Sales Collateral

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The following materials provide information that will help you market Blue Cross plans to your small and large group clients.

Small Group Market

VantageBlue Select Materials

Employer

Plan Pairing Grid
Select Network Options Brochure
Provider Listing
Premailer

Member

Member Brochure
Small Group Application
Gold Plan Benefit Summary w/Pediatric Dental
Gold Plan Benefit Summary w/o Pediatric Dental
Silver Plan Benefit Summary w/Pediatric Dental
Silver Plan Benefit Summary w/o Pediatric Dental

Renewal Kit Materials

Renewal Notice
SelectRI Overview

Health Plans That Work for You
Top 5 Dental Plans
2015 Summary of Available Plan Types
Employer Support Team Flyer
Member Handbook Flyer
Request for Amendment to Sales Agreement
Group Activity Report Instructions
Group Activity Report Form
Legal Requirements and Disclosure
Group Electronic Payment Form
BlueSolutions for HSA Brochure
HRA Brochure
FSA Flyer
CDHP Ancillary Service Contract Flyer
CDHP Ancillary Service Contract

Additional Materials

Small Group Member Application
Addendum to the Small Group Application
Small Group Waiver Form (New Business)
New Business Submission Checklist
Electronic Enrollment Agency/Broker Authorization Form
Electronic Enrollment Agency/Broker Change Form
SmartChoice Program Flyer
Class Verification Form
Class Verification Form Stuffer
Renewal Certification Form
Small Employer Waiver Form

Monthly Rate Tables

February 2015

BlueSolutions for HSA 85/60 2000 February 2015
BlueSolutions for HSA 100/60 1500 February 2015
BlueSolutions for HSA 100/60 2000 February 2015
BlueSolutions for HSA 100/60 3000 February 2015
BlueSolutions for HSA 100/60 5000 February 2015
HealthMate 100/80 2000 February 2015
VantageBlue 70/50 2000 February 2015
VantageBlue 80/60 1000 February 2015
VantageBlue 80/60 2000 February 2015
VantageBlue 80/60 3000 February 2015
VantageBlue 100/60 1500 February 2015
VantageBlue 100/80 250 February 2015
VantageBlue 100/80 500 February 2015
VantageBlue 100/80 750 February 2015
VantageBlue 100/80 2000 February 2015
VantageBlue SelectRI 100/80 1000 February 2015
VantageBlue SelectRI 100/80 2000 February 2015
VantageBlue Select Gold February 2015
VantageBlue Select Silver February 2015

January 2015

BlueSolutions for HSA 85/60 2000 January 2015
BlueSolutions for HSA 100/60 1500 January 2015
BlueSolutions for HSA 100/60 2000 January 2015
BlueSolutions for HSA 100/60 3000 January 2015
BlueSolutions for HSA 100/60 5000 January 2015
HealthMate 100/80 2000 January 2015
VantageBlue 70/50 2000 January 2015
VantageBlue 80/60 1000 January 2015
VantageBlue 80/60 2000 January 2015
VantageBlue 80/60 3000 January 2015
VantageBlue 100/60 1500 January 2015
VantageBlue 100/80 250 January 2015
VantageBlue 100/80 500 January 2015
VantageBlue 100/80 750 January 2015
VantageBlue 100/80 2000 January 2015
VantageBlue SelectRI 100/80 1000 January 2015
VantageBlue SelectRI 100/80 2000 January 2015
VantageBlue Select Gold January 2015
VantageBlue Select Silver January 2015

December 2014

BlueSolutions for HSA 85/60 2000 December 2014
BlueSolutions for HSA 100/60 1500 December 2014
BlueSolutions for HSA 100/60 2000 December 2014
BlueSolutions for HSA 100/60 5000 December 2014
HealthMate 100/80 2000 December 2014
LifeStyleBlue 1 December 2014
LifeStyleBlue 2 December 2014
VantageBlue 70/50 2000 December 2014
VantageBlue 80/60 1000 December 2014
VantageBlue 80/60 2000 December 2014
VantageBlue 100/60 1500 December 2014
VantageBlue 100/80 250 December 2014
VantageBlue 100/80 500 December 2014
VantageBlue 100/80 2000 December 2014
VantageBlue SelectRI 100/80 1000 December 2014
VantageBlue SelectRI 100/80 2000 December 2014
VantageBlue Select Gold December 2014
VantageBlue Select Silver December 2014

November 2014

BlueSolutions for HSA 85/60 2000 November 2014
BlueSolutions for HSA 100/60 1500 November 2014
BlueSolutions for HSA 100/60 2000 November 2014
BlueSolutions for HSA 100/60 5000 November 2014
HealthMate 100/80 2000 November 2014
LifeStyleBlue 1 November 2014
LifeStyleBlue 2 November 2014
VantageBlue 70/50 2000 November 2014
VantageBlue 80/60 1000 November 2014
VantageBlue 80/60 2000 November 2014
VantageBlue 100/60 1500 November 2014
VantageBlue 100/80 250 November 2014
VantageBlue 100/80 500 November 2014
VantageBlue 100/80 2000 November 2014
VantageBlue SelectRI 100/80 1000 November 2014
VantageBlue SelectRI 100/80 2000 November 2014
VantageBlue Select Gold November 2014
VantageBlue Select Silver November 2014

