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Health Net Is Exiting the California Group Market
Health Net will no longer offer small or large group coverage in CA. In-force groups terminate February 28, 2027. Your Claremont team is ready to help find alternatives. Call 800.696.4543 or email quotes@claremontcompanies.com.
On April 2, 2026, the Centers for Medicare and Medicaid Services (CMS) finalized new rules affecting how employer group health plans determine Medicare Part D “creditable coverage” status, effective for plan years beginning on or after January 1, 2027.
The change
Starting in 2027, the Simplified Determination Method is retired. Group health plans that do not participate in the Retiree Drug Subsidy (RDS) program may only use the Revised Simplified Determination Method or a full Actuarial Equivalence determination.
Under the Revised Simplified Determination Method, a plan is creditable if it:
That threshold rose from 72% in 2026 and 60% in prior years.
What’s different from 2026
2026 was a transition year — plan sponsors could choose between the Simplified Determination Method and the Revised Simplified Determination Method. That choice ends in 2027: only the Revised Simplified Determination Method (at the higher 73% threshold) or an actuarial certification will be accepted.
Separately, the final rule also exempts account-based plans (HRAs, ICHRAs, and health FSAs) from the creditable coverage disclosure requirement altogether.
Why it matters
Plans that comfortably met the 60% or 72% thresholds under the Simplified Determination Method may not automatically meet the 73% threshold under the Revised Simplified Determination Method. Groups with leaner prescription drug benefits should have their plan design reviewed before their 2027 renewal to confirm creditable coverage status — losing that status can expose Medicare-eligible plan members to late-enrollment penalties. We will monitor the carriers and provide updates when creditable plans for 2027 are announced.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
With Health Net’s exit from the California group market, Blue Shield is positioning itself as a stable, long-term option for affected groups — and backing that up with new transitional support announced at a broker roadshow this week.
What’s new for Health Net groups applying to Blue Shield (10/1/26–3/31/27 effective dates):
A stronger, tiered broker bonus
The bonus is cumulative across all Health Net members a broker places with Blue Shield — not calculated per group — and it has no cap:
For example, a broker placing five groups of 20 members each (100 members total) would earn $100 x 50 + $150 x 50. Paid alongside standard commission and stacking with other bonus programs. Note “Health Net” as the prior carrier on all submissions to ensure eligibility. Download the flyer.
What’s next
Q1 2027 rates go live via e-vendors in early October, alongside new market materials. If you have a Health Net group that fits this window, now’s the time to run the numbers on Blue Shield. We can help, reach out to your Claremont team, or request a quote below.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Covered California for Small Business (CCSB) has rolled out new flexibility for brokers navigating the Health Net exit, plus a deadline extension that applies to every new small group.
Simplified Documentation
CCSB now accepts a prior Health Net bill (showing at least one enrolling subscriber) in place of a DE-9 or payroll report. Employees not listed on that bill can be verified with a paystub or offer letter. Owner-only and husband-and-wife groups remain ineligible.
Extended Deadlines — All Groups
Submission deadlines are extended to the 15th of the month for effective dates October 2026–March 2027, regardless of current carrier. CCSB expects high application volume through March, so early submission each month helps avoid delays.
CCSB Fundamentals
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
In addition to California’s most comprehensive access to doctors and hospitals, CCSB health plans offer choice and control, with:
As a trusted CCSB partner since its 2014 launch, we are a top-producing general agency in our sales territory. From agent certification and quoting to assessing new group eligibility and resolving post-enrollment issues, our CCSB experts will provide guidance and support every step of the way.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Health Net’s exit from the California group commercial insurance market has put thousands of small businesses on the clock to find a new carrier. For brokers, that’s a lot of urgent client calls at an already busy time of year. CaliforniaChoice is stepping up to make the transition easier for your groups and offering you a new Health Net Transition Bonus.
For every Health Net member who transitions into the CaliforniaChoice program, you earn $100 per enrolled member. There are no maximum bonus and no minimum group size to qualify
This bonus applies to Health Net direct groups moving to CaliforniaChoice, written directly with CaliforniaChoice or through Claremont Insurance Services.
CaliforniaChoice has also built a special underwriting path to make moving Health Net groups faster and simpler. Groups are eligible when:
Note: Owner-only groups are not eligible, and all standard CaliforniaChoice eligibility criteria still apply.
Moving displaced groups under a deadline is stressful — let us do the heavy lifting for you. Our Claremont team is standing by to help you map out timing, compare quotes, evaluate eligibilty, and enroll your Health Net groups through CaliforniaChoice quickly, so your clients keep uninterrupted access to care. Contact your Regional Sales Manager or the Claremont Answer Team at 800.696.4543 or info@claremontcompanies.com for assistance.
