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Eight Insurance Carriers for the Price of One

Join over 300,000 Californians who have increased their health care options while keeping costs down.

With CaliforniaChoice you can provide medical, dental, vision, chiropractic, life, and ad&d in a single consolidated bill.

As an employer considering health insurance for your employees, you have multiple options available to you. You can look for coverage on your own. Or, you can shop for coverage with assistance from an employee benefits broker. You may choose to go directly to an insurance company to purchase coverage. Alternatively, you can shop for health coverage via a public or private health insurance exchange.

So, you may be wondering, what’s a health insurance exchange? A health insurance exchange offers you and your employees access to multiple health insurance plans through a single program. There are both “public” health insurance exchanges and “private” health insurance exchanges. In California, the public health insurance exchange is known as Covered California, which was established as part of the Affordable Care Act (ACA) signed into law by President Barack Obama in 2010. One example of a private health insurance exchange is CaliforniaChoice, which has been serving small businesses in California since 1996.

 

What Are the Similarities?

Both the state exchange (Covered California) and a private exchange (like CaliforniaChoice) offer you the option to choose from multiple health insurers in a single program. Some of your employees may choose one type of coverage – like a Health Maintenance Organization (HMO) health plan – while others may want to be able to access a certain doctor, medical group, or hospital that is only available through a Preferred Provider Organization (PPO) health plan.

Other health plan options may also be available like an Exclusive Provider Organization (EPO) plan, Health Care Service Plan (HSP), and Health Savings Account (HSA) qualified plan.

Both a public exchange and a private exchange give you choices and allow you and your employees to shop and compare health plans – so you find the coverage that is right for your specific health care needs.

 

What Are the Differences?

As you might expect, a public health insurance exchange is one administered by the government – at either the state or national level. California was the first U.S. state to establish its own state health insurance marketplace as part of the ACA. Covered California offers medical and dental coverage to individuals and small businesses statewide.

As required by the ACA, Covered California also offers pediatric dental and vision benefits, but vision coverage for adults is not an option on the state exchange.

As of 2018, a dozen states and the District of Columbia operated their own public health insurance exchanges. All other states used the federal marketplace, HealthCare.gov, to offer ACA compliant health coverage to their residents.

A private health insurance exchange – like CaliforniaChoice – is an insurance marketplace established by a private organization such as a Third Party Administrator (TPA). CHOICE Administrators is the TPA that operates CaliforniaChoice, and all plans offered through CaliforniaChoice are ACA compliant. Through the CaliforniaChoice private exchange, small businesses in California can access dozens of health plan options from eight different health insurers that operate in the state. Businesses can also add options for employee and dependent dental and vision benefits as well as other coverage.

While a public exchange generally offers only medical and dental insurance, a private exchange may offer more. For example, CaliforniaChoice offers employers and their employees a variety of discounts (including dental, vision, and hearing services) as well as resources that could help you and your employees save time and money.

These include a free Premium Only Plan (POP), access to HRAnswerLink (human resources support), employee discounts through the Cal Perks program, a no-cost California Rx prescription-drug discount card, an online Health Savings Account (HSA) Resource Center, a free Flexible Spending Account (FSA) for groups of 15 or more employees, COBRA billing services, and other benefits.

Optional services, including payroll, 401(k) integration, and access to other types of insurance, are also often available through a private exchange.

Because Covered California was launched in connection with the ACA, it has been in operation for about 10 years. The CaliforniaChoice private exchange opened in 1996, so it has more than 22 years of experience and expertise in delivering employee choice and multi-carrier exchange services to small businesses in California.

 

What’s Right for You and Your Business?

If you are interested in learning more about what’s available from a public or private exchange, talk with your employee benefits broker. He or she can help you decide what might work best for your business and your employees’ individual or family health care needs. If you do not have a broker, we can help you find one who will meet with you and provide you with a custom quote for health and other coverage for your employees (and dependents, if you choose).

You might also want to read our posts on Health Insurance Can Help You Better Compete for Employees and 7 Reasons to Use a Broker and a Private Exchange for Your Small Business Employees’ Health Insurance in 2018.

