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A new year is here and with it come several changes to health care, insurance requirements, and costs. Here’s what you need to know for 2019.

The State of the ACA

In December 2018, a Texas judge ruled that the Affordable Care Act (ACA) is unconstitutional. However, it will still take time for the case to play out. It is now being considered by the Fifth U.S. Circuit Court of Appeals in New Orleans. Even after that court rules, further appeals are expected, and the case could wind up before the U.S. Supreme Court in 2020.


New for 2019, the U.S. Department of Health & Human Services (HHS) – the federal agency that administers the ACA – announced updated payment and cost-sharing provisions, risk adjustment program changes, and increased flexibility in the operation of the federal and state-based exchanges. The latter includes Small Business Health Options Program (SHOP) exchanges, such as Covered California for Small Business.


In proposed rules, the ACA’s risk adjustment program, which mitigates potential adverse selection for participating insurers, would be updated. The goals are to reduce regulatory requirements and empower both consumers and employers. Among the measures designed to grant states increased flexibility is the ability to modify Essential Health Benefits (EHBs), which could increase affordability of coverage for individuals and small businesses.

Large Employer Mandate

The federal employer mandate, which affects businesses with 50 or more full-time or full-time equivalent employees, continues in 2019. It requires Applicable Large Employers (ALEs) to offer “affordable” health insurance that provides minimum value to 95% of full-time employees and their children up to age 26, or to face penalties. For help determining whether your business is an ALE, ask your employee benefits agent, or visit the IRS ALE web page.


Smaller employers – those with fewer than 50 full-time equivalent employees – are not subject to the ACA employer mandate and are not required to provide employees with health insurance coverage. Those businesses that elect to offer employee health insurance may qualify for a Small Business Health Care Tax Credit, subject to certain federal qualification guidelines.

Health Insurance Reform in California

California Gov. Gavin Newsom announced in his inaugural address on January 7, 2019, that he wants the state to adopt its own individual mandate. He also called for new state-funded subsidies to help middle-class Californians afford health insurance. Whether Congress will act to give the state greater authority to implement its own health care programs, while still receiving federal funding, remains uncertain.

Premium and Deductible Forecasts

Experts at HR consultant Mercer expect an average group health insurance premium increase per employee of 4.1 percent in 2019 for employers making plan changes. For those not making plan changes, the expected increase is 5.3 percent. Over the past decade, health care cost increases have ranged from 2.1 percent (in 2013) to 6.9 percent (in 2010) for employers making plan changes, based on research by the Society for Human Resource Management (SHRM).


In 2018, employees paid nearly a quarter of their premium for single coverage (23 percent) and one-third (31 percent) of their family coverage premium. Those amounts are up less than one percent from the previous four years, according to a report by the International Foundation of Employee Benefit Plans (IFEBP). A similar trend is expected in 2019. Mercer research last year found the average cost of employee health coverage was $12,666 for all employers, $12,148 for employers with 10-499 employees, and $13,018 for employers with 500 or more employees.


For workers with employer-sponsored health plans, deductibles have gone up, too. Those with individual health coverage, nearly half (46 percent), now have a deductible between $1,000 and $2,999. For employees with family coverage, roughly one-third (29 percent) have a similar deductible, while 26 percent have a deductible of $3,000 to $4,999, and nearly a quarter (23 percent) have a deductible of $5,000 or more.

What Does It Mean for Your Business?

To understand what these changes mean for you and your business, it’s important to consult an expert. Your employee benefits agent can walk you through your options and provide a health insurance quote based on your budget and needs. If you’re not currently working with an agent, you can search here for one in your area.

Multiple Options: One Program

Employees worry about two things when choosing their health care benefits – access to their preferred doctors and hospitals and the monthly expense. With CaliforniaChoice, they don’t have to worry. That’s because we offer multiple options and affordable rates in one program.

Give Your Employees Choice with 8 Health Plans

CaliforniaChoice has been helping small businesses offer flexible health insurance solutions to their employees since 1996. With CaliforniaChoice, your employees can choose from one of eight health insurance carriers and you can control your costs.

Total Choice Option

Total Choice satisfies everyone. CaliforniaChoice gives you access to health plans and benefits available in all four tiers: Bronze, Silver, Gold, Platinum. Employees can buy up or down, allowing you to keep costs low without limiting choice to employees.

Cal Perks

With Cal Perks, small businesses can get discounts to the things employee love most including movie tickets, theme and water parks, and more. Check out this video for a highlight of the available extra benefits provided to you and your employees when using Cal Perks through the CaliforniaChoice employee benefit program!

If you’re shopping for insurance for your small business, you may have come across the term “health insurance package.” While the term may be foreign, the concept should be familiar.

Think of a health insurance package in the same way you can “bundle” your phone, cable, and wi-fi services. Three different services in one package that make it easier for you to manage.

Health insurance packages are similar. They bundle a variety of health insurance and other employee benefits into a single program. The goal is to help you meet your employees’ individual and family health care needs, while also minimizing administration for your business.

Health Insurance + More

The core insurance offered is typically Health Insurance and may include HMOs (Health Maintenance Organization), PPO (Preferred Provider Organization), EPOs (Exclusive Provider Organization), or HSA (Health Savings Account) compatible plans.

Besides Health Insurance, what really makes it a “package” is the additional coverage you have access to, such as:

Value-Added Extras

Your Health Insurance package may be further enhanced by value-added benefits like the following:

Advantages of a Small Business Health Insurance Package

Like with telecommunications services, one of the biggest advantages of packaging your employee health care with other benefits is convenience. When you bundle your services, you have just one contact for your benefits – your agent. You also have one administrator responsible for billing all of your organization’s benefits for employees. That way, you only have to write one check each month for all of your employees’ coverage – and you have one website and one toll-free number for service-related questions.

It’s Easy to Learn More

Your employee benefits agent can provide more information on a Health Insurance Package to suit the needs of your business and employees. If you do not already have an agent, you can search for one in your area here


Good News for Groups!

CaliforniaChoice recently made two big announcements, both of which are a net positive for California small business owners and employees.
Oscar Health is now available to small groups in Los Angeles County and Orange County for coverage beginning December 1, 2018, or later. That means, CaliforniaChoice now offers eight different network options.

CaliforniaChoice Health Plans

The Oscar provider network offers employees access to more than 3,500 physicians across 140 medical specialties and sub-specialties. It gives employees access to many of the region’s top hospitals and medical centers, including:

Oscar brings a consumer-centric approach to health insurance with nine affordable Exclusive Provider Organization (EPO) plans across all four Affordable Care Act metal tiers. While many health plans require members to visit a primary care physician before seeing a specialist, Oscar does not have such a requirement. Your employees enrolled in Oscar have the freedom to go directly to any in-network specialist – saving them time and money.

The Oscar “Doctor on Call” program lets insured employees and their dependents talk to a board-certified doctor free and get a prescription over the phone. No copay is required and no office visit is needed.

Oscar also offers a no-cost Concierge Service, which gives members access to a personalized care team with a comprehensive knowledge of their health history. The Oscar mobile app makes it easy for participating employees and dependents to manage benefits, look up doctors, view lab results, send messages to their Concierge team, and access a digital ID card.

No More Late Fees

In other news, effective 10/1/18, CaliforniaChoice is no longer charging a late fee if a small business is late on its monthly payment.

If you are interested in learning more about Oscar Health for your small business employees, or if you want to get a quote for any of the eight health plans available through CaliforniaChoice, call or email your employee benefits agent. If you do not already have an agent, we can help you find one.