Judy

Hi, Eric.

Thank you for your work in developing this portal.  It’s much needed and I think will be very useful with brokers and in showing Blue that we are committed to continued development as a GA; we just need to build out a solid plan to follow the portal.

I did review the portal, and as I mentioned in our call, I made some notes of things we may want to consider adding or changing:

Small Group Tab

• In the column to the left of the page, we should probably have a link about getting appointed, like we do under the individual market tab.
• 1^st paragraph – should we define ATNE?
• Under GI section – …no medical questions to answer, no pre-x exclusions, limitations, waiting periods or surcharges.  I’m not sure what you mean by limitations (there are limitations and exclusions), same with waiting periods (there are waiting period to access coverage as a new hire) or surcharges (I think you mean rating up for specific conditions).  Wondering if we should explore alternative terminology?
• Last sentence under GI section – ….these plans are medically underwritten and not guarantee issue.
• Min Requirement section – only one of two employees needs to enroll if the other has a valid waiver, BSW does require at least 2 enrollees. I think this is incorrect. If two are eligible and one enrolls, the other does not have to have a valid waiver.
• Business formats section – I think we need to add in here somewhere that there have to be 2 employees – can be an owner and one PT W2 employee.
• I’m still not able to get to getting a quote – asking me for a login in to view content.
• Small group enrollment paperwork section under the Employee application/change form:  First sentence said each eligible employee who work 30+ hours a week and have satisfied waiting period….they don’t have to satisfy the waiting period if waived on initial enrollment.
• Still in Enrollment paperwork section – one of the scenarios I come across often that isn’t listed here is a husband and wife group where they are both on LLC formation documents as managing partners.  I think we should add this.
• Still in paperwork section under LLC filing as a partnership – can we be more specific in saying that the Secretary of State docs with the state seal?  That makes it easier to identify exactly what is being asked for.
• Still in paperwork section – it indicates that a page from the partnership agreement showing the initial members and ownership percentages.  I’ve never just sent the one page in – it’s always been the full agreement so they can see the company name, date company formed, etc.. Do you think we should indicate that full agreement is needed?
• Submission deadline section – I mentioned this in the meeting, but I do think we need to educate how the 15^th of the month can be problematic in terminated employees, dropping dependents and those moving to Medicare.
• Small Group Case Approval in ID card section – HMO IDs are mailed to employee’s home address and PPO cards are mailed to the employer’s address.
• Employer Portal Access – first bullet says add and terminate employees.  Should also include dependents.  I think we should add a bullet: Complete Regulatory tasks such as MSP, RxDC, etc.
• Benefits Compliance Requirements section – under ABY – we may consider adding more bullets to include Medicare HRA and wrap documents
• Annual BCBSTX Requirements – we may want to add that these tasks are communicated in News from the Blues and Employer Newsletters
• SBC Monitoring – maybe add when they are usually due
• MSP – When usually due
• RxDC – when usually due
• For the bullets above we should mention that only the BAE administrator can access this data unless someone else is granted delegated access to do so
• Compliance – a deeper dive under new hires – I thought the packet was to be given within 10 days of the hire date? No packet requirement. It’s the notice of coverage options that must be provided within 14 days of date of hire.
• Annual renewal process – under amendment form – 3^rd bullet – mid year changes like AD change requires a 60 day notice, not 30 days
• Paperwork and processing – second bullet says to send paperwork to JME for submission – should we tell them what email?
• Getting Appointed and Getting Certified – how to get appointed – may be a question for Marlene, but do they need to also submit a copy of E&O?
• Eligibility for Individual coverage section – in the common SEP event section – wondering if the document on RPP about what does/doesn’t qualify as SEP and provides what doeuments are needed and how eff dates are assigned would be a good fit here.
• Individual – getting a quote area – tools and quoting area may be a good place for the Sherpa videos/manuals.
• HMO Market section – We say here that only HMO plans are available, but when the quotes are done, the Plus plans display as EPOs.  We may want to address these plans:  have out of network benefits, but deductible doubles and there is no out of pocket max on OON.
• Guarantee issue section – third bullet says there are no premium surcharges for medical conditions.  Maybe use the term rate-up instead of surcharges
• Plan grid section – not sure what is being used here.  Are these the metallic comparison plans created by Blue?
• Helping clients enroll in coverage section – keeping income info up to date: we tell them to go to healthcare.gov then say to go through Sherpa.  Are both access points for updating income and if so, which is the easier way?  Probably a Marlene question.
• Under the selecting PCP section – we should probably tell them which HMO network to use since.
• Binder payment – there is a flier I think for making payments.  Should we add a link to it here?
• Post enrollment support – Do we hve a sample of an enrollment kit to include?
• Creating BAM accounts – is there a step-by-step flier we can add?
• Servicing individual clients – Tip – should we add some language that tells them submitting application before the event, if possible prevents a gap in coverage?
• Last bullet discusses that filing to report changes may result in repayment of excess tax credits.  I’m wondering if we shouldn’t create a template document for the agent to have clients sign as a form of CYA?  Marlene may know if this situation happens enough for agents to worry about it.
• Individual market commissions section – under commission schedules – usually paid monthly as long as the client remains enrolled and pays their premium.  Should say pays premium timely.
• Marketing & Growth – staying in touch year round – I think we may want to add language about web site content with things about how to get the best out of your benefits, etc.  Like some of the things on our blog.

Let me know when you loop back around to the JME site.  I have some feedback on that one that I think will be helpful.  Looking forward to seeing the final product!

Judy Loden Gragg

I’m going through the list and have found some of the documents I mentioned.  For the Health Sherpa videos, you’ll have to log into your account to obtain them, but there are several (quote/apply, import applications from Healthcare.gov, then view, edit and service them).  There is also a quick-start guide and information on how to set up a client-facing enrollment site.

Here is the link to the individual medical comparison charts and summaries:  summary-plan-tx-2025.pdf

Same for dental plans: summary-dental-tx-2025.pdf

How to make payments (member): Pay Online or Automatically for BCBSTX | Blue Cross and Blue Shield of Texas

Retail readiness microsite:  Blue Cross and Blue Shield of IL, MT, NM, OK and TX | Sales Toolkit

How to create a BAM account:  Sign Up for Blue Access for Members in Texas | Blue Cross and Blue Shield of Texas

I hope this helps a bit.