Hot Topics

Quarterly Quick Tips for Brokers

Dickerson / Hot Topics

2026 Q4 Hot Topics


Selling Highlights:

  • Telehealth Benefit - $0 cost-share, no deductible on HSA plans for covered in-network telehealth services provided by CVS Virtual Care.
  • Hearing Aid Benefit is available on all plans. 
  • Small Group Producer Program – Earn More, Grow your Business: Producers can earn more for new groups with effective dates from January 1, 2026, through December 31, 2026. Check out the flyer for more information.
  • ASG Early submission Admin Credit Offer – Starting with 11/1 effective dates, groups can get up to $450 per sub by submitting the sold medical cases through Aetna Sales Gateway by the submission dates. Groups can get an additional $150 per sub by adding dental.

Underwriting:

  • No DE9C required for 5+ enrolling for groups with current coverage.

Selling Highlights:

  • Sales Promotion: New groups submitted to Anthem from now through December 2026 will be allowed to select any combination of networks with no restrictions for the life of the group.
  • Union Carve Out Groups: For groups with total employees exceeding 100, but have a union population that has coverage, we can now offer coverage to the non-union employees.
  • PEO sub/hybrid groups are now eligible (groups that stay in the PEO) to enroll with Anthem.
  • Anthem may consider employers with out-of-state employees on a case-by-case basis. 
  • Virtual Access Plus: Prioritizes virtual care and offer copays for all services, resulting in transparent, predictable costs for employees.

Underwriting:

  • The CA Enrollment Compliance Form can be used in lieu of a Reconciled DE9C/payroll or Reconciled Prior Carrier Billing Statement

Health Net Welcome to Anthem Promo: New Groups Effective 10/1/26 to 3/1/27

  • 25% Participation for all groups with 2-100 lives (no waiver form needed)
  • What is required: Employer Application, Quote, EFT, No DE9C required (send prior invoice), and Enrollment Application or Census Enrollment
  • Existing Groups Written Alongside Health Net: Anthem will allow members to come on to Anthem as a special enrollment effective 10/1 - 3/1 and during the group renewal month.
  • Groups who left Anthem: Anthem will allow groups to reinstate within 60 days of leaving Anthem (as long as the group left in good standing). Groups will be required to pay back premium. 
  • Group cancelled on 8/1 to go to Health Net can reinstate back to 8/1 but must pay 8/1, 9/1, and 10/1 all at once.

   

Selling Highlights:

  • Why BBSI? Gain access to competitive plans and rates. Experienced professionals partner with you to make decisions as easy as possible and guide you through enrollment.
  • Comprehensive Benefits Package: Dental, Life, AD&D, Long and Short Term Disability, Group Legal, FSA, EAP, Accident, Vision, Identity protection, Pet Insurance, HSA, Critical Illness.
  • Regional plans and networks are also available!

Rates:

  • Quarterly Rate Change Average: PPO 4% and HMO 3.6% 
  • *Average rates only – view full rate tables and rate books for medical and specialty here.

Selling Highlights:

  • Enhanced PPO plans with Virtual Blue: 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 NurseHelp 24/7℠ upon renewal.
  • Wellvolution Programs – Support Mental Well being, Digital Physical Therapy, Quit Smoking, Weight Management and Diabetes treatment.
  • Flexible provider options with Trio HMO – offers traditional in-person and virtual providers.
  • Maven Maternity – 1:1 personalized support, care advocacy, specialized virtual support and virtual classes.
  • Sell more, Earn more – Earn points when you enroll members in Blue Shield that can be redeemed for gift cards and rewards. Points apply to groups with effective dates beginning 2/1/26 through 1/31/27. See full details here 

Underwriting:

  • DE9C not required with 3 or more subscribers enrolling! Owners are not included in the count of eligible employees.
  • Relaxed Participation requirements through 12/31/26: 25% participation for groups with 5+ enrolled employees! 

