SFHSS approves 2026 health-plan rates, limits GLP‑1 weight-loss coverage to BMI≥40 and adopts SB 729 infertility changes

The San Francisco Health Service Board voted unanimously to approve 2026 renewals for multiple city-sponsored health plans and to adopt plan-design changes tied to state law and emerging drug-policy decisions.

The board approved rate renewals and contribution schedules presented by Aon actuaries and HSS staff for the Health Net Canopy Care non‑Medicare HMO; Blue Shield of California Access Plus and Trio HMOs; and the Blue Shield non‑Medicare self‑funded PPO. Roll-call votes showed Chair Kremen, Supervisor Matt Dorsey, Commissioner Diana Guevara and Commissioner Wilson voting “aye” on each item.

Aon and staff presented plan-level rate actions as follows: Blue Shield Access Plus HMO (recommended total rate increase including stabilization: 8.7 percent), Trio HMO (9.2 percent), Health Net Canopy Care HMO (1.7 percent before stabilization adjustment) and the non‑Medicare PPO (0.5 percent). Actuaries attributed the higher increases on the Blue Shield HMOs largely to recent medical and prescription trends and the expiration of prior rate buy‑downs; Health Net’s capitation structure and an elevated stabilization buy‑down contributed to its comparatively small change.

The board also approved two plan-design changes that will apply in the 2026 plan year. First, the plans will incorporate the statutory infertility coverage expansion established in Senate Bill 729 (SB 729), which took effect in state law in late 2024 and requires enhanced infertility benefits for covered plans beginning with 2026 calendar-year plans. Aon staff presented an implementation note and a web link to the statutory materials during the presentation.

Second, staff and Aon recommended aligning Blue Shield and PPO plan coverage of GLP‑1 and similar anti‑obesity medications with Kaiser’s clinical approach: covering GLP‑1 drugs for weight loss only in adults with a body‑mass index of 40 or greater (class 3 obesity) or for members with qualifying medical diagnoses. Aon and SFHSS staff said Blue Shield reported about 350 members currently taking weight‑loss medications, and roughly 250 of those meet the BMI‑40 threshold and would remain covered under the tighter clinical criteria; staff said they would work with Blue Shield to help affected members plan transitions into 2026.

Staff presented the Health Net Canopy Care renewal as cost‑competitive, noting that Canopy’s capitation model covers a large share of medical services and that Canopy Health’s ownership structure (including UCSF among partners) supports negotiated provider rates. Chandra Walsh, chief operating officer of Canopy Health, told commissioners that UCSF’s continued commitment helps sustain Canopy as an option for SFHSS members.

Votes at a glance: - Health Net Canopy Care HMO 2026 rate cards — outcome: approved; roll call: Chair Kremen (Aye), Supervisor Dorsey (Aye), Commissioner Guevara (Aye), Commissioner Wilson (Aye). - Blue Shield Access Plus and Trio HMO 2026 rate cards — outcome: approved; roll call: Chair Kremen (Aye), Supervisor Dorsey (Aye), Commissioner Guevara (Aye), Commissioner Wilson (Aye). - Blue Shield non‑Medicare PPO 2026 rate cards (including “choice not available” pricing) — outcome: approved; roll call: Chair Kremen (Aye), Supervisor Dorsey (Aye), Commissioner Guevara (Aye), Commissioner Wilson (Aye).

Ending: Staff said it will work with carriers to notify affected members and implement the SB 729 and GLP‑1-related design changes during the open‑enrollment process for the 2026 plan year.