Offering group health insurance to employees – no matter what size your organization – is important. That’s because, more than at any other time in recent history, current and potential employees are seeking a better work and benefits experience. That’s what MetLife reports in its 2018 U.S. Employee Benefit Trends Study. Even if your business is not “required” to offer health benefits, it might still be something to consider – as you compete for workers in an increasingly competitive talent marketplace.

How to Qualify for Group Health Insurance

Let’s start by discussing what group health insurance is, and the rules concerning who qualifies for coverage? A group health insurance policy is one issued to an employer to provide coverage for eligible full-time employees. At the discretion of the employer, it may also include benefits for part-time employees (those working fewer than 30 hours per week) and/or the qualified dependents of employees.

If an employer offers any full-time or part-time employees health coverage, it must offer insurance to all employees, regardless of any pre-existing medical conditions.

Health insurers will write groups with as few as two covered persons (the business owner and an employee). However, some carriers will not write a policy for a husband and wife group if both are owners of the business, or if it is a sole proprietorship. Other business types such as an LLC, S-Corp, C-Corp, and Partnerships where the spouse is a W-2 employee are acceptable.

ACA Requirements for Small Businesses

The Affordable Care Act (ACA) employer mandate (still in force despite the House of Representatives’ effort to change it) requires employers with 50 or more full-time and full-time equivalent employees to offer health insurance. (Link here to the Healthcare.gov website for a calculator to determine your group size.)

Fifty-plus employers who do not offer eligible employees affordable coverage that includes what the ACA defines as “essential health benefits” are subject to a penalty. However, employers with fewer than 50 employees are not required to offer health benefits, and are not subject to a penalty – although many choose to offer benefits as part of their recruitment and retention strategy.

Group Health Coverage Costs

If you decide to purchase group health insurance for your employees, whether you pay the full cost of coverage or you share the cost with employees, what you pay is based on the ages of those individuals insured under your plan (including any dependents).

You will be able to choose from four ACA metal tiers: Bronze, Silver, Gold, and Platinum, each offering a different shared health care cost percentage, as shown in the graphic below:

ACA Metal Tier pricing

Some programs – including the CaliforniaChoice multi-carrier private exchange – allow you to choose more than one metal tier for your employees’ coverage. This gives you and your workers greater access to doctors, hospitals, and other providers offered by the eight plans available from CaliforniaChoice, so you can find the plan that’s right for your individual or family health care needs.

In addition, with CaliforniaChoice, you can more easily manage your employee benefits budget using Defined Contribution. You select your preferred plan and decide how much you want to spend on employees’ health insurance. You can choose a Fixed Percentage of the costs (from 50% to 100%) or a Fixed Dollar Amount. The choice is yours – and your cost per employee is locked-in for a year. At renewal, you can adjust your contribution (up or down) and lock it in for another 12 months.

Guaranteed Access

If you’re a small employer (with two to 50 full-time employees) and you want to offer health insurance to your employees, federal law guarantees your access to it. To learn more, contact your employee benefits broker. If you don’t already have a broker, we can help you find a CaliforniaChoice broker, who will work with you to build an affordable health plan quote that meets your employees’ needs.

Pro Tip: Broker services are typically available at no cost.

If you have a small business and you want to offer health insurance to your employee, there are three important things to know.

 

1. You Decide Who to Cover

If you’re a small business with fewer than 50 full-time and full-time equivalent (FTE) employees, the Affordable Care Act (ACA) does not require you to offer health insurance to employees. However, many smaller businesses offer employee benefits as part of their employee recruitment and retention strategy.

Small businesses do not have to offer coverage to employees’ dependents either, although many do – again, to help attract and retain top talent.

You also do not have to offer benefits to part-time workers (those averaging less than 30 hours per week) or seasonal workers.

 

2. You Set Your Budget

Controlling the cost of benefits is important for every business, but it’s even more important for a small business. The good news is you get to choose how much you want to contribute to your employees’ insurance premiums. Depending on the health plan or health insurance exchange you select, you may have a choice of a fixed percentage amount (50% to 100%) or a fixed dollar amount for each employee. If an employee selects a plan that costs more than you are contributing, he or she simply pays the difference. And, at renewal, you have the option to change your contribution – giving you control over your costs for another year.

You could qualify for a Small Business Health Care Tax Credit. To take advantage of this tax credit program, all of the following must apply:

Link here to find out if your company qualifies for SHOP coverage.

