News

Blue Shield’s Middle Market 2027 portfolio changes include enhanced PPO Savings plans with expanded weight loss drug coverage, along with a streamlined Virtual Blue care experience featuring $0 virtual care across medical plans. Additional refinements include EOC language updates and targeted portfolio adjustments, while dental plans remain largely stable with select market status changes.

2027 Portfolio Changes
Pharmacy updates - PPO Savings Plans with expanded weight loss drug coverage
In response to market demand, Blue Shield will launch three PPO Savings Plans offering expanded weight loss drug coverage in 2027:
•    Full PPO Savings Embedded Deductible 5500 with Enhanced+ Rx
•    Full PPO Savings Embedded Deductible 3400 100% with Enhanced+ Rx
•    Full PPO Savings Two-Tier Embedded Deductible 1700/3400/3400 90/60 with Enhanced+ Rx

The plans are great options for manually rated groups not eligible for benefit customization as cost shares can be customized within existing filed ranges. Please note: weight loss drugs under these plans are covered with prior authorization for BMI ≥30, or ≥27 with certain weight-related conditions, lowering the requirement from the previous BMI of ≥40.

Dental plans
Blue Shield will not make any benefit dental plan changes in 2027. However, four plans will receive market status changes.
Changing from “Not Marketed” to “Withdrawn” status:
•    Smile SM Spectrum Advantage 50/1500/Ortho/U80
Changing from “Not Marketed” to “Marketed” status:
•    Smile SM Spectrum Premier Plus 50/1000/Ortho/U90
•    Smile SM Spectrum Premier Plus Rollover 50/1500/Ortho/U90
•    Smile SM Spectrum Premier Plus 25/1500/Lifetime Ortho 1500/U80

Blue Shield Middle Market PPO Portfolio
Beginning 1/1/27, Blue Shield’s fully insured Middle Market PPO, HDHP, and EPO plans will include the Virtual Blue care experience—with $0 copays for virtual care—bringing virtual primary care, behavioral health, and specialty care into the PPO experience members already know and trust.

This enhanced experience replaces Teladoc and NurseHelp 24/7 for new and renewing Middle Market groups, with Premier and ASO groups able to opt in.

The Virtual Blue experience helps simplify access to care through:
•    Virtual access to primary care, urgent care, behavioral health, and 19 specialty providers
•    Ability to select a virtual PCP for ongoing care
•    24/7 access to doctors
•    Personalized and coordinated member support
•    Care team that helps with navigation and in-person appointments
•    Access to physicians supporting 25+ languages
•    $0 vitals kits
Additionally, a number of Virtual Blue plans are being moved to “Not Marketed” in 2027.

EOC language changes for 2027
Updates to EOC language impact the following benefits:
">Behavioral Health: language updated to reflect insourcing initiative

Skilled Nursing Facilities (SNF): updating visit limit maximum from calendar year to benefit period
GIFT (Gamete Intrafallopian Transfer) and ZIFT (Zygote Intrafallopian Transfer): including bracketed lifetime limits ("limited to [1-3] per lifetime"); GIFT/ZIFT coverage is only included when customized

Disabled Over-Aged Dependent Children: language in the EOC to add more clarity regarding the required documentation for Over Aged Disabled Dependents
LifeReferrals 24/7: language updated to reflect vendor change from Magellan to Headspace
Mental Health and Substance Abuse (MHSU): update to SOB to improve alignment with EOC language

Connect with your Dickerson Sales Representative to review renewal strategies and position these updates as a competitive advantage.