Here are the facts
According to a new survey by the business-to-business research, ratings, and review firm Clutch, nearly one-quarter (23 percent) of full-time employees in the U.S. do not receive employee benefits, such as health insurance, paid vacation, or a retirement savings plan, from their employer. As a consequence, in an increasingly competitive job market, with the national unemployment rate at 4.1 percent in January 2018 (and California’s rate at 4.3 percent in December 2017), employers could risk losing top talent in the recruitment and retention of employees.
In last year’s annual survey of U.S. employers, the Society for Human Resource Management (SHRM) notes, “Recruiting difficulty has continued to increase over the last five years, and competition for talent is high. To attract and retain top talent, organizations must leverage the benefits package they offer to their employees.”
SHRM’s 2017 survey found nearly one-third of employers enhanced their benefits in the prior 12 months, with health and wellness benefits most affected. Nearly one-quarter of employers (22 percent) taking part in the survey made health benefits changes – with the top reason cited as wanting to remain competitive in the talent marketplace.
Other surveys find similar results
The 2017 SHRM survey follows the organization’s 2016 report, Leveraging Benefits to Retain and Recruit Employees, which found a majority of employees rank health care as the most important benefit. In an earlier Unum survey, as reported by Benefitfocus, 78 percent of workers base their acceptance or rejection of a job offer in part on the employer’s benefits package.
That statistic aligns with a previous study by Aflac that found 60 percent of employees would take a job with lower pay but better benefits. The same survey noted two in five employees (42 percent) said improving their benefits is something their employers could do to keep them in their jobs, while 16 percent said they have left a job or turned down a job in the prior 12 months due to the benefits offered.
A multi-carrier exchange can help you control costs and broaden employee choice
A multi-carrier program like CaliforniaChoice gives you and your employees access to a variety of health plans – not just a single medical carrier and one plan type for everyone. You and your employees have the flexibility to shop and compare coverage from seven leading insurers across California. That gives you the ability to find the plan that best suits your individual and family health care needs.
One of your employees might choose PPO coverage from Anthem Blue Cross, because it includes a preferred doctor or a specific hospital in its network. Another employee who rarely visits the doctor might choose an HMO plan from Kaiser Permanente. A third worker might select Health Savings Account-compatible coverage from UnitedHealthcare or another carrier. With CaliforniaChoice, it’s each employee’s individual choice.
What you spend is up to you
Working with your broker, you determine what you want to spend on your employees’ health benefits. With CaliforniaChoice, you can choose a fixed dollar amount or a fixed percentage of the cost – for example, 50% of the lowest-cost health plan. Your employee pays the other half of the plan premium and his or her deductible, co-pays, and co-insurance amount (depending on the plan’s metal tier).
The amount you select is locked in for a year – and, at renewal, you have the flexibility to adjust your premium contribution, up or down.
Get started today
You can improve your odds in today’s talent marketplace by offering a competitive employee benefits package. If you want to learn more about how CaliforniaChoice can help you, talk with your broker. An experienced employee benefits broker will help you sort out your coverage options, help you determine a budget for your employees’ health insurance and other benefits, give you a quote, and help get your employees enrolled.
And, you might be surprised to learn, using a broker doesn’t cost you a dime. In fact, having a broker help you shop and compare health insurance options for your employees could save you money. That’s because a broker has the expertise and technology to help you find the right plan that balances your need to control your company costs while still offering your employees access to the health care professionals and facilities they want and need.
If you don’t already have an employee benefits broker, we can help you find a CaliforniaChoice broker to speak with about your coverage options and get a quote for your business.
Nearly eight years ago, the Affordable Care Act (ACA) introduced the concept of “Metal Tiers” to employers and consumers looking to purchase health insurance. The Metal Tier levels – Platinum, Gold, Silver, and Bronze – help you and your employees make a more cost-conscious decision when shopping for health coverage. Each tier aligns with the benefits offered by the plans in that tier, and it’s a good way to forecast what you can expect when it comes to cost sharing when visiting the doctor or being treated at a hospital in your health plan’s provider network.
