plan.

• Adult Vision Plan
• Adult Vision Plan - Employee Only

Small group personal funding accounts

Personal funding accounts offer your business a consumer-driven approach to improving the bottom line-combining quality healthcare coverage with a choice of tax-advantaged healthcare spending accounts.

Personal funding accounts:

• Give employees more choice and control over their healthcare spending
• Encourage a more health-conscious, productive and satisfied workforce
• Help employees offset out-of-pocket expenses with potential tax advantages
• Minimize costs and add an affordable healthcare program to the total compensation package
• Take advantage of potential tax savings for your business (please consult a tax advisor regarding IRS guidelines)

Already have an HSA account? Check out our how-to-guide that walks you through how to fund your employer contributions!

As part of the Affordable Care Act of 2010, all health plans must provide a summary of benefits in a standard four-page format. These summaries help you understand how a plan works and makes comparing plans easier.

Small Group Plan SBCs

Healthy rewards for healthy employees

We offer a variety of programs and services that are designed to keep employees healthy, lower costs, and reward people for doing the right thing.

A wellness program designed with small businesses in mind.

New wellness programs available to employer groups with 1-50 employees starting January 1, 2014 for new business and renewing groups on non-grandfathered plans.

We know that healthier employees lead to a healthier budget. That's why we have included a robust wellness program where:

• Employers will save 7.5% on premiums for each employee who completes wellness activities
• Employees who qualify may receive telephonic health coaching at no additional cost
• Employees will earn a $100 Visa® debit card (once they have completed the wellness activities)

Help your clients launch a successful wellness program with our wellness program employer toolkit.

Group Enrollment (up to 50 employees)

Group Master Application Up to 50

Group Master Application Benefit Selections Up to 50

Group Master Application Dental Benefit Selections Up to 50

Personal Funding Accounts Enrollment and Change Application

Personal Funding Account Setup - For Metallic Groups

Electronic Funding Authorization (HRA and HSA)

ERISA Business Associate Agreement - For Metallic Groups

Non-ERISA Business Associate Agreement - For Metallic Groups

Group Verification of Medicare Coverage

New Group Enrollment Checklist Up to 50

Small Group Renewal Checklist

Late Enrollment Acknowledgement Form

Quick Reference Guide for Plan Administrators

Key Employee Verification Form

Member Enrollment

Deductible Credit Form

2016 Small Group Member Enrollment and Change Application

2016 Small Group Member Enrollment and Change Application Spanish Version

2015 Member Enrollment and Change Application

2015 Member Enrollment and Change Application Spanish Version

2015 Member Enrollment and Change Application Guide

Enrollment Spreadsheet (in lieu of member enrollment applications) 

HIPAA Pre-existing Change Notice and Instructions

HIPAA Pre-existing Change Notice and Instructions Spanish Version

Other Coverage Questionnaire Enrollment

Request for Certification of Disabled Dependent

Waiver of Coverage

Small Group Marketplace Census Template

Member, Other

Transition of Care Form

HRA Electronic Funding Authorization

Member, UMB Bank Forms

UMB HSA Beneficiary Designation Form

UMB HSA Name Change Request Form

UMB HSA Account Closure/Withdrawal Request

UMB HSA Funds Transfer

HSA Expense Manual Claim Form

Small group webinars and presentations

• 2016 Small Group Product Webinar: October 1, 2015

Helpful Tools For Your Clients

Find a Doctor

Rx Search

24 Hour NurseLine

Save Money Now...

...with special discount offers for Premera Blue Cross members.

• No extra fees!
• Make purchases in person, over the phone, or online with your health plan ID card
• Available to most members of Premera Blue Cross.