Blue Shield Access Plus and Trio renewals win board approval after Aon cites large‑claim spike

Aon actuary Mike Clark recommended renewal increases for Blue Shield of California’s two flex‑funded plans: a 3.6% increase for Access Plus and a 6.3% increase for the Trio plan after applying a rate‑stabilization buy‑down; the weighted increase across Blue Shield plans is approximately 4.4%.

Clark explained Trio’s higher increase related to substantially higher large‑claim experience in 2019: Blue Shield reimbursed about $9.3 million in claims that exceeded the $1,000,000 large‑claim threshold for separate individuals in 2019 compared with $3.7 million in 2018, which raised large‑claim pooling fees. He said the administrative fee rose modestly while the large‑claim pooling fee increased by ~18% due to that experience.

Blue Shield area vice president Paul Brown emphasized the plan’s provider partnerships and efforts to control specialty drug and other rising costs, and he cited innovations the carrier has launched to manage care. Commissioners asked whether network changes (for example, Sutter joining Trio) materially affected rates; Blue Shield said the recent Sutter inclusion was negotiated to be effectively cost‑neutral for Trio and that the 2019 large claims were concentrated at UCSF rather than Sutter or other new entrants.

Public callers urged rejection of premium and copay increases, citing pandemic economic hardship. Following deliberations, the board voted unanimously to adopt the Blue Shield rate recommendations and associated rate cards. Staff noted large‑claim audits are underway and will be reported to the board as they conclude.