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Board adopts Blue Shield HMO and PPO renewals; Aon warns of higher HMO trend, PPO shown as stable
Summary
The Health Service Board approved 2026 rate cards for Blue Shield Access Plus and TRIO HMOs and the non‑Medicare PPO; the board accepted Aon’s recommendation to align GLP‑1 weight‑loss coverage to BMI ≥40 and to adopt SB 729 infertility changes.
The San Francisco Health Service Board approved 2026 renewals for Blue Shield of California HMO plans (Access Plus and TRIO) and for the non‑Medicare Blue Shield PPO plan during the May 20 meeting.
Aon’s lead actuary, Mike Clark, summarized the recommendations: Access Plus HMO will carry an 8.7% total increase (including stabilization), TRIO HMO 9.2%, and the non‑Medicare PPO a 0.5% increase overall. Clark told the board that national trend assumptions used in projections were roughly 9% for medical cost trend and that the Blue Shield HMOs showed higher recent medical and prescription trends compared with the Health Net Canopy Care product.
The board also considered a recommended clinical design change for GLP‑1 and other anti‑obesity medications. Clark said staff recommended restricting coverage for GLP‑1 medications used for weight loss only to adults with a body‑mass index of 40 or greater (class 3 obesity), consistent with Kaiser’s earlier coverage decision and California regulatory guidance. Clark said Blue Shield reported about 350 members currently taking weight‑loss medications under the program, roughly 250 of whom meet the BMI ≥40 threshold.
“Of the 350 or so that are currently on for weight loss only, 250 will be able to stay on given that they meet the BMI of 40 or above criteria,” Clark said. The recommendation to align coverage and to adopt SB 729 infertility changes was presented as a staff clinical recommendation and included in the rate cards.
Board members asked about the evidence for long‑term cost or clinical benefit of wider GLP‑1 coverage. Clark said studies are ongoing and that the long‑term balance of benefits and costs is not yet definitive.
Both the HMO and PPO rate‑card approvals passed on unanimous roll calls (Chair Kremen: Aye; Supervisor Matt Dorsey: Aye; Commissioner Diana Guevara: Aye; Commissioner Wilson: Aye). Staff said the approved rate cards will feed open‑enrollment programming and employer‑contribution formulas under city MOUs and the city charter.
