Product cycle updates and benefit changes

2027 Plan and Portfolio Updates

You can expect minimal changes to our plan portfolios. The changes introduced include expanded pharmacy savings, enhanced telehealth access for high-deductible health plans, improved behavioral health benefits, and plan design updates to maintain compliance with federal and state requirements.

Expanded Pharmacy Savings Through Rx Spectrum

Beginning January 1, 2027, the Rx Spectrum tiered pharmacy network will be available across HMO and PPO offerings for Off-exchange and Mirror plans.

Members can maximize savings by using preferred Level A pharmacies, including:

• CVS Pharmacy
• CVS at Target
• Costco Pharmacy
• Safeway and Vons Pharmacy locations

Members currently filling maintenance medications at non-preferred pharmacies will receive advance communications about available savings opportunities, including transferring prescriptions to a preferred pharmacy or using convenient home delivery services.

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.

Virtual First and Telehealth Enhancements

Blue Shield continues to expand convenient, affordable care options through its Virtual First approach. Beginning in 2027, deductibles for telehealth services will be waived on HDHP plans, helping members access timely virtual care at a lower cost. These enhancements can improve employee access to care, support a better member experience, and encourage the use of cost-effective care options.Learn how our VirtualBlue^SM integrated program is a convenient option for employer groups.

Updates to Medical Plans

For 2027, Blue Shield continues to focus on helping employer groups access high-quality, cost-effective care while maintaining a broad range of plan options for employer groups.

Additional benefit changes include:

• Enhanced behavioral health coverage, with Mental Health and Substance Use (MHSU) outpatient services moving to no-cost-share in applicable plans.
• Updated annual out-of-pocket maximums to align with regulatory requirements.
• Updated deductible and out-of-pocket maximum limits for HDHP/HSA-qualified plans to reflect annual IRS guidelines.
• Benefit refinements to imaging, outpatient surgery, and emergency room services on select off-exchange plans.

For exact terms and conditions of coverage for all 2027 plan offerings, refer to the Evidence of Coverage for the plan, or contact your Blue Shield sales representative.

See below list for impacted PPO plans with cost share and name changes. You can view the full list of 2027 plan names and benefit changes on Broker Connection.

Plan name changes for 2027

To help employers better identify plan features, several HMO, PPO, and PPO Savings plans will feature updated plan names for 2027.

Off-exchange PPO and Mirror PPO Plans

HMO Mirror plans (no name changes for Off-exchange HMO plans)

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 2027.
• Use the network comparison tool to see current and future providers in our network.
  
  

Select Medical Plans no longer available for 2027

Because Virtual Blue benefits are now included in our PPO plans, the following Virtual Blue plans will no longer be available in 2027. Groups enrolled in these plans will be automatically mapped to an equivalent PPO plan with Virtual Blue program enhancements.

Employer groups currently offering any of the following withdrawn medical plans will:

1.        Receive a 90-day notification before 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.

Use the plan comparison tool to compare benefits year over year, including a withdrawn plan against its recommended replacement or any other available plan.

Medicare Creditable Coverage Changes

Due to changes in the CMS standard for Medicare creditable coverage, the following plans will no longer be Medicare creditable upon renewal in 2027. This means that the plan’s expected value falls below that of standard Medicare Part D coverage. This change may affect Medicare-eligible employees, dependents, and retirees, especially regarding potential Medicare Part D late enrollment penalties. 

Employer groups offering any of these plans have two options: 

1. They may keep their plan and notify their employees that their prescription coverage is not Medicare creditable using CMS Model Notice language. 

1. Select an alternative plan that is Medicare creditable. Visit the Medicare Creditable page for a listing of all creditable and non-creditable plans.

You can visit the Small Business Medical page for a full list of Non-creditable plans for both HMO and PPO plans. 

Specialty Plans (Dental, Vision, Life)* update

While there are no specialty product or benefit changes at this time, we’re continuing to offer a strong, valuable portfolio of services, including:

• Bundled Savings – Add vision or dental to a medical plan and receive a 10% discount.

• Two-year initial rate guarantee for new and existing medical groups that add dental, vision, or life coverage.

• Streamlined administration with one bill, one renewal, and one point of administration through Employer Connection.

Vision discounts available through EyeMed2

Offering your group more choices with access to a vast network of independent eye doctors and popular retailers, it’s easy to book an exam and access discounts through Insight Discount. You can visit the https://www.blueshieldca.com/en/broker/small-business/vision

Sell more, earn more with our various rewards programs

Earn a new broker bonus while helping your clients transition from Health Net. The program applies to coverage effective dates from October 1, 2026, through March 1, 2027. Learn more about the Health Net transition rewards program.

Sign in to Broker Connection and visit the Broker Rewards page to explore all available rewards programs.

Resources for a trusted advisor

• Q1 2027 Small Business Roadshow
• Q1 2027 Small Business Roadshow Slides
• 2027 Broker Roadshow FAQs
• 2027 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.