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COVID-19 has underscored the importance of health insurance for Americans across the country. Harvard researchers Sumit Agarwal and Benjamin Sommers, tackle this topic in their online article. The article was published in August 2020 in the the New England Journal of Medicine. Agarwal and Sommers explore how the protections provided by the Affordable Care Act (ACA), have increased as we deal with COVID-19.

The researchers reference data from the U.S. Department of Health & Human Services, including its Medical Expenditure Panel Survey of individuals and families, medical providers, and employers. They compare actions taken by those who lost their jobs in 2014 (before the ACA took effect) and those losing their jobs more recently.

Argawal and Sommers point out the differences versus the pre-ACA health insurance market. Today, a wide range of insurers offer guaranteed issue coverage and are mandated to cover essential health benefits. This contrasts to a pre-ACA market with fewer insurer regulations, no pre-existing condition limitation, skimpier plans with coverage dollar limits (annually or lifetime), and often-unaffordable rates with no available subsidies.

They also note the expansion of coverage through the ACA that permits children to be covered on a parent’s health plan though age 26, as well as the expansion of Medicaid programs (Medi-Cal in California) to give new options for coverage unrelated to employment.

State and Carrier Actions

With the onset of COVID-19, health insurance carriers and states made coverage available to those previously declined during open enrollment. Some opened a special enrollment period (SEP). California’s public health exchange, Covered California, gave eligible uninsured individuals the opportunity to apply from March 20 to June 30. That SEP was extended to July 31, and then extended further to August 30.

Although the Centers for Medicare & Medicaid Services (CMS) did not authorize a nationwide SEP (where anyone who is uninsured could enroll), the agency reported higher HealthCare.gov enrollment through existing SEPs. A June report cited more than 892,000 individuals used a SEP to enroll for coverage through May 2020 – an increase of 27% compared to 2019. Loss of employer-sponsored coverage or coverage through a spouse are among several life events that can trigger an SEP. More information on Covered California qualifying life events is available here.

Coverage Options

For individuals who lose their employer-sponsored health insurance, coverage options include:

While short-term (limited duration) health insurance plans are available in many states, they are not an option for Californians. The legislature eliminated availability in Senate Bill (SB) 910, which was enacted in 2018 and became effective in 2019.

Court Review

The U.S. Supreme Court is schedule to hear arguments in the case challenging the constitutionality of the Affordable Care Act the week following the November 2020 election. With the recent death of Associate Justice Ruth Bader Ginsburg, the case could be delayed. A ruling by the Court to end the ACA could disrupt health care coverage for millions of Americans. This includes those getting coverage through their employers, the state and federal exchanges, Medicaid, and elsewhere.

The lawsuit centers on a case brought by Republican attorneys general who argue the ACA’s individual mandate provision was made unconstitutional when the penalty for not having ACA-compliant health insurance was reset to zero under a 2017 tax overhaul implemented by the Trump administration. That position stems from the Supreme Court’s prior ruling in a 2012 case that upheld the ACA because it found the law was an appropriate use of the power of Congress to tax.


The Affordable Care Act (ACA) mandates that employers with 50 or more full-time and full-time equivalent (FTE) employees must offer affordable, minimum value medical coverage to full-time employees and their dependents (up to the end of the month in which they turn age 26). If an employer does not provide coverage, it is subject to ACA penalties.


The challenge for employers is finding coverage that meets ACA requirements and fits within budget. CaliforniaChoice can help. Our program offers four distinct advantages over a single health plan option.

1. More employee choice

Today, more than ever before, people expect choices – whether they’re shopping for gas, cell phone service, or health care. CaliforniaChoice delivers.  

CaliforniaChoice offers you and your employees:

At CaliforniaChoice, we recognize that each of your employees is different. We are different, too. We offer 80+ coverage options from eight health plans doing business in California: Anthem Blue Cross, Health Net, Kaiser Permanente, Oscar Health, Sharp Health Plan, Sutter Health Plus, UnitedHealthcare, and Western Health Advantage.

One of your employees might choose Anthem Blue Cross PPO coverage because it includes his or her preferred doctor. Another employee, who is looking to minimize costs, might choose an HMO from Kaiser Permanente or UnitedHealthcare – or one of the Northern California or San Diego regional health plans available through CaliforniaChoice. Someone looking for an EPO might choose Oscar Health or Anthem Blue Cross. With CaliforniaChoice, it’s their choice. Whatever they choose, you get one bill for all of your employees’ coverage each month.

