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Board approves Blue Shield Access Plus and TRIO renewals after review of large claims and enrollment shifts
Summary
Aon and Blue Shield presented recommended renewals for Access Plus and TRIO; the board approved the proposed rate cards (aggregate 8.8% increase across both plans) after discussion of large claims, ACO partnerships and network capitation fees.
Aon recommended that the board approve Blue Shield of California rate renewals for Access Plus and TRIO for the 2019 plan year; the board voted unanimously to accept the renewals and the rate cards presented.
Aon actuary Mike Clark said the aggregate 8.8% increase across both plans reflected a 10.5% increase for Access Plus and a 5.6% increase for TRIO, driven in part by unexpectedly large claims in 2017 and higher dependent content in Access Plus than originally estimated. Clark summarized the large‑claim experience: "in calendar year 2017, there was approximately $6,000,000 of claim amount pooled out representing 8 individuals," and noted the pooling rules where amounts above $1,000,000 become the insurer’s responsibility.
Blue Shield’s representative explained that TRIO includes accountable‑care partners that actively manage pharmacy and other costs, and that TRIO’s capped premium increases and provider arrangements deliver additional risk protection to SFHSS.
Board members asked for clarification on capitation (provider) fees, pharmacy drivers and differences between the two plans' provider networks. After discussion the board approved the Blue Shield renewals and 2019 rate cards.
