Hot Topics

Quarterly Quick Tips for Brokers

Dickerson / Hot Topics

2026 Q2 Hot Topics

Click here for a PDF version.

Rates:

  • Quarterly Rate Change Average: PPO 4.8% and HMO 1.8%  
    *Average rates only – rate actions vary by plan and rating region

Selling Highlights:

  • Simple Savings with Small Group: Save automatically with credits for new groups. Different savings offers for Aetna fully insured or Aetna Funding Advantage.
  • 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.

Underwriting:

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

Rates:

  • Quarterly Rate Change Average: PPO 2.3% and HMO 3.6%
    *Average rates only – rate actions vary by plan and rating region

Selling Highlights New for 2026:

  • Virtual Access Plus
    • Copay centric/Ded/Copay Plans = Predictable costs. Eliminates coinsurance uncertainty 
    • $0 Virtual Primary Care through in-network PCPs
    • $0 Virtual Behavioral Health visit through online in-network providers
    • Office based Behavioral Health visits= PCP copay
    • Network Access Prudent Buyer PPO/Select PPO= Broad network access
    • A simplified and integrated Sydney experience.
  • Doula Benefit: Coverage =  9 visits, (1 initial, 8 prenatal/postnatal) plus labor & delivery support. Members can access either “The Doula Network of providers” or locally contracted providers under our FindCare provider search.


Underwriting:

  • DE9C not required with 3 or more subscribers enrolling!

   

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 2.4% and HMO 2.1% 
  • *Average rates only – view full rate tables 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.
  • 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.
  • Blue Shield’s Oncology Utilization Management Program – The new program includes an innovative provider engagement model supporting the most efficacious treatments with the lowest clinical toxicity and cost containment.
  • 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! 


  • 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 Q2 2026. 
  • Seven new medical plans are being added: 
    • 6 New Anthem Blue Cross Plans (Platinum HMO C, Platinum HMO D, Gold PPO H, Gold PPO I, Silver HMO D, Silver PPO F, Gold HMO F) 
    • 1 New Kaiser Permanente Plan (Gold HMO F). 

Underwriting:

  • Participation Promo: Prior carrier bill accepted in place of DE9C if 6+ enrolled

  • ChoiceBuilder is now quoting for Q1 2026. 

Selling Highlights:

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


Selling Highlights for CCSB Dental Plans:

  • CCSB Dental Plans are completely voluntary: No ER contribution required and can only be added to a group at inception or renewal. Dental is not a stand-alone product, but an employee can waive medical and have dental. Check out the CCSB dental plan booklet for more information.

Underwriting: 

  • Easier eligibility verification for small groups. Groups previously insured can now submit their prior carrier bill instead of a DE-9C. For enrolling employees not listed on the prior carrier bill, you can provide either a DE-9C or 30 days of payroll records.

 

Rates:

  • Quarterly Rate Change Average: HMO: 13.2% and PPO: 3.9%
    *Actual rate changes may vary by network and rating area.

Selling Highlights:

  • Thrive at Work: EAP included at no extra cost for members. These value-added benefits include Teladoc, Behavioral Health, Nurse Advice Line, Unwinding by Sharecare, and a free online directory of social service organizations.
  • $0 Deductible HMOs: All HMOs come with no deductible.
  • ShareCare: All members aged 18+ can earn up to $100 annually by participating in ShareCare.
  • Virtual Options:Teledoc is available on all plans, offering $0 copays for medical and behavioral health visits.


Simplified Underwriting:

  • Enhanced Choice (HMO & PPO) – Groups with 4-9 enrolling employees, 25% participation, or no participation requirements when 10+ employees enroll. Mix and match PPOs and all HMOs. No DE9C required. No Prior carrier bill. No ownership documents required.
  • Flexible Underwriting –  2 weeks payroll for a startup group of any size. 
    • Groups 1-4 enrolling: 70% participation
    • Groups of 5-100 enrolling, 25% participation required – Not a promotion


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.

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)

Underwriting:

  • Contingent Approval: Small groups enrolling less than 5 EEs and No DE9C
  • New Documents Required: must submit relevant IDs, Marriage Certificate and birth certificate for matching one of the parents. For domestic partners, a CA certificate of registered domestic partnership or notarized domestic partner declaration from Mexico.
  • Existing Clients may be subject to random recertification at renewal
  • MediExcel will continue to accept 1 enrolled employee on select plans


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 is HR designed for for everyone: Payroll Services, Risk Mitigation, Technology Platform and HR Expertise 
  • Trinet offers comprehensive HR solutions for your clients:
    • Trinet PEO is a full-service HR solution that unifies HR, payroll, access to big-company benefits and risk mitigation.
    • Trinet HR Plus is a scalable solution that combines flexible service options alongside all-in-one technology platform to simplify HR, benefits administration and payroll processing.
  • NEW! Enhanced onboarding experience for clients that simplifies how brokers gain Trusted Advisor Access – no extra steps required.
  • NEW! TriNet’s Human-Centered AI Suite is available now! The Personal Health Assistant, powered by Healthee, enables employees to accew3ss important healthcare information throughout the year. 


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