2. Tools to find and enroll in the right plan

CaliforniaChoice offers a variety of tools to help you and your employees find and enroll in the right coverage.

3. Affordable coverage – and a way to control your costs

Using what we call Defined Contribution, you decide what amount you want to contribute to your employees’ health benefits. You can choose a Fixed Dollar Amount or a Fixed Percentage Amount (50% to 100%) toward a specific plan or benefit level.

Your employees then use your contribution to pay for the cost of the plan they like best. If the coverage they select costs more than you’re contributing, the employee pays the difference. It’s that simple.

Your costs are locked in for 12 months, and at renewal you have the option to adjust your contribution – up or down.

4. Easy admin plus value-added extras

With CaliforniaChoice, you get outstanding service from our A+ rated team plus value-added services you would have to pay more for elsewhere. That includes free HR support, a Flexible Spending Account, COBRA administration, and discounts for your employees on dental, vision, hearing services, wellness products, entertainment, and more.

Talk with a broker to learn more

A health insurance broker can help you determine your Defined Contribution, shop and compare plans, and provide you with a quote tailored to your business. You might not know the services of a broker are usually free, and using a broker can actually save you money. Your broker will know your area and have information about what doctors and hospitals are available in each plan. If you don’t already have a broker, you can search for one here.

When it comes to group health insurance, small business owners have many questions on the subject. For example:

We’ve provided answers to these frequently asked employer questions and insights related to group health insurance.

Group Size

As we discussed in a prior article, How to Get Group Health Insurance — and What It Covers, group health insurance is available to groups with as few as two employees. However, some plans and insurers do not offer coverage to husband and wife groups if both are owners of the company. Other business types like an LLC, S-Corp. C-Corp, or Partnership (where the spouse is a W-2 employee) are acceptable.

Smaller groups often think individual health insurance may be less expensive than offering a group health plan to employees; however, since the introduction of the Affordable Care Act (ACA), with the elimination of the pre-existing condition limitation, coverage for smaller groups is sometimes more affordable than individual plans for multiple plans. An employee benefits broker can help you compare plans to find the one that works best for you, your business, and your employees. 

Coverage Options

Regardless of your group size, if you are shopping for a group health plan, you’re likely to see HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), or EPO (Exclusive Provider Organization) plans. You may even be able to select a High Deductible Health Plan that is compatible with an HSA (Health Savings Account). In some areas, Point of Service (POS) plans may also be available.

Each plan offers different out-of-pocket costs and co-pays and may or may not include coverage outside of a specified provider network. Some EPOs and HMOs may serve only a certain geographic region.

If you select the CaliforniaChoice multi-carrier, private health exchange, you can give employees the option to select the plan type that works best for their individual or family health insurance needs, while still controlling costs for your business.

More Than Health Coverage

You can also offer your employees access to other types of insurance, which can be offered on a voluntary-only basis. Of course, you can also contribute to your employees’ cost for coverage, if you choose.

Popular ancillary and supplemental coverages include:

Value-Added Extras

Depending on your source for coverage, your health plan, carrier, or administrator may offer value-added benefits such as these available through CaliforniaChoice:

Getting a Quote

An employee benefits agent can provide you with more information on specific plans available in your area and the costs associated with each. If you do not already have an agent, you can search for one here.

It’s hard to know for sure what might be “the norm” by the time Halloween rolls around this year. Some workplaces in California may be fully staffed and working on-site, while others may still be working remotely.
Still, Halloween can be used as an opportunity to strengthen your culture, build morale, and nurture collaboration – for onsite and offsite workers.

Here are onsite and remote options to help you celebrate Halloween with employees in 2020.

WORKING ONSITE

Be sure to pick the one that best fits your company, culture, and work situation.

Department or Office/Cubicle Decorating: If your employees have returned to work, even if they are alternating days in the office, you can encourage them to get in the spirit of the season by decorating their workspace. Halloween is on a Saturday this year, so if you have a competition among employees or departments, you will want to have your judging on Thursday or Friday, so employees know before they take off for the weekend whether they won. You can give individual awards (like a gift card) or hand out a ribbon and bragging rights until next year. It’s helpful to have pre-determined themes – like a graveyard or haunted house – or you can leave it to your leaders and employees to come up with a theme on their own.

