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Why Choose Health Net?
✔ Lowest rates in the market – Affordable options without compromising quality.
✔ Robust PPO network – Competes with major carriers like Anthem and Blue Shield.
✔ Flexible HMO options – Networks to fit nearly every group statewide and every budget.
✔ Simplified underwriting – Only 25% participation required for groups with 5+ enrolling. No DE9C or prior carrier bill needed.
✔ Easy-to-sell benefits – $0 deductible HMO plans + four years of rate stability.
✔ Nationwide coverage – Cigna network access for out-of-state employees + state plurality rules for group qualification.
Start Including Health Net in Your Quotes Today!
Need guidance on networks, plan designs, or have questions? We’re here to help!
Call us at 800.696.4543 | Email us at info@claremontcompanies.com.
Login To PrismHere’s what brokers need to know about Blue Shield of California heading into Q3 — from a strong rate story to a revamped virtual care benefit and a points-based bonus program worth stacking.
Starting January 2026, Virtual Blue replaces Teladoc and Nurse Help 24/7 for renewing Small Group off-exchange PPO plans. Virtual Blue is a valuable upgrade for PPO members and includes:
Download the Virtual Blue program flyer.
Blue Shield’s Producer Rewards program makes it easy to earn — no complicated tiers, no calculations. 1 point = $1, paid quarterly.
| Enrollment | Points Earned |
|---|---|
| New medical member (initial sale) | 25 pts |
| New dental member | 10 pts |
| New vision member | 5 pts |
| New life insurance member | 5 pts |
| All three: dental + vision + life | 2x (40 pts total) |
Key details:
Broker Talking Points
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Effective February 1, 2026, Community Medical Centers (CMC) facilities are no longer part of Blue Shield of California’s network. CMC’s affiliated PPO group, Community Health Partners (CHP), continues to serve a limited number of PPO members; however, some CHP providers may no longer accept Blue Shield members due to their out-of-network status.
Members enrolled in a Blue Shield PPO plan may choose to receive care from non-contracted providers, but out-of-pocket costs could be higher depending on plan design and any required prior authorization. Benefit details and cost-sharing responsibilities can be found in the member’s Evidence of Coverage (EOC).
Members who were in an active course of treatment with a CHP provider prior to February 1, 2026, may be eligible to continue receiving care at in-network benefit levels. Eligibility is determined through Blue Shield’s established Continuity of Care policy, and members must submit a request for consideration.
Members needing emergency services should call 911 or go to the nearest emergency room immediately, even if the hospital is out of network. Emergency services are covered according to the member’s plan benefits.
Members with questions should contact Blue Shield Customer Service using the number on the back of their member ID card.
Blue Shield is requesting employer participation in its annual Medical Loss Ratio (MLR) survey for groups under 150 employees.
The Affordable Care Act requires health plans to spend a minimum percentage of premium dollars on medical care and quality improvement. To meet this requirement, carriers must confirm accurate group size data each year.
What brokers should do
Please encourage your Blue Shield small-group clients (under 150 employees) to submit their group size information by March 31, 2026.
How employers can submit
Online: Access the online survey, and use Group ID with web key #44n50c
Fax: Complete the print survey and fax to (855) 895-3497
Why it matters
Accurate group size reporting helps Blue Shield meet federal MLR requirements and ensures proper regulatory reporting.
Questions:
Access the MLR FAQs, or contact the Blue Shield MLR team: MLRassist@blueshieldca.com or (800) 352-5166
Pharmacy costs remain one of the fastest-growing components of employer healthcare spend. In response, Congress recently passed the Pharmacy Benefit Manager (PBM) Reform Act, alongside new Department of Labor transparency rules targeting PBM pricing practices. Learn more.
These reforms are designed to improve affordability and accountability in prescription drug benefits—an area that has historically lacked visibility for employers and brokers.
The legislation introduces two core requirements affecting group health plans:
This level of reporting significantly increases employer visibility into pharmacy benefit economics.