 

3. You Choose Your ACA Metal Tier

The ACA divides health plans into four “metal” tiers: Bronze, Silver, Gold, and Platinum. The tiers offer different levels of cost sharing between your employees and their selected health insurance plan, as shown below:

 

Plan Category/Metal Tier Insurance Pays Insured Employee Pays
Bronze 60% 40%
Silver 70% 30%
Gold 80% 20%
Platinum 90% 10%

 

Here’s a summary of the features of each tier:

Bronze

Silver

Gold

Platinum

You can offer your employees access to a single ACA metal tier or multiple tiers, depending on which insurance carrier(s) or health insurance exchange you select for your group’s coverage.

 

Help Is Available

Offering health insurance to your employees is easier than you might expect. A health insurance or employee benefits agent can assist you in shopping for coverage and determining your benefits budget. Working with an agent is free, too. If you don’t have an agent, we can help you find one.

At CaliforniaChoice, we are all about offering you and your employees health care choices. That’s why we have expanded our Affordable Care Act (ACA) metal tier options for coverage effective in 2019.

You can now choose from three metal tier options for your CaliforniaChoice coverage:

  1. SINGLE TIER: Access to a single ACA metal tier (Bronze or Silver or Gold or Platinum).
  2. TIERED CHOICE: Access to plans and benefits in two adjoining metal tiers (Bronze/Silver, Silver/Gold, or Gold/Platinum).
  3. TRIPLE TIER: Access to plans and benefits in three metals tiers: Silver, Gold, and Platinum.

 

 

Best of all, the Triple Tier option does not cost you more. That’s because you decide what you want to spend on employees’ health care with Defined Contribution. Your contribution is the same for each employee regardless of how many ACA metal tiers are offered or what tier each employee chooses.

 

How ACA Metal Tiers Work

Each metal tier offers a different level of cost sharing between the health plan/insurer and the insured employee (or dependent).

 

ACA Metal Tier Health Plan/Insurance Pays Insured Pays
Bronze 60% 40%
Silver 70% 30%
Gold 80% 20%
Platinum 90% 10%

 

For employees who want to minimize their monthly premium, and may not need a lot of medical care, a Bronze metal tier HMO plan makes sense. For an employee who may want access to a broader network of doctors and specialists, a Gold tier PPO may be the way to go. For employees who can afford higher premiums, and want the lowest out-of-pocket costs when seeking care, a Platinum plan is appealing.

 

Learn More by Talking to an Agent

Call or email your employee benefits agent to learn more about the expanded metal tier options available from CaliforniaChoice. He or she can also share information on the many other ways CaliforniaChoice can help you offer affordable health insurance to your employees. If you do not have an agent, we can help you find one.

If you own or manage a small business and you’re considering offering health insurance to your employees, it’s important to be informed before making a decision. We’ve answered seven of the most common questions concerning health insurance for employees of small businesses.

 

1. Is health insurance required?

Currently, the “employer mandate” of the Affordable Care Act (ACA) is still in place. If your business employed, on average, a combination of 50 or more full-time and “full-time equivalent” (FTE) employees during six months or more of last year (or, this year, if you’re a start-up), you are considered an Applicable Large Employer. As an ALE, you must provide employees and their eligible dependents with affordable, minimum essential health insurance coverage. If you do not offer such coverage, your business is subject to ACA penalties if at least one full-time employee receives a premium tax credit for enrolling in health insurance through a state exchange (like Covered California).

If you have fewer than 50 employees, you are not required to offer health insurance coverage (nor are you subject to a penalty for not offering it). However, many small business owners do elect to extend such benefits to their employees. That’s because, in today’s highly competitive talent marketplace, health insurance and other perks can help level the playing field when it comes to attracting new employees and retaining your existing staff.

 

2. How is “affordable” coverage determined?

Affordability is determined by whether the employee’s share of the premium for personal coverage costs no more than 9.56% of his or her household income in 2018. The figure for 2019 is 9.86% of household income. If an employer’s coverage is not considered affordable, the business is subject to a penalty: the lesser of $3,480 for each full-time employee receiving a premium tax credit subsidy or $2,320 for each full-time employee (minus the first 30 employees).

