If you’re considering health insurance and employee benefits for the first time, you may not know what to expect. Here are five of the most common questions that employees ask about employee benefits and insurance coverage. Knowing how to respond can make a big difference in successfully attracting and retaining employees.
1. Who selects my plan?
Traditionally, you (as the employer) select the health plan you want to offer to employees. However, let’s face it, the chances of one health plan satisfying the needs of every employee are not likely.
CaliforniaChoice offers a different approach to employee benefits. With our program, you no longer have to select one health plan; instead, you can offer eight different health plans from which employees can choose.
For example, one might choose an HMO plan from Kaiser Permanente, while another finds a PPO from Anthem Blue Cross is a better fit for the needs of his or her family. It’s their choice.
If your workforce is scattered across California, your employees can choose from three of the state’s leading regional health insurers: Sharp Health Plan in the San Diego area and Sutter Health Plus and Western Health Advantage in Northern California.
With CaliforniaChoice, you can offer your employees access to one, two, or three Affordable Care Act (ACA) metal tiers:
- a single tier (Bronze, Silver, Gold, or Platinum)
- two adjoining metal tiers (Bronze & Silver, Silver & Gold, or Gold & Platinum)
- three tiers (Silver, Gold, and Platinum)
Your decision does not affect your costs, since you’re able to lock-in your benefits budget using Defined Contribution. (See below.)
Because CaliforniaChoice offers eight health plans statewide and both full and limited networks, our program offers your employees more choice when it comes to doctors, specialists, and hospitals than any single health plan.
2. How much will my coverage cost?
The cost of health insurance for your employees ranges quite a bit, depending on the type of coverage you offer. Typically, you base what you spend on a percentage of the cost of the insurance or you pay a fixed amount.
One of the advantages of the CaliforniaChoice program is you get to choose what you want to spend. You define what you can contribute toward employee benefits, then each employee can take those dollars and use them toward the health plan they like best. Employees aren’t forced to choose something.
We call this budgeting approach Defined Contribution:
- You can contribute a Fixed Percentage (50% to 100%) of a specific plan type, OR you can choose to contribute a Fixed Dollar Amount.
- You decide whether you want to contribute to coverage for your employees’ dependents as well.
If an employee selects a plan that costs more than your contribution, he or she simply pays the difference. At renewal, you have the option to adjust your Defined Contribution up or down, giving you complete control over what you spend on your employees’ benefits.
If you contribute only to employee coverage, enrollees will pay more if they choose to add dependent coverage. If you contribute to employee and dependent coverage, employees will pay less when enrolling eligible family members.
It is important to note, though, that if your company is what the ACA defines as an Applicable Large Employer (ALE), you must include dependent child coverage (through age 25) for children of full-time or full-time equivalent employees. You are not required to offer spouse coverage, nor do you have to include coverage for a stepchild, foster child, or a child who is not a U.S. citizen. For more information, refer to the Q&A on the Healthcare.gov website. (Note: rules could change if there’s a future ruling in the pending court challenge to the ACA.)
3. When am I eligible to enroll?
You, as the employer, determine when your employees are eligible for health insurance and other benefits. Under ACA guidelines, for plan years beginning on or after January 1, 2015, employers cannot apply a waiting period exceeding 90 days for group health insurance. More information is available in the archives of the Federal Register.
Many employers choose to have coverage on the first of the month following 30 days of employment. For example, if an employee began work on February 10, 2019, he or she would be eligible for benefits on April 1, 2019. Other businesses might choose the first of the month following 60 days of employment. Using this same hypothetical new hire, who starts on February 10, 2019, he or she would be eligible for benefits starting May 1, 2019.
Consider what other employers in your area or your industry are using as a standard for benefits eligibility when establishing your waiting period.
4. Is my current doctor in the network?
If you offer CaliforniaChoice to your employees, there’s a good chance their current doctors are part of one or more of the provider networks offered by the eight health plans that are part of CaliforniaChoice.
It’s easy to determine your doctor’s network status by using the Provider Search tool on the CaliforniaChoice website. It allows you, your employees, and their dependents to look up California medical providers by name, gender, city or ZIP Code, distance from your home or office, affiliated health plans, language(s) spoken, hospital, or medical group. The Provider Search is one of several online tools from CaliforniaChoice to help you and your employees compare plans and find the one that’s right for your health care needs.
5. Can I get Dental, Vision, and other coverage?
CaliforniaChoice offers a comprehensive array of optional employee benefits, including Dental, Vision, Chiropractic & Acupuncture, and Life Insurance. CaliforniaChoice also offers discounted health care services, human resources support, COBRA billing services, Rx Discounts, and more available to you and your employees at no added cost through the Member Value Suite and Business Solutions Suite.
Get a Custom Quote
If you and your employees have questions of your own, your employee benefits agent can provide you with answers. He or she can also deliver a custom CaliforniaChoice quote for your business.