Here is a snapshot of the Metal Tiers:
ACA Metal Tier
|Insurance Plan Pays||You pay|
What Metal Tier is right for you? That depends on your individual or family health care needs and budget.
A Bronze health plan:
- Offers the lowest monthly premium
- Includes higher out-of-pocket costs when you need care
- Can have a deductible (the amount you must pay before your health plan begins to pay) of thousands of dollars annually
- Is a good choice if want a low-cost way to protect yourself from worst-case medical scenarios (such as a serious sickness or injury)
While your monthly premium is lower with a Bronze-tier plan, your annual costs could be greater than with a different plan tier; that’s because of your deductible and the higher portion of costs you must pay for covered health care services.
A Silver health plan:
- Offers a moderate monthly premium and moderate costs when you need care
- Has a deductible that is typically lower than a Bronze-tier plan
- Is a good choice if you are willing to pay a slightly higher monthly premium and want to have more of your routine care covered
A Gold health plan:
- Has a higher monthly premium (than a Bronze- or Silver-tier plan)
- Offers lower costs when you need care (because the plan pays a greater portion of the costs for covered services and your deductible is typically less than with a Silver or Bronze plan)
- Is a good choice if you are willing to pay more each month to have a larger portion of your health care costs covered when you need care
If you expect to need a lot of health care, health care experts say a Gold plan can be a good value.
A Platinum health plan:
- Has the highest monthly premium
- Offers the lowest cost when you get care (because it pays the highest percentage for covered services when you seek treatment)
- Typically has a lower deductible (the amount you must pay before your plan begins to pay)
- Is a good plan choice if you’re willing to pay more each month to have a greater percentage of your eligible medical services covered when you seek care
All plans in all tiers include free preventative care and some offer free or discounted services for eligible care before you meet your deductible. (To read an earlier post about Understanding the ACA Metal Tiers, link here.)
People under age 30 and those of any age with a hardship exemption or affordability exemption may be eligible to purchase a fifth health plan type – a Catastrophic plan. The monthly premiums for a Catastrophic plan are usually lower, but the deductible (the amount you must pay before your health plan begins to pay) is very high — $7,150 for 2018.
CaliforniaChoice offers plans in every Metal Tier: With CaliforniaChoice, you and your employees can choose plans in every Metal Tier. In fact, CaliforniaChoice offers a total of more than 70 HMO, PPO, EPO, and HSP (Health Care Services Plan) options, as shown in the table below.
|Metal Tier||HMO Plans||HSP Plans||EPO Plans||PPO Plans|
Here is a look at Metal Tiers and the insurers and health plans offered by CaliforniaChoice:
|CaliforniaChoice Metal Tier Availability by Carrier and Plan Type|
|Anthem Blue Cross||1 EPO||1 HMO
|Health Net||1 HSP||2 HMOs
|Kaiser Permanente||2 HMOs||3 HMOs||2 HMOs||2 HMOs|
|Sharp Health Plan||3 HMOs||3 HMOs||3 HMOs||3 HMOs|
|Sutter Health Plus||2 HMOs||2 HMOs||2 HMOs||2 HMOs|
|UnitedHealthcare||2 HMOs||4 HMOs||3 HMOs||3 HMOs|
|Western Health Advantage||3 HMOs||3 HMOs||4 HMOs||2 HMOs|
|Total Options||1 EPO
Note: The table listing Metal Tier availability by carrier is accurate as of January 2018, although it is subject to change. Ask your broker for the latest health plan information.
It’s good to remember, though, that CaliforniaChoice is much more than great health care. You and your employees also get access to valuable extras through the no-cost Business Solution Suite. It includes discount Dental, Vision, and Hearing services, a free Premium Only Plan*, online HR support from HRAnswerLink, employee discounts from Cal Perks, a free prescription drug discount card, Cal-COBRA or Federal COBRA billing (depending on how many employees you have), and a free Flexible Spending Account (for groups of 15 employees or more).
