Today’s healthcare system has become extremely complex and expensive.  As part of its ongoing commitment to offering competitive wages and benefits, the County is dedicated to finding innovative, long-term solutions to help all employees maximize their healthcare dollars.

Transitioning to Blue Shield with the Accolade Navigator PPO (Accolade is not available through Anthem) targets our employee’s top priorities by helping you navigate your benefits and the healthcare system, and by providing you with tools to help you manage your care and costs, which ultimately impacts the premiums paid by the County and employees. Accolade will support and guide you toward choices that will allow you to manage your out-of-pocket costs today and mitigate future premium increases by reducing the cost of our healthcare claims.   

As with any network/carrier transition, there will be some provider disruption. Provider disruption has been increasing, with or without a network change, as medical providers change the networks that they participate in. The addition of Accolade will provide employees with the high level of support to navigate disruption that had been missing. If you need to find a new provider, Accolade will provide on demand support to help you. In addition, they will help you schedule an appointment and steer you to existing resources you may not have been aware of. For example, they may remind you of our Free Employee Health Clinic and the Free Virtual Primary care available through Accolade.

Blue Shield’s Tandem network is an Accountable Care Organization (ACO) network and currently includes 504 physicians in San Luis Obispo County and 953 physicians in the County of Santa Barbara. ACO networks are narrower and strategically designed to provide value-based care that delivers better outcomes while keeping claims costs low. For employees, this means help mitigating future premium increases. By offering a plan with a narrow network, it provides an option for employees who are willing to navigate within the existing network for lower premiums. The County will continue to offer four other medical plans with a full network to ensure employees have choices that meet their needs or preferences. Employees will have the choice to migrate to another medical plan during Open Enrollment. This includes the lower premium High Deductible High Plan (HDHP) which utilizes the Blue Shield of California PPO full network of providers.

Employees will also have access to new digital solutions with the intent to expand access to care, including:

• Free Virtual Primary Care (applies to all plans except HDHP)
• Free Mental Health Care (applies to all plans except HDHP)
• Free Digestive Healthcare including access to Dieticians
• Free Physical Therapy Healthcare
• Free Expert Second Medical Opinion
• Free Surgery for Qualified Surgeries

Most doctors utilized by County employees will still be in-network with the transition to Blue Shield, but there will be some provider disruption to both provider networks. The best way to see if your current doctors will still be in-network is to do a provider search by visiting Blue Shield’s website.

Follow the steps below to conduct a provider search:

1. Go to the Blue Shield provider search tool: www.blueshieldca.com/prism
2. Choose your search criteria:
   • Enter your location
   • Enter your doctor's name, specialty, or medical group
   • Choose a Plan:
     • For those currently on Anthem Choice, Care, EPO, and HDHP, select the Blue Shield of California PPO Network
     • For those currently on Anthem Select, select the Tandem PPO
3. After entering your search criteria, choose "Search"
4. A results list will be populated based on your given criteria

No. Over the past few years we have seen provider disruption increase under our current plans due to a variety of factors including provider retirements or relocation. The County is not alone with this experience. In the next three years, the nation is projected to face a shortage of 200,000+ registered nurses and 50,000 physicians. These shortages are also contributing to rising healthcare costs as providers request increased wages and benefits.

By expanding access to digital technology solutions, the County is able to help maintain and increase access to healthcare. Furthermore, those solutions are specifically designed to treat chronic conditions that increase medical insurance premiums. Provider disruption is very impactful and difficult to navigate. Accolade will now be available to help connect individuals with existing solutions based on their individual healthcare needs as well as help find and book appointments with doctors.  

A cafeteria contribution is the fixed dollar amount the County contributes towards employees’ healthcare premiums when enrolled in County medical insurance. The monthly cafeteria amount is determined by your Bargaining Unit (BU), and contribution tiers are based on the number of medically-enrolled dependents you have on your plan.

In 2018, the County prioritized increasing cafeteria contributions and creating dependent cafeteria tiers to address healthcare affordability. The County continued that commitment in subsequent negotiations with represented employee associations including the negotiations for the current contracts. Over the life of the current mutually agreed upon MOUs for represented staff and Board of Supervisors’ resolution for unrepresented staff, the County will contribute $95 million towards employee healthcare costs which includes $2.6 million of new spending.

