We put together this Group Health Insurance FAQ as a helpful guide for companies looking to start offering group health insurance plans to their employees.
Here’s just a preview of what you’ll find inside:
- Common questions from businesses like yours about group health insurance and the CaliforniaChoice program
- Answers to questions about managing the cost of offering health insurance coverage
- Information on group health insurance eligibility and requirements
- Insights on the benefits of offering group health coverage
- Tips for allowing your employees to pick a health plan that works best for their needs
Download your copy today!
Decoding the Affordable Care Act (ACA) employer mandate can be difficult for the average small business owner. For some businesses, offering health insurance coverage is required. For others, it’s a choice. We’re breaking it down and shedding light on what you need to know to ensure your business is ACA compliant.
Do employers have to offer benefits to full time employees?
Applicable Large Employers with 50 Employees or More
The Tax Cuts and Jobs Act of 2017, signed by President Trump on December 22, 2017, eliminated the ACA individual mandate penalty (for not having health insurance). However, it did not affect the employer mandate, which applies to Applicable Large Employers (ALEs) with 50 or more full-time employees and/or full-time equivalent (FTE) employees. The ACA employer mandate remains in force. If your business employs 50 or more full time employees, offering health insurance is required.
Depending on how you staff your organization, calculating the number of full-time employees (including FTEs) can be complex. If you’re unsure of your group size, visit the Healthcare.gov website to use a group size calculator. When considering your group size, employees working 30 or more hours per week are considered full-time.
Employers that qualify as ALEs are subject to the ACA’s shared responsibility provisions and the reporting requirements concerning minimum essential coverage. ALEs must offer health insurance that is “affordable” and provides “minimum value” to 95% of full-time employees and their eligible children up to age 26. If you are an ALE and do not offer ACA-compliant coverage, you are subject to penalties. For 2019 employer penalty information, consider reading this article by the Society for Human Resource Management.
If your business had, on average last year, fewer than 50 full-time employees (including FTEs), you are not an ALE for the current calendar year. Still, it’s important that you evaluate your potential ALE status annually.
While non-ALEs are not required to offer health coverage to employees, you can voluntarily do so. In fact, many employers not subject to the employer mandate offer health insurance and other employee benefits because it helps them compete in an increasingly competitive talent market.
Qualifying for Group Health Insurance
If you offer full-time employees health coverage, you must make it available to all employees, regardless of any pre-existing medical conditions. Health insurers will write groups with as few as two insured persons (the business owner and an employee). However, many 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. LLC, S-Corp, C-Corp, and Partnerships where a spouse is a W-2 employee are acceptable to most insurers. Ask your employee benefits agent for more information on qualifying for group health insurance.
Cost of Coverage
If you choose to purchase health insurance for your employees, the next step is determining how much you want to contribute toward the premium. With Defined Contribution, available from the CaliforniaChoice multi-carrier private exchange, you can choose a Fixed Percentage Amount (from 50% to 100% of the cost of a selected coverage level) or a Fixed Dollar Amount. Whatever amount you choose applies to each employee, and your cost is locked-in for a full year. At renewal, you can adjust your contribution up or down and lock it in for another 12 months.
Finding a Plan
You can choose to purchase coverage directly from an insurance company, or you can use an independent agent to help you shop multiple plans. A multi-carrier exchange like CaliforniaChoice or the state’s ACA exchange, Covered California, can expand your employees’ options without increasing your costs.
CaliforniaChoice also allows you to choose one or more ACA metal tiers for your employees. This gives you and your staff greater access to doctors, hospitals, and other providers offered by the eight health plans available across the state from CaliforniaChoice. The networks for CaliforniaChoice include 84,355 individual health care providers and 389 hospitals (as of August 2019).
To learn more about the health plan options available for your group, contact your employee benefits agent. If you don’t already have one, we can help you find an agent.
Health Care Benefits Don’t Have to Be One Size Fits All
Each of your employees is different, and those differences extend to their health care needs. Traditional “one size fits all” health plans can prove limiting. As an employer, you may have wondered whether you can offer different health care benefits to your employees. You can, with CaliforniaChoice. Our multi-carrier private health insurance exchange includes eight different health plans across California.
Coverage Choice Wherever You Are
With CaliforniaChoice, you and your employees have access to Anthem Blue Cross, Health Net, Kaiser Permanente, and UnitedHealthcare statewide. If you are located in Northern California, you also can choose coverage from Sutter Health Plus and Western Health Advantage. Southern California businesses have added health plan options from Oscar Health in Los Angeles and Orange counties and Sharp Health Plan in the San Diego area. Combined, there are nearly 90 options available, so you and each of your employees can easily find coverage that’s right for their individual or family health care needs.