Health Net Blue Shield Transition Bonus:  Groups with effective dates from October 1, 2026 through March 1, 2027 are eligible. 
Download the flyer for more information

Small Group Medical Members$ Per Member
1 - 50 members$100 per member
50 - 100 members$150 per member
101 + members$200 per member


  • NEW for 2026:
    • CalCPA Health is introducing a suite of alternative health plans that access the same Anthem PPO network as traditional plans. The new CalCPA Health tiered copay plans are powered by Coupe Health and offers a more simplified plan designed to connect members with the highest quality, best value providers of their choice.
    • New tiered copay plans are being offered for 2026
      • PPO HSA PRx 1900-C
      • PPO HSA PRx 2900-C
      • PPO 30/0-C
      • PPO 50/0-C
      • PPO 60/0-C

Selling Highlights: 

  • CaliforniaChoice is now quoting for Q4 2026.  
  • Additional Anthem Out-of-State Options for 7/1: 

    o    2 Anthem Select Gold PPO Plans for out-of-state employees 

CaliforniaChoice Bonus Program for Groups moving from Health Net:

  • Earn $100 per enrolled member, with no cap and no limit, when eligible Health Net direct groups move to CaliforniaChoice! Groups sold through Dickerson are eligible for this program. Effective dates: 10/1/2026 - 1/1/2027
    • Bonus Amount: $100 per enrolled Health Net member, NO CAP!
    • Eligibility: Bonus applies to Health Net direct groups moving to CaliforniaChoice
  • Download the flyer for more information

  • ChoiceBuilder is now quoting for Q4 2026. 

Selling Highlights:

  • No Participation requirements between carriers
  • Simple administration – one enrollment, one renewal
  • Dental, Vision, and Life in one program


Selling Highlights:

  • IRS Employer Tax Credit: CCSB is the only place where qualified small businesses can use federal tax credits to help pay for health coverage for employees. Average annual wages under $67,000 and less than 25 Full-Time Equivalent Employees to qualify.

  • Broker Bonus Program: Earn more with a partnership that pays! Sell new small group coverage with effective dates from  July 1, 2026 – January 1, 2027 and earn extra. Check out the flyer for more information.

Underwriting: 

  • Relaxed Participation:  70% of employees covered by any valid coverage, No more than 30% uninsured (waiving for cost)   
  • Minimal Payroll Requirements: Prior Carrier Bill in lieu of DE9C for groups of 3+ enrolled employees. Employment Offer Letters when payroll not available for new hires.

Health Net Transition: Easier Eligibility Verification- CCSB will accept a prior Health Net bill showing at least one enrolling subscriber in lieu of a DE-9 or payroll report. In addition:

  • Employees not listed on the carrier bill may be verified with a recent paystub or offer letter.
  • New group submission deadlines have been extended to the 15th of the month for effective dates from October 2026 through March 2027.
  • Owner only and husband and wife groups remain ineligible
  • Easy Participation - Only 70% of eligible employees must be enrolled in creditable coverage, regardless of where that coverage is obtained.
  • Coverage for Out-of-State Employees - For groups with employees outside California, Blue Shield’s BlueCard® network provides access to a national provider network, helping employers support geographically diverse workforces.
  • No Administration Fees - CCSB does not charge administration fees, keeping costs predictable for clients.

 

Health Net has made the decision to exit the California small and large group market. Coverage is expected to end February 28, 2027. This change does not impact the Medi-Cal, Marketplace/Covered California or Medicare lines of business.

Selling Highlights:

  • NEW Kaiser Permanente Plus (KP Plus) Plan: Effective 1/1/26, Kaiser will offer this new plan with out-of-network flexibility. With KP Plus, not only do employees benefit from the true value-based care, they also have the flexibility to keep their favorite out-of-network doctors with up to 10 physician visits or outpatient medical services, and 5 prescription fills or refills annually, without the need for referrals or prior authorization.
  • Bonus Program for KP Plus plans – Sell new KP Plus plans to small groups in CA with an effective date between 1/1/26 – 1/1/27. One-time payment of $100 per new KP Plus enrollee. 
  • Member Rewards – Drive better health, members can earn up to $150 annually.
  • New Digital Experiences - upgrades to business.kp.org. 