Cafeteria contributions are mutually agreed to by both the County and employee associations during contract negotiations for a successor MOU, or are set by Board of Supervisors’ resolution for unrepresented employees. For example, the County and SLOCEA agreed to the terms of the current contract and the cafeteria rates for 2023, 2024, and 2025 in August of 2022.  At that time, neither party knew that we would face such a dramatic increase to health premiums in 2024. The negotiated and agreed upon increases to the cafeteria were forecasted to be in line with the market and expected to remain competitive through the life of the contract. After the actual rates for 2024 were announced this year, the County shared the increase amounts with the employee associations on July 13, 2023 at the annual Health Care Committee meeting.

Medical insurance premiums are primarily driven by claims (costs) billed to insurance when someone utilizes their medical care. Premiums are determined based on the prior year’s claims and expenses. For the County, 98% of employees and retirees utilized their medical care to some extent in 2022. Unfortunately, in 2022 there was a dramatic and unforeseen increase to medical premiums driven by several factors, including:

• Increased medical costs and fees paid to providers stemming from higher labor costs, clinical staffing shortages, and inflation within other supply chains
• Increased treatment costs caused by increased late-stage diagnoses due to deferred preventive care during the Pandemic
• Dramatic rising costs of prescription drugs and specialty medications
• Approval and expanded use of new medical technology and procedures
• Medical provider group consolidation leading to higher provider reimbursement rates
• 18.4% increase in County claims over $50,000

While the County cannot control these factors currently impacting medical cost trends across the state, the County continues to evaluate and implement innovative solutions to contain costs for future increases and help employees and retirees maximize the benefits available to them. The County remains committed to offering a robust healthcare package as part of its competitive compensation package.

The County purchases medical insurance through Public Risk Innovation, Solutions, and Management (PRISM). PRISM determines the annual premium increase based on our medical claims experience (the number and size of the medical bills of our employees). The annual medical premium increase is not determined by the County.

No, the County’s transition to Blue Shield is not causing the premium increases. The 15.5% medical renewal the County received applies for 2024 regardless of the medical insurance carrier. If the County kept Anthem Blue Cross medical plans for 2024, the premium increase would have been 15.5%.

No. The 15.5% increase is on the medical insurance premiums only.

No, the County’s contribution for medical insurance is not changing and would be the same if the County continued with Anthem as a medical insurance carrier. The County’s contribution to medical insurance is collectively bargained and mutually agreed upon with all employee associations through cafeteria contributions.

No. Medical plan designs are not changing. Copays, coinsurance, deductibles, and key plan elements will remain the same. Out of network providers and services are reimbursed based on allowable rates, which may vary. Please review Blue Shield Summary of Benefits for your medical plan, located on our Blue Shield plans page. 

No, medical plan designs are not changing. Copays, coinsurance, deductibles and key plan elements will remain the same. Out of network providers and services are reimbursed based on allowable rates, which may vary. Please review summary of benefits for your medical plan, located

The benefit plan comparisons are a part of the Benefits Brochure. The new 2024 Employee Benefits Brochure will be released a few weeks prior to Open Enrollment. The brochure will be posted on this webpage (see above) and it will also be announced via an email. 

As a note, the plan designs are not changing. All the copays, coinsurances, etc. will be remaining the same. You can review the 2023 Employee Benefits Brochure to view the plan designs and compare until the new brochure is released.

Yes. You will continue to have out-of-state coverage with Blue Shield’s narrow network (Tandem) and the Blue Card PPO network associated with the other plan options such as Care or Choice.

Yes, you may continue to see you doctor if they are not in-network with Blue Shield; however, you will be subject to the out-of-network costs. If you do not wish to pay higher costs for an out-of-network provider, Accolade can help you find a new provider, schedule an appointment, and guide you to existing resources.

Employees will continue to have access to Rx 'n Go and Express Scripts. Rx 'n Go is a standalone program that does not go through the County medical carrier. Express Scripts is through PRISM, the County's insurance pool. Neither are impacted by the transition to Blue Shield. 

No. County insurance plans do not require a referral from a primary care provider to see a specialist.

However, sometimes for certain services providers or doctors may decide to require a referral before they will see you.  If this occurs, you have a few options. You can get a referral from your primary care doctor. You can also utilize the Employee Health Clinic, Accolade Virtual Primary Care and telemedicine for referrals.