ICYMI: 2026 Small Group Product Launch
In September, Premera Blue Cross held an online session for small group agents to share updates for 2026. If you missed it, you can watch the recording via the Producer Learning Center. Here’s a summary of the questions asked during the session.
Kinwell
Q: What are the expansion plans for Kinwell in 2026?
A: While there are ongoing conversations on where Kinwell could go next, there’s significant physical capacity in the existing clinics, so new building expansion isn’t expected in 2026. We’re excited to see the Premera member population continue to use Kinwell with an average of 350 new patients per week establishing their care at Kinwell in 2025.
Q: Who has access to Kinwell clinics?
A: Kinwell is exclusive to Premera Blue Cross group health and individual plans, BlueCard members (living or traveling in Washington state), and LifeWise Health Plan of Washington members.
SB 5213 Pharmacy
Q: Who’s impacted by Senate Bill 5213 and when does it go into effect?
A: SB 5213 applies to all fully insured groups. The law goes into effect on January 1, 2026, regardless of a group’s renewal date. Members will also receive new ID cards.
Key take aways from SB 5213:
- No mandatory mail order
- No mandatory pharmacy on specialty drugs
- Equivalent 90-day retail prices and mail-order prices
- Retail and mail order must have the same cost shares
Premera will release edits to the plans on January 1, 2026.
Provider networks
Q: What’s the difference between the Heritage and Dental Choice and the Heritage Signature and Dental Choice networks?
A: Both networks have comprehensive coverage. Heritage is our largest network available to the small group market. The main difference between Heritage and Dental Choice and Heritage Signature and Dental Choice, is CHI Franciscan is in-network for Kitsap County only. Outside of Kitsap County, CHI Franciscan providers are out of network in the Signature network.
Premera Blue Cross HMO uses the Sherwood network.
To learn more, view the flyer.
Medical plans
Q: Are the new Balance plans considered creditable?
A: Producers should visit the Resources section on the small group products page on premera.com to view the small group creditable coverage status report. Producers can also read the latest creditable coverage in the September producer newsletter.
In 2026 all our platinum gold and silver plans were considered creditable. The 2025 plans tested against the 2026 CMS guidelines confirm the Platinum and Gold plans are still considered creditable; Silver and Bronze plans are not. The 2026 Silver and Bronze plans are also not creditable. As CMS makes changes to the Medicare Part D plan, those benefits are getting richer so the testing is not keeping up.
Q: For plans that aren’t considered creditable, will Premera send out notifications to impacted members?
A: Premera no longer sends creditable coverage status notices to members on behalf of the employer group. The Centers for Medicare and Medicaid Services (CMS) requires the employer group to notify eligible active and retired employees and their spouses and dependents whether their coverage is “creditable” prescription drug coverage when compared to Medicare Part D. Information including plan testing status and links to CMS for more information on creditable coverage and model notice letters can be found in the Resources section of the small group product page on premera.com.
Q: How will groups and members be impacted by the Bronze 8550 exclusive provider organization discontinuation?
A: Groups enrolled on the Balance Bronze 8550 EPO will be mapped to the Balance Bronze 7000 at plan renewal. Employer groups will receive notice of this plan discontinuation 90 days in advance of their renewal date informing them of this change. We’re also required to notify members directly when a plan is discontinued. Groups can choose to change to another plan if they like. Plan deductibles, copays, and out-of-pocket maximum limits reset every January regardless of the plan renewal date. Member out-of-pocket cost shares will automatically carry over with plan changes made at renewal.
Q: Will HSA plans cover telehealth visits in full before the deductible is met as stated on the One Big Beautiful Bill (OBBB)? Will these changes be retroactive to January 1, 2025?
A: Currently, not for small group products. We’re just starting to get information on how Premera will approach this for self-funded business. The OBBB legislation allows for telehealth or virtual care visits to be covered in full before the deductible is met for HSA plans but the nature of our filing in Washington state would require a complete refile of our plans for 2026. We’re looking at it for 2027.
Q: How can members find in-network ambulatory surgical centers (ASC) and freestanding birth centers to use the site-of-service expansion benefit?
A: Members can easily search in-network providers and locations using the Find Care tool on premera.com.
Q: Are virtual care providers changing for the 2026 health plan year?
A: Yes. Primary/urgent care virtual care is transitioning to 98point6. Virtual mental healthcare providers include Spring Health and Talkspace. Members can view their virtual care providers in their online account and the Premera mobile app.
Premera members living in Washington state can also use virtual care services at Kinwell.
Renewals
Q: If a group is going to renew without any changes, do they need to send in any paperwork or do anything online to renew?
A: Groups with less than 3 enrolled employees must submit a group size attestation and W-2 for 1 enrolled IRS common law employee prior to the renewal date. Groups of 3 or more will renew as is. If those groups want to make changes, they need to complete a benefit selection worksheet and submit it to their general agency partner.
Q: What’s the deadline for submission?
A: The new group submission deadline is the 20th of the month prior to the requested effective date. Existing groups can submit plan changes up to the last day of the month prior to their renewal date.
Q: When will the draft summary of benefit changes be available?
A: The 2026 Employer Group Agreement (EGA), Benefit Selection Worksheets, and Benefit Highlights were posted to premera.com on October 1, 2025.
General
Q: How do I get a list of the general agencies that represent Premera?
A: Information and links to each of our general agency partners are available on the small group producer page.
Q: What are the eligibility requirements for a small group plan?
A: In Washington state, the only two rating factors are the geographic location of the employer group and the ages of the enrolled members. To be considered a small group employer, the group must have averaged less than 51 employees on payroll in the previous calendar year. There are some exclusions including self-employed individuals and sole proprietorships without an IRS common law employee enrolled on the plan. The group size attestation is a great resource for who’s considered an eligible small group employer. Premera does require new groups with one to two employees to provide a W2 for one IRS common law employee enrolled on the plan.