CaliforniaChoice is the only small group (1-100 employees) private exchange for employee benefits in California. Partnering with seven top health plans and 18 provider networks, CaliforniaChoice offers a variety of full and limited network HMOs, PPOs, and other benefit options to choose from – all at different price points so you can help your clients control costs and offer their employees choices. Learn more.
With CaliforniaChoice, you can offer multiple health plans side-by-side in a single employee benefits package. That means you only have to learn one product and run one quote, while still giving your clients the value of choice.
Health Net announced today that it will exit the commercial group health market in California to focus on Medi-Cal, Medicare, and IFP/Covered California. This affects all small group and large group medical plans. Dental, vision, and EGWP plans are also included, and Health Net will send separate communications on those.
Below are examples of the notices and FAQs being sent by Health Net:
We are standing by to help you move every affected group to a new carrier with as little disruption to networks and benefits as possible. We can identify replacement plans that best match your client’s current network and benefit design, quote across our carrier portfolio for 10/1 and later effective dates, and pull census and invoice information for any group where Claremont is the GA of record.
Contact your Regional Sales Manager or reach us at 800.696.4543 or info@claremontcompanies.com to get started. We will share more from Health Net as we receive it.
The Census Enrollment spreadsheet is now available for in force group to request member-level changes. This may be especially helpful during open enrollment or for larger groups with many changes. Here are the forms needed for Census Enrollent for new and in-force groups:
Employer-level changes cannot be made using the census enrollment spreadsheet, as those will continue to be made by using the Employer Change Request Form.
Contact your Claremont Answer Team at 800.696.4543 or info@claremontcompanies.com for assistance.
CaliforniaChoice is the only small group (1-100 employees) private exchange for employee benefits in California. Partnering with seven top health plans and 18 provider networks, CaliforniaChoice offers a variety of full and limited network HMOs, PPOs, and other benefit options to choose from – all at different price points so you can help your clients control costs and offer their employees choices. Learn more.
With CaliforniaChoice, you can offer multiple health plans side-by-side in a single employee benefits package. That means you only have to learn one product and run one quote, while still giving your clients the value of choice.
Humana has launched a new online Dental Wellness Center where members can access dental benefit and network information, educational resources, claims support, oral-health assessments, an Ask-a-Dentist feature, and a Dental Cost Estimator.
Humana will host The Importance of Dental and Vision Benefits for Children’s Well-Being on Tuesday, September 1 at 2:00 p.m. ET. The webinar will cover how dental and vision health can affect children’s overall well-being and how benefit coverage can support preventive care and treatment.
Humana’s Benefits That Matter: The Strategic Role of Life and Disability Benefits explores employee perspectives on life and disability coverage and offers research-based insights brokers can use in client conversations. Watch on demand
Humana’s Employee Assistance Program, powered by TELUS Health, just got more valuable:
Available 24/7 by phone, app, or online at one.telushealth.com (Username: MyEAP / Password: wellness).
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Join Covered California for Small Business’s Dan Tyler and Shawn Rutledge for a webinar highlighting some exciting developments for 2027 including:
When: Tuesday September 22, 11:00 a.m.
In addition to California’s most comprehensive access to doctors and hospitals, CCSB health plans offer choice and control, with:
As a trusted CCSB partner since its 2014 launch, we are a top-producing general agency in our sales territory. From agent certification and quoting to assessing new group eligibility and resolving post-enrollment issues, our CCSB experts will provide guidance and support every step of the way.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Blue Shield of California has released several updates affecting Small and Large Group business, including new 2027 HSA-compatible plan deductible requirements, its upcoming Small Business Broker Roadshow and an update on the California Managed Care Organization (MCO) tax.
The IRS has increased the minimum deductible requirements for HSA-compatible plans for 2027.Beginning in 2027:
The changes apply to both Small and Large Group HSA-compatible plans.
Effective January 1, 2027, the American Medical Association (AMA) is changing CPT codes used for maternity care services.According to Blue Shield, the updated coding is intended to improve transparency and reporting across a member’s maternity care.
Blue Shield will host its annual Small Business Broker Roadshow on September 22, 2026, at 1 p.m.The webinar will cover Blue Shield’s Q1 2027 Small Business updates. Register for the Small Business Broker Roadshow
Blue Shield also provided an important update regarding California’s Managed Care Organization (MCO) tax.The anticipated $8.85 per member per month MCO tax will be excluded from January 1, 2027, fully insured and flex-funded Large Group renewal and new business rates.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
During the call, Health Net will review the following tools designed to simplify doing business:
When:
Wednesday, August 12th
10:00 a.m. PST
Learn more about Health Net’s versatile health plans, ancillary coverage, wellness programs, and value-added services.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.