 

3. What’s the maximum Waiting Period?

If you offer health insurance to your employees, you must offer it to all eligible employees within 90 days of the date they start their employment. Coverage must begin no later than 91 days after employment begins.

You can choose a shorter waiting period, such as 30 or 60 days, but you cannot offer a longer waiting period. Many employers choose to make coverage effective the first of the month following 30 days of employment. So, for example, if an employee started on May 15, coverage would be available beginning on July 1. (Link here to download a PDF of IRS guidance on the 90-day waiting period limitation.)

 

4. What are the rules on SBCs?

Businesses that offer health insurance to employees are required to provide a standard “Summary of Benefits and Coverage” (SBC) that explains what’s covered by each plan and the related costs. The SBC is designed to help employees better understand their health insurance options when comparing plans. Failing to comply with the ACA’s requirement concerning SBCs could subject your business to a fine. Your insurance company, health insurance exchange, or third party administrator will be able to provide you with an SBC in advance of your group’s enrollment.

 

5. What are the ACA reporting requirements?

The ACA requires Applicable Large Employers (see above) to report to the IRS annually on health insurance coverage offered – or not offered – to eligible employees and dependents.

It further requires reporting by all employers of any size who sponsor self-insured health insurance coverage or a QSEHRA (Qualified Small Employer Health Reimbursement Arrangement).

 

6. Is there a minimum employer contribution?

Employers with fewer than 50 full-time equivalent employees are not subject to the ACA’s employer mandate, so they are not required to make a certain percentage contribution to employees’ costs.

Small businesses looking to qualify for a Small Business Health Care Tax Credit must:

Some health insurance carriers and administrators do require at least 50% of the premium be paid by the employer. Ask your employee benefits agent for information about the plans you’re considering.

 

7. Where can I get help?

Using a health insurance or employee benefits agent can help you save time and money. And, working with an agent is free.

Your agent can provide you with valuable assistance, including answers to any questions you may have – about health insurance, offering voluntary or employer-sponsored coverage (or a combination), and benefits budgeting. If you do not already have an employee benefits agent, we can help you find one.

In 1996, CaliforniaChoice challenged the health care status quo. We created the first multi-carrier, employee-choice private health insurance exchange designed to meet the needs of small businesses in California. Today, CaliforniaChoice serves more than 18,000 employers and 300,000 members, and our membership continues to grow.

If your organization has fewer than 50 employees, CaliforniaChoice can help you deliver valuable health insurance options to your employees. Here are five reasons to choose CaliforniaChoice:

 

1. Employee Choice

The modern workplace has evolved. Offering a single health plan option to your multigenerational workforce is no longer sufficient. Today’s employees have different health care needs. To compete for the most talented workers, you must be able to give your employees a choice.

CaliforniaChoice offers you access to eight different health plans statewide – and the greatest access to doctors, specialists, and hospitals in California – through a single program. You and your employees can choose from dozens of Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO), Health Care Service Plan (HSP), and Health Savings Account (HSA) compatible options.

For example, one employee might select a PPO from Anthem Blue Cross because of a specific doctor or hospital in its network. A second employee might choose an HSP from Health Net. Another employee who wants a lower copay plan might select an HMO from Kaiser Permanente or UnitedHealthcare. A fourth employee might want access to a regional option like Oscar, Sharp Health Plan, Sutter Health Plus, or Western Health Advantage. With us, the choice is yours.

 

2. Employer Cost Control

Controlling benefits costs is an important consideration for employers, and CaliforniaChoice makes it easy. Using what we call Defined Contribution, you choose how much you want to contribute to your employees’ health insurance premiums. You can choose a Fixed Percentage Amount (50% to 100%) toward a specific benefit, or a Fixed Dollar Amount, for each employee. (Your contribution must be the same for all employees.)

Each employee then uses your generous contribution toward the cost of the plan he she prefers. (Think of it as a sort of health care voucher.) If employees pick plans that costs more than your contribution, they simply pays the difference.

The amount you choose is locked in for a full year – and you can change it at your group’s renewal.

 

3. Optional Benefits

CaliforniaChoice offers great medical benefits for your employees, and the opportunity to offer additional benefits like Dental, Vision, Chiropractic & Acupuncture, and Life and AD&D. Employees can tailor their coverage to their specific individual or family needs.