PBM reform signals a broader market shift toward transparent pharmacy pricing models. As these requirements take effect, brokers can expect:
Blue Shield has been an early advocate for PBM transparency and affordability initiatives. Notable efforts include:
As of 2026, Blue Shield reports full compliance with SB 41 requirements.
Blue Shield will be collecting D1 Premium Contribution data on behalf of employer groups to meet the Consolidated Appropriations Act, Section 204 (2021) reporting requirements for Prescription Drug Cost Reporting (RxDC).
According to Blue Shield, employer groups or brokers with access to Employer Connection account are encouraged to complete the RxDC Reporting Survey in the portal.
Employer groups or brokers without access to Employer Connection, are able to submit the required information via the Prescription Drug & Healthcare Spending Survey link. Once the link is accessed, the employer group or broker will need to enter in the Group ID# following the key: #26yr25
Deadline to submit information is April 10, 2026. Groups that do not provide their D1 data by the deadline will not be included in Blue Shield’s filing and must report directly to CMS to avoid potential non-compliance.
Blue Shield will submit D2 as well as D3-D8 for employer groups with prescription drug benefits under a Blue Shield health benefit plan. All data reflects the 2025 calendar year.
For any additional information on the RxDC Reporting Survey, please refer to the Prescription Healthcare Spending Survey FAQs.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Blue Shield of California is currently in good-faith negotiations with Community Medical Centers (CMC) to reach an agreement that supports affordable healthcare costs.
If an agreement is not reached, select CMC hospitals—including Clovis Community Hospital, Community Regional Medical Center, and Fresno Heart and Surgical Hospital—will be out of network for Blue Shield members effective February 1, 2026. Blue Shield maintains a strong Fresno County network, with alternative in-network hospitals such as St. Agnes Medical Center and Valley Children’s Hospital.
CMC’s affiliated medical group, Community Health Partners, serves a limited number of Blue Shield PPO members. If CMC terminates its contract, services with this group would be billed at out-of-network rates.
Notifications to impacted members will begin January 27, including members who received care at a CMC facility within the past 12 months or who live within a 15-mile radius of a CMC facility. Updates will be shared as negotiations continue.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Blue Shield of California’s Q2 2026 Small Business portfolio is now available for quoting with an average statewide rate action of 2.3%.
Groups with renewal dates in April, May, and June are now available to download. Visit the Blue Shield Small Business Renewal Center for downloads and deadlines.
Beginning January 1, 2026, Blue Shield will directly manage the behavioral health benefit for all members including those receiving applied behavioral analysis (ABA) services. With Blue Shield Behavioral Health, members have access to an expanded, quality network of behavioral health providers. This centralization effort allows for better coordination of care between primary care physicians, specialists, and behavioral health providers. Learn more
Employer Enrollment Tool Resources
Q2 2026 Broker Sales Guide – Medical Plan, Small Business
Small Business Rewards Program for Brokers
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Blue Shield of California’s Q1 2026 Small Business portfolio is now available for quoting with an average statewide rate action of 1.2%.
Groups renewing in January will be available to brokers through Shield Renewals on Thursday, October 16 while group-level changes can be made using the Employer Enrollment tool starting Friday, October 17. Groups renewing in February and March will be available on Tuesday, November 4 while group-level changes will be available starting Wednesday, November 5 and Monday, December 1 respectively.
Starting January 2026, several key enhancements are coming to expand access and improve the member experience:
These updates reflect Blue Shield’s continued focus on value, convenience, and whole-person care for small business clients. If you missed the 2025 Broker Roadshow, here are links to the presentation slides, the FAQs, and the session recording.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Blue Shield Small Business leadership team invites you to join a very special webinar session to learn how they are expanding access to care and prioritizing ease of doing business in 2026 and beyond. During the webinar, the team will share Blue Shield’s roadmap for the year ahead. Time will be reserved for answering your questions at the end of the session. Hear from speakers including
When?
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Visit the Blue Shield News Center for more detail.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.