Simplified Underwriting:  

  • Beginning January 1, 2026, all new group enrollments with 5 or less subscribers must provide the following documentation:
    • DE 9C or equivalent payroll report for startups
    • Business-entity verification
    • Waivers (if applicable)

Health Net Groups: For new small group submissions tied to Health Net transitions, include "Health Net" in the email subject line for Kaiser to quickly route.

  • No DE-9C required for 5 or less subscribers; a Health Net bill is sufficient (does not apply to groups purchasing a Kaiser Permanente PPO plan). 
  • Dedicated Small Group California support to help answer questions and guide submissions
  • Digital tools are available through business.kp.org and administrative platforms to support ongoing group and employee administration.

Special Open Enrollment for Existing Kaiser Permanente Groups:Anniversary Dates Change for Q1: Groups may move to a 1/1, 2/1, or 3/1 effective date to align with another carrier's renewal date. Mid-year plan changes: Groups may request upgrades, downgrades, or plan additions within 60 days of losing Health Net coverage, and if adding a Kaiser Permanente PPO, Employer / Employee relationship documentation (either the DE-9C or payroll). Download the flyer here

  • Q4 Small Group Rate Pass

Selling Highlights: 

  • New! Extended appointment and walk-in hours at Excel Hospital. 
  • Ceramic Braces Promotion: Exclusive for MediExcel members
  • Expanded U.S. Urgent Care Network: Access to 60 in-network clinics in CA

Underwriting Updates:

  • Contingent Approval: Small groups enrolling less than 5 EEs and No DE9C
  • MediExcel will continue to accept 1 enrolled employee on Gold 80 and Platinum 90 Plans
  • Existing clients may be subject to random recertification at renewal.

Selling Highlights:

  • Provide medical coverage for employer groups that operate within the US but are owned by a foreign company or parent.
  • Global Coverage with Aetna International (medical and prescription coverage while traveling outside the US)
  • Traditional East Asian Medicine (Acupuncture, herbal supplements, cupping, hypnotherapy and tai chai covered)
  • Additional benefits: Active & Fit, Prenatal Program, Teladoc, ActiveHealth wellness program and Care Management.
  • Nippon uses the national PPO network of Aetna signature Administrators of over 1 million providers for our large group and global business opportunities
  • They review any 100+ large groups in CA and also in other situs states as well


Underwriting Guidelines: 

  • 1-4 subscribers enrolled: Minimum of 60% participation, excluding any valid waivers.
  • 5+ subscribers enrolled: Minimum of 25% participation, excluding any valid waivers.

Selling Highlights:

  • NEW: Starting Jan. 1, 2026, small group non-grandfathered plans will switch to a 4-tier prescription benefit upon renewal. SHARP will notify employer clients affected by this change 90 days prior to their renewal. 

Trinet puts brokers first with Payroll Services, Risk Mitigation, Technology Platform and HR Expertise. 

  • TriNet PEO (Master Medical) - Full service benefits solution for HR, payroll, benefits and risk mitigation
  • TriNet PEO (MDV Carveout) - TriNet PEO combined with open market medical, dental and vision benefits.
  • TriNet HR Plus (ASO) - Outsourced services for HR, payroll, payroll tax compliance
  • Q4 SPIFF Incentive – for each client you refer for PEO and Open Marker Solutions that completes a demo that becomes a TriNet client between 9/1/26-12/31/26, you’ll earn an additional $5,000 payment on top of your standard referral compensation.
  • NEW! TriNet Assistant – AI powered gateway to help complete tasks.
  • NEW! TriNet IT – brings IT and HR together to help employees with onboarding. 

Underwriting Guidelines: 

  • CA Groups with 3+ enrolling can submit a participation certification form in lieu of a DE9C.  
  • o    UHC updated underwriting guidelines: See the full guide here