October 2014

BlueSolutions for HSA 85/60 2000 October 2014
BlueSolutions for HSA 100/60 1500 October 2014
BlueSolutions for HSA 100/60 2000 October 2014
BlueSolutions for HSA 100/60 5000 October 2014
HealthMate 100/80 2000 October 2014
LifeStyleBlue 1 October 2014
LifeStyleBlue 2 October 2014
VantageBlue 70/50 2000 October 2014
VantageBlue 80/60 1000 October 2014
VantageBlue 80/60 2000 October 2014
VantageBlue 100/60 1500 October 2014
VantageBlue 100/80 250 October 2014
VantageBlue 100/80 500 October 2014
VantageBlue 100/80 2000 October 2014
VantageBlue SelectRI 100/80 1000 October 2014
VantageBlue SelectRI 100/80 2000 October 2014
VantageBlue Select Gold October 2014
VantageBlue Select Silver October 2014

September 2014

BlueSolutions for HSA 85/60 2000 September 2014
BlueSolutions for HSA 100/60 1500 September 2014
BlueSolutions for HSA 100/60 2000 September 2014
BlueSolutions for HSA 100/60 5000 September 2014
HealthMate 100/80 2000 September 2014
LifeStyleBlue 1 September 2014
LifeStyleBlue 2 September 2014
VantageBlue 70/50 2000 September 2014
VantageBlue 80/60 1000 September 2014
VantageBlue 80/60 2000 September 2014
VantageBlue 100/60 1500 September 2014
VantageBlue 100/80 250 September 2014
VantageBlue 100/80 500 September 2014
VantageBlue 100/80 2000 September 2014
VantageBlue SelectRI 100/80 1000 September 2014
VantageBlue SelectRI 100/80 2000 September 2014

August 2014

BlueSolutions for HSA 85/60 2000 August 2014
BlueSolutions for HSA 100/60 1500 August 2014
BlueSolutions for HSA 100/60 2000 August 2014
BlueSolutions for HSA 100/60 5000 August 2014
HealthMate 100/80 2000 August 2014
LifeStyleBlue 1 August 2014
LifeStyleBlue 2 August 2014
VantageBlue 70/50 2000 August 2014
VantageBlue 80/60 1000 August 2014
VantageBlue 80/60 2000 August 2014
VantageBlue 100/60 1500 August 2014
VantageBlue 100/80 250 August 2014
VantageBlue 100/80 500 August 2014
VantageBlue 100/80 2000 August 2014
VantageBlue SelectRI 100/80 100August 2014
VantageBlue SelectRI 100/80 2000 August 2014

July 2014

BlueSolutions for HSA 85/60 2000 July 2014
BlueSolutions for HSA 100/60 1500 July 2014
BlueSolutions for HSA 100/60 2000 July 2014
BlueSolutions for HSA 100/60 5000 July 2014
HealthMate 100/80 2000 July 2014
LifeStyleBlue 1 July 2014
LifeStyleBlue 2 July 2014
VantageBlue 70/50 2000 July 2014
VantageBlue 80/60 1000 July 2014
VantageBlue 80/60 2000 July 2014
VantageBlue 100/60 1500 July 2014
VantageBlue 100/80 250 July 2014
VantageBlue 100/80 500 July 2014
VantageBlue 100/80 2000 July 2014
VantageBlue SelectRI 100/80 1000 July 2014
VantageBlue SelectRI 100/80 2000 July 2014

Large Group Market

Large Employer Healthcare Reform Overview
SelectRI Overview
Dental Only Employer Flyer
Medical/Dental Employer Flyer
Prescription Drugs: Balancing Coverage and Cost
SmartChoice Program Flyer

Medicare Market

2014 Plan Highlights
2014 Individual Enrollment Form
Living Fit Flyer
2014 Plan65 Rate Sheet
2014 Plan65 Application
2014 Blue MedicareRx Plan Brochure
2014 Blue MedicareRx Enrollment Form Instructions
2014 Blue MedicareRx Premier Formulary
2014 Blue MedicareRx Value Plus Formulary
2014 Comprehensive Formulary
2014 Retiree Group Plan Highlights
2014 Employer Group Enrollment Form
2014 Group Formulary
Group Medicare Options
Creditable Coverage Flyer

2015

2015 Individual Formulary
2015 Group Formulary
2015 Pharmacy Directory
2015 Group Pharmacy Directory
2015 Provider Directory
2015 Group Provider Directory
2015 Select Provider Directory
BlueCHiP for Medicare Select FAQs
2015 PCMH Directory
2015 $0 Premium Benefit Summaries
2015 Premium Benefit Summaries
2015 Group Plus Summary of Benefits
2015 Group Preferred Summary of Benefits
2015 Group Preferred Unlimited Summary of Benefits
2015 Group Preferred Unlimited 2 Smmary of Benefits
Scope of Appointment Form
2015 Individual Enrollment Application
2015 Plan Selection Form
Dental Rider Info Sheet
Living Fit Flyer
2015 Blue MedicareRx Plan Brochure
2015 Blue MedicareRx Enrollment Form Instructions
2015 Plan 65 Brochure
2015 Plan 65 Rate Sheet
2015 Plan 65 Application