Ask your broker for more information about private exchanges and CaliforniaChoice. He or she can help you determine what amount you want to contribute to your employees’ health insurance and discuss how CaliforniaChoice offers easy administration, while giving you and your employees an easy way to find a health plan that best matches your individual or family health care needs. If you don’t already have an employee benefits broker, we can help you find a CaliforniaChoice broker to speak with about coverage for your employees.
*Initial case set-up is covered; fee applies after first year
If you’re a small business owner or manager, shopping for health insurance benefits for your employees can be complicated and confusing. Researching plan options and finding a plan that works for – and satisfies – all of your employees can be overwhelming.
Why not consider a different approach? Ask an employee benefits broker for help.
A broker can assist you, your small business, and your employees in many ways, including:
- Researching different health insurance coverage options: HMOs, PPOs, Health Savings Account-qualified High Deductible Health Plans, and other choices.
- Introducing you to the concept of a private health exchange, which gives you and your employees access to multiple health plans in a single program;
- Helping you find out which plans offer access to your preferred doctors and hospitals;
- Determining your employee benefits budget, so it’s right for your business while still offering your employees more choice and access to the health care they want and need;
- Enrolling your employees – whether you want a traditional “paper” enrollment or the convenience and speed of online enrollment;
- Making changes to your employees’ coverage throughout the year, such as when you hire a new employee, or assisting with a claims-related matter;
- Helping you at renewal, whether you want to continue your existing coverage, adjust your employee benefits budget, or consider a change to your employee health plan.
There’s no cost to you for your broker’s services
You may be surprised to learn a broker’s services are free. In fact, a broker could save you and your company money because he or she has the insurance expertise to find the most comprehensive benefits at the most competitive cost for your business.
What makes a private exchange a good choice for your company and employees?
While no two small businesses are alike, many employers like the convenience and ease of administration offered by a private exchange.
For example, the CaliforniaChoice multi-carrier, employee-choice program offers many advantages:
- More employee choice – you and your employees get access to seven of the state’s leading health plans (and dozens of coverage options), so it’s easy to find the right plan for your individual or family health care needs; if you want to change plans at renewal, you can stay within the CaliforniaChoice program year after year.
- Cost control – you decide what you want to spend on your employees’ benefits, and that amount is locked in for 12 months. If an employee selects a plan that costs more than your contribution, he or she simply pays the difference in premium.
- Increased efficiency – one bill for all of your employees’ coverage (even if they choose different health plans from different insurers), one toll-free number when you or an employee needs assistance, and one website to manage your CaliforniaChoice benefits.
- Added perks – CaliforniaChoice offers more than just health care. It also offers a Business Solutions Suite which includes discount Dental, Vision, and Hearing services, a Premium Only Plan (POP), online human resources support from HRAnswerLink, an entertainment discount program and a free Flexible Spending Account (for groups of 15+), and more.
CaliforniaChoice has been helping small businesses offer the best health insurance for employees since 1996. If you would like to get a quote for CaliforniaChoice coverage for your employees, fill out our Contact Form and we’ll put you in touch with a broker who can help your employees sign up. Or, if you already have a broker, ask him or her about how CaliforniaChoice can help you increase choice for your employees, while still helping you control your costs.
When the Affordable Care Act (ACA) was enacted by 111th Congress and signed into law by President Barack Obama in 2010, it introduced the concept of “Essential Health Benefits” (or EHBs). However, how many of those 10 EHBs can you name? Here’s a summary.
