Product cycle updates and benefit changes

Small Business (1-100)

2026 Medical Updates

Enhanced PPO plans with Virtual Blue^SM

Starting January 2026 all Small Group Off-Exchange PPO plans will now have virtual health care through the Virtual Blue program benefits, replacing Teladoc and Nurse Help upon renewal. A notice of this change will be communicated to members who have utilized Teladoc and/or NurseHelp the past 12 months.

Additional virtual care features include:

• Preventive care: Connect to primary care healthcare professionals (MDs/DOs) often with a same-day appointment.  
• Specialist Care: Specialists available in 20 specialties, appointments confirmed with three days.  
• Dedicated 24/7 Care Team: Doctors, behavioral health providers, nurses, and health coaches available to connect around the clock.  

Visit the Virtual Blue page for more information. 

Blue Shield’s Oncology Utilization Management Program

Available to all Small Group Off-Exchange PPO plans upon renewal. The new program includes an innovative provider engagement model supporting the most efficacious treatments with the lowest clinical toxicity and cost containment will be available to help improve provider experience through:

• Focused oncology expertise
• Collaboration
• Clinical pathways
• Reduced admin burden

Behavioral Health update

Beginning January 1, 2026, Blue Shield will directly manage the behavioral health benefit for all of our members including those receiving ABA services. This transition enhances overall member and provider experience, ensures high-quality care and builds a whole-person approach by connecting physical and behavioral health. Blue Shield members will experience:

• An expanded quality network of behavioral health providers
• A dedicated behavioral health customer support team 
• A connected support system across customer care, claims and care management
• Easier provider search through the Blue Shield portal

Plan Name and Cost share updates

See below list for impacted PPO plans with cost share and name changes. You can view the full list of 2026 plan name changes here.

PPO and PPO savings plan (no plan name changes for PPO Mirror plans)

HMO and HMO Mirror plans

For a full list of 2026 plan changes and updates you can visit the ‘Changes To’ page on broker connection. To view exact terms and conditions of coverage for all 2025 plan offerings, refer to the Evidence of Coverage for the plan, or contact your Blue Shield account manager. You can also use the Plan comparison tool to see plan updates across multiple years and compare plan benefits within the same plan family.

Pharmacy Updates

RX Spectrum tiered pharmacy network expansion

Upon group renewal, Small Business Access+ HMO, Local Access+ HMO, and Full PPO Off-Exchange plans will have the Rx Spectrum tiered pharmacy network.

Rx Spectrum allows members to receive preferred member cost-share for prescriptions at Level A retail pharmacies, reducing out-of-pocket costs.

Level A, or preferred, network pharmacies offer preferred cost-sharing at CVS, Costco, Safeway, and Vons pharmacies nationwide.

Level B, or non-preferred, network pharmacies include all other pharmacies within Blue Shield’s pharmacy network. A higher cost-share applies for prescriptions filled at a Level B pharmacy.

Additional helpful resources

• Compare prescription drug prices using our Price Check My Rx tool
•  Consider home delivery options through Amazon Pharmacy or PillPack
• Use our online pharmacy locator tool to find a nearby Level A in-network pharmacy

Specialty Plans (Dental, Vision, Life)* update

Select dental plans no longer available for 2026 renewals

As part of our product transformation and portfolio simplification efforts DPPO and DINO plans will be withdrawn from our Specialty portfolio beginning January 1, 2026.

See mapping grid for list of withdrawn plans and corresponding recommended available plans. You can also use the Plan Comparison Tool to compare benefits between a withdrawn plan and new available plan by using the compare year over year function. Plans being withdrawn:

We will be providing written communication to your employer groups enrolled in any of these withdrawing plans 60 days prior to their anniversary. Please contact your blue shield account manager for more information.

Easily offer added specialty products with these enhanced programs

Bundled Savings discount program where groups will now receive a 10% discount on their dental or vision premium when added to their medical plan.

Quick Match Program^SM Matching for small business life insurance plans has been enhanced. We can now match a current group's combined Basic Life/AD&D renewal rates at $0.08 per $1,000, for amounts between $15,000 and $200,000. 

Sell more, earn more with our various rewards programs

The small business incentive program will reward you for newly enrolled members and offer added bonuses when enrolling a new member in all three specialty products: dental, vision, and life. We are continuing to reward direct-selling brokers with our Direct Elite Rewards program. Each point you earn is equal to $1 available to both independent and individual brokers within an agency that has opted into a program. Learn more about enrolling in Producer Rewards here (authentication required).

Resources for a trusted advisor

• 2026 Broker Roadshow recording 
• 2026 Broker Roadshow Presentation
• 2026 Broker Roadshow FAQs
• 2026 Medical Plan cheat sheet
• Plan comparison tool
• Q1 Medical Sales Guide
• Q1 Specialty Sales Guide

For additional support and information your Blue Shield support team is available to you throughout the year. Contact Broker Services: (800) 599-5905 or email at producer.services@blueshieldca.com.

* Underwritten by Blue Shield of California Life & Health Insurance Company.