What's new for small businesses – Q1 2026

1-100 employees – Effective January 1, 2026

Expanding Access and Enhancing Care: Pharmacy, Virtual, Provider, and Behavior Health Management

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 your employees 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.

We encourage your employees to: 

• 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

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.

Your employees will receive additional virtual care features that include:

• Preventive care: Connect to primary care healthcare professionals (MDs/DOs) ften with a same-day appointment.  
• Specialist Care: Specialists available in 20 specialties, appointments confirmed within three days.
• Behavioral Health Care: Behavioral Health appointments with licensed clinical social workers and family therapists.  
• 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 pathwaysReduced 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 provide
  
• 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

Medical and Specialty updates – offering competitive healthcare with minimal plan adjustments

Updates to Medical Plans

Plan name changes for 2026

Compare benefits by using our plan comparison tool where you can:

• Compare multiple plans across multiple years to see changes and updates to our plans.
• Compare cost shares across all of our available plans for 2026.
• Use the network comparison tool to see current and future providers in our network.

For exact terms and conditions of coverage for all 2026 plan offerings, refer to the Evidence of Coverage for the plan, or contact your Blue Shield sales representative.

Updates to your dental coverage

Select dental plans no longer available for 2026

For employer groups who are currently offering any of the following withdrawing dental plans, you will:

1. Receive a 90-day notification prior to your renewal date informing you of your plan withdrawal
2. Be mapped to a recommended available plan upon renewal
3. Have the option to opt out of the recommended plan and choose any available marketed plan

You can refer to this plan mapping grid or visit the plan comparison tool to compare withdrawing plans with available plans to help make the best choice by using the compare year over year feature. 

For more information, please reach out to your designated Blue Shield representative.

Updates to Vision Plans

Insight discount with EyeMed¹ Doctors for 2026

Use your discount with these three easy steps:

1. Locate an eye doctor – Select from a broad network of independent eye doctors. Visit Blueshieldca.com to find a provider near you. 
2. Schedule an appointment – Call ahead or stop by one of the many eye doctors that offer walk-in appointments.
3. Use your discount – When you arrive, let the eye doctor know you have a discount plan through Blue Shield of California. 

Please note your discount cannot be combined with any other discounts, coupons or promotional offers. Learn more about our vision discount. 

Life Plans² reminders

Get more out of your Blue Shield life insurance with these services:

• Beneficiary assistance services offers your employees care and support for family members who have suffered a recent loss of a loved one. 
• Travel assistance services offers your employees and their families a broad range of worldwide travel and medical assistance services.

For exact terms and conditions of coverage refer to the Evidence of Coverage and the Plan Contract and to the Summary of Benefits for a comprehensive summary of plan benefits. You can access these plan documents here.