CaliforniaChoice gives you the ability to meet nearly all of your employees’ health needs without the hassle of dealing with multiple insurance agents.

 

4. Free Value-Added Extras

When you make CaliforniaChoice coverage available to your employees, you also get no-cost extras.

 

Business Solutions Suite
1-14 Employees 15-19 Employees 20+ Employees
Discount Dental

Discount Vision

Discount Hearing Program

Premium Only Plan

(Initial set-up fee covered at no cost)

Online HR

Cal Perks Employee Discounts

Prescription Drug Discount Card

HSA Resource Center

Cal-COBRA Billing

Discount Dental

Discount Vision

Discount Hearing Program

Premium Only Plan

(Initial set-up fee covered at no cost)

Online HR

Cal Perks Employee Discounts

Prescription Drug Discount Card

HSA Resource Center

Cal-COBRA Billing

Flexible Spending Account

Discount Dental

Discount Vision

Discount Hearing Program

Premium Only Plan

(Initial set-up fee covered at no cost)

Online HR

Cal Perks Employee Discounts

Prescription Drug Discount Card

HSA Resource Center

Flexible Spending Account

Federal COBRA Billing

 

5. Easy Enrollment and Single Source Administration

CaliforniaChoice offers Smart Decision Technology to streamline the enrollment process, provide more information about each available plan, and simplify the process of finding the right doctor.

You can choose online or paper enrollment, or a combination, depending on the method that best suits your employees. In addition, throughout the year, your agent or our Customer Service team will help you when you hire a new employee, add coverage for a dependent, or make other changes.

 

Talk to an Agent to Learn More

If you’re ready to find out how CaliforniaChoice can help you offer health insurance to your employees, contact your employee benefits agent. If you don’t have an agent, we can help you find one.

CaliforniaChoice Adds Oscar Health to Portfolio

CaliforniaChoice, recently announced that it is adding Oscar Health to its CaliforniaChoice small business, multi-carrier private exchange. With the addition of Oscar, employers with up to 100 employees have access to eight health plans through CaliforniaChoice.

Oscar Health, a consumer-focused, technology-driven insurer known for its industry-leading member engagement, is offering Los Angeles County and Orange County employers 9 EPO (Exclusive Provider Organization) plan options, including two Bronze, two Silver, three Gold, and two Platinum plans.

“Oscar is an affordable health care alternative for small businesses,” said Ron Goldstein, president and chief executive officer of CHOICE Administrators. “It offers employees free 24/7 telemedicine, a personalized Concierge service, and a mobile app that makes it easy to manage health benefits and find care.”

“We are pleased to partner with CaliforniaChoice to offer employers and employees access to our strong provider network that includes top physicians and hospitals like UCLA Health, Providence St. Joseph Health, and others,” noted Michael Lujan, California Market Director at Oscar Health.

In addition to Oscar, the health plans available regionally or statewide through CaliforniaChoice are Anthem Blue Cross, Health Net, Kaiser Permanente, Sharp Health Plan, Sutter Health Plus, UnitedHealthcare, and Western Health Advantage.

About CHOICE Administrators

CHOICE Administrators is the parent organization of the nation’s largest multi-carrier, small group private health exchange, CaliforniaChoice, and America’s first ancillary benefits exchange, ChoiceBuilderCHOICE Administrators’ programs are designed to extend greater access and choice to the health care purchasing experience. The company empowers enrollees to make more informed enrollment decisions, while providing sponsoring employers with the infrastructure to control their employee benefits budgets.

About Oscar Health

Oscar is a data-driven, consumer-focused health insurer that is committed to improving the member experience by making it easier for members to navigate the complex health care system. Oscar achieves this through personalized, technology-enabled service that helps members along their health journey and empowers them to choose quality, affordable care. The Oscar member experience includes a personalized concierge team, 24/7 telemedicine, mobile and web apps to access health information easily, and a tightly integrated network of first-rate physicians and hospitals. Oscar has been offering individual plans in California since 2016 and started serving the small business community in 2018. To learn more visit https://hioscar.com/la.

Click here to Get a Quote or Speak to an Agent  about Oscar Health plans for your group today!