All ACA-qualified plans must cover all of the following:
- Ambulatory Patient Services (outpatient care you can get without being admitted to a hospital)
- Emergency Services
- Hospitalization (including surgery and overnight stays)
- Pregnancy, Maternity, and Newborn Services
- Mental Health and Substance Use Disorder Services (including behavioral health treatment, counseling, and psychotherapy)
- Prescription Drugs
- Rehabilitative and Habilitative Services and Devices
- Laboratory Services
- Preventive and Wellness Services and Chronic Disease Management
- Pediatric Services, including Oral and Vision Care (Adult Dental and Vision coverage are not EHBs.)
Ambulatory Patient Services are the most common form of health care that you and your employees will likely need. This includes outpatient care, such as doctor’s office visits.
Emergency Services are those provided by a hospital emergency room (or emergency department) in the event of a sudden and serious health condition (such as a stroke or heart attack). ACA plans typically do not require a preauthorization for ER visits, although pre-authorization is often required before a covered employee or dependent is admitted to the hospital.
Hospitalization is covered, but plans may include a required co-payment or co-insurance amount (such as 20% if you or your employee has not yet reached your out-of-pocket maximum for covered services.
Pregnancy, Maternity, and Newborn Services: categorized as preventive services, maternity and newborn care are included in all ACA plans at no added costs. Traditionally, prior to the ACA, individual plans have excluded this coverage.
Mental Health and Substance Use Disorder Services: All ACA-qualifying plans must cover behavioral health treatment (such as psychotherapy and counseling), mental and behavioral health inpatient services, and substance use disorder (substance abuse) treatment. Pre-existing mental and behavioral health conditions are covered and spending limit cannot be more restrictive than limits applied to medical and surgical services.
Prescription Drugs were previously an available option that could be added to employer-sponsored health plans at an additional cost. Now, all ACA-qualified individual and small group plans include at least one drug in every category and class in the nation’s official publication of approved medications, U.S. Pharmacopeia. Another important distinction with ACA-compliant plans is that drug costs count toward an insured’s maximum out-of-pocket cap on medical expenses.
Rehabilitative and Habilitative Services include care to help you and your employees relieve pain resulting from injuries, disabilities, and chronic conditions (like multiple sclerosis) – and to help you recover mental and physical skills or regain your ability to speak, walk, or work.
Laboratory Services include preventive screening tests, such as prostate exams and Pap smears, as well as tests ordered by a doctor in diagnosing an illness (although a deductible, co-pays, and/or co-insurance may apply).
Preventive and Wellness Services, including chronic disease management, have no copay under ACA-qualified plans. In fact, the health care law requires 50 procedures recommended by the U.S. Preventive Services Task Force be covered at no extra cost, including well-woman visits, domestic violence screening, breastfeeding equipment, contraception, blood pressure screening, and cholesterol screening. More information is available here.
Pediatric Services, including health care and some Dental services and Vision care, are also covered for dependent children insured under ACA plans. It’s important to note, however, that adult Dental and Vision care are not Essential Health Benefits. (If you want to include Dental and Vision for your employees, you can add Voluntary or employer-sponsored coverage for those services.)
What to Know About Potential AHP Coverage
The White House proposal to expand the use of Association Health Plans (AHPs), where small business owners and their employees could join others in an association to purchase health insurance, could result in the elimination of coverage for some services now considered EHBs. Because association plans would be classified as Large Group plans, they would not be subject to the current ACA guidelines. Critics of AHPs have voiced concern about the potential elimination of benefits under the next generation of plans; however, it’s not yet known what form the plans could take. The “public comment period” is now underway and federal agencies and Congress will likely not adopt final rules until later this year or early next year.
Shop and Compare – with Help from a Broker
If you’re interested in knowing more about the employee benefits options available to you, your business, and your employees, a great place to start is to talk with your broker. If you do not currently have an employee benefits broker, we can help you find a CaliforniaChoice broker to speak with about a quote for your business. Contrary to what you might think, broker services are available at no cost to you.
All of the health plans offered through the CaliforniaChoice multi-carrier, employee-choice program are ACA-compliant and include the EHBs described above.