The provider network for CaliforniaChoice is unparalleled. Each health plan offers a diverse roster of physicians, medical groups, and hospitals. In total, there are 84,355 unique individual health care providers and 389 unique hospitals across the state.
CaliforniaChoice gives your employees the freedom to choose the health plan that’s right for them. One of your employees might select a PPO from Anthem Blue Cross because it includes a favorite doctor or hospital in its network. A second employee might choose coverage from Health Net. Another employee who is looking for a lower copay might select an HMO from Kaiser Permanente or UnitedHealthcare. A fourth employee might prefer a regional plan like Sutter Health Plus, Western Health Advantage, Oscar, or Sharp Health Plan. With CaliforniaChoice, it’s their choice. As an added perk for you, the coverage selected by all of your employees is included in a single bill each month.
Tools to Find the Right Plan
CaliforniaChoice offers several tools to help match your needs to the health plans available through our multi-carrier exchange.
- Automated Choice Profiler: Thisonline assistant give users the ability to review premiums, deductibles, and other out-of-pocket costs (like copays and co-insurance) to get a total estimated cost of coverage. Employees can view side-by-side plan comparisons based on costs, risk, and quality.
- Online Provider Search: This tool takes the guesswork out of finding the right doctor by helping employees find out in advance whether a preferred doctor is part of any of the health plans offered through CaliforniaChoice. It’s easy to search by city or ZIP Code, doctor’s name or gender, health plan, hospital affiliation, language(s) spoken, and distance from a targeted city or ZIP Code (like home or office).
- Online Rx Search: You and your employees can use this tool to match your prescription drug needs to available plans. It’s easy to look up medications alphabetically, by brand or generic drug name, therapeutic class (prescriptions for pain, infection, or treatment of the heart), or health condition.
Employer Cost Control
Beyond giving your employees more options from which to choose, CaliforniaChoice helps you control your employee benefits expenses, too. With Defined Contribution, you choose how much you want to contribute to your employees’ health insurance premium. It’s up to you if you want to choose a Fixed Dollar Amount or a Fixed Percentage Amount (50% to 100%) toward a specific benefit. The contribution for each employee does need to be the same.
Your employees then use your contribution toward the cost of coverage for the plans they like best. It’s like a health care voucher. If employees choose coverage that costs more than you’re contributing, the employees simply pay the difference. The amount you choose is locked-in for the plan year, and you can change it at renewal if you choose.
Get Help from an Agent
A health insurance agent can help you set your contribution amount and discuss available options. Best of all, there’s no cost for an agent’s service. If you do not already have an agent, you can search for one here. You can find additional information on this subject in our prior post, 6 Things to Consider When Choosing an Insurance Agent for Your Business.
CaliforniaChoice Takes Your Digital Security Seriously
Cyberattacks and information security breaches are on the rise in today’s high tech and data-driven environment. The list of examples goes on at length.
In July 2017, it was discovered that an Equifax data breach exposed the names, birth dates, Social Security Numbers, and credit card information for 147.9 million consumers. In September 2018, Marriot International had data stolen on approximately 500 million customers. More worrying, the Marriot breaches started in 2014 and were not discovered for four years.
Security magazine reports 2.8 billion consumer data records were exposed in 2018, costing U.S. organizations more than $654 billion. Health care was the hardest hit sector – with 48% of all breaches. Among the most high profile health care breaches are the 2015 Anthem, Inc. hack that affected nearly 80 million people and a breach at Premera, which impacted Blue Cross and Blue Shield members in 30 states.
Data protection is serious business. Companies who want to earn and maintain the trust of customers must be willing to invest in security products to protect consumer data. CaliforniaChoice is committed to preventing breaches in security as is reflected in the recent certification from HITRUST, the most prestigious certifiable security framework for the health care industry.
The HITRUST CSF Certification is the benchmark that organizations required to safeguard Personal Health Information (PHI) are measured against regarding information protection. By taking the steps necessary to obtain HITRUST CSF Certified status, CHOICE Administrators has distinguished itself as an organization that people can count on to keep their information safe. This achievement places the companyin an elite group of organizations worldwide that have earned this certification.
You and your employees can take comfort in knowing your personal information is secure with CaliforniaChoice and CHOICE Administrators.