Halloween Party: A party is not likely a viable option this year, since close interaction with others could increase the risk of exposing workers to the coronavirus. If you do attempt a socially distant party, it’s imperative employees wear a mask. A ready reserve of hand sanitizer is recommended, too.

WORKING OFFSITE

Costume Contest: A costume contest is something you can do in-person and in a socially distant and responsible way via Zoom or other online meeting technology.

Establish rules for your competition and share them with all of your employees. Avoid costumes that would embarrass anyone or be too provocative. You want the contest to be fun and encourage creativity, without crossing the line concerning good taste.

While group competitions are fairly common in company-sponsored costume contests, this year you may to emphasize individual competitions instead. Doing so equalizes things for all competitors – whether they are onsite or remote.

As far as evaluation criteria, you might consider “most original/creative,” scariest, worst, and best costumes. One or more of your employees who seem shy may want to show off hidden talents when behind a mask or wearing a costume. Being in lock down for much of 2020 may spur unknown creativity among a few of your workers.

Pumpkin Carving Contest: This is also something that works in the office or if your employees are working remotely. For onsite workers, you can ask competitors to carve their pumpkins offsite and bring them to work ready for judging. If you’re not concerned about the mess, and you can arrange for employees to be socially distant, have them carve their pumpkins onsite and limit the window in which they have to do the carving. The added pressure could yield more interesting results.

For onsite competitions, be sure you supply all of the tools needed – and a de-seeding station. If everyone guts their pumpkins before taking them to the “carving station,” you can limit the mess. Providing aprons can be helpful, too.

A table with paint, glitter, and other decorative options gives everyone an equal chance to win. You can also avoid the mess altogether by limiting your contest to jack o’ lanterns decorated with a Sharpie.

If you have offsite workers, you can ask everyone to prepare their pumpkin and “unveil” them on a prearranged Zoom call/meeting. Then everyone can publicly – or secretly – cast their ballot by sharing it in an email . . . with results announced before the sign-off for the week.

START PLANNING NOW!

We know, it’s only September, so you’re thinking Halloween is weeks away. Don’t wait to announce your plans. If you want your employees to be enthusiastic about a competition, give them time to prepare. Some organizations with a serious commitment to All Hallows’ Eve start planning in August.

When you’re looking at the options available to you and your business for your employee benefits program, you’ll want to research value-added extras offered by the insurers, exchange, or third-party administrator you’re considering. Those value-adds can make a big difference in employee satisfaction.

CaliforniaChoice offers a variety of value-added features and benefits for employers and employees. Among the most popular employee programs is Cal Perks, which is part of the CaliforniaChoice Member Value Suite.  

What’s Included in Cal Perks?

The Cal Perks discount program gives you and your employees access to 200+ amazing offers that can save you hundreds of dollars annually on things you will use and places and services you and your employees will love.

The Cal Perks program includes deals on:

Download the Cal Perks flyer.

Best of all, Cal Perks is constantly evolving. Many savings opportunities were just added in 2020. Cal Perks is just one of the value-added advantages offered to CaliforniaChoice members.

In addition to Cal Perks, the CaliforniaChoice Member Value Suite offers you:

Learn more about the value-added benefits in the CaliforniaChoice program by watching the video here.

You can also talk with your broker to learn more about CaliforniaChoice. It’s the multi-carrier, private health exchange offering health insurance benefits from eight of California’s leading health plans – Anthem Blue Cross, Health Net, Kaiser Permanente, Oscar Health, Sharp Health Plan, Sutter Health Plus, UnitedHealthcare, and Western Health Advantage – plus other benefits you would pay more for elsewhere. If you don’t already have an employee benefits broker, check out our broker directory.

The Mycalchoice.com link roundup brings you the latest updates in Employee Benefits and Group Health Insurance news. Here are the top stories of the week for Labor Day Weekend September 4th:

Employee Benefits News

Virtual Benefit Fairs

September 2020 Predictions

Group health care trends

Predictions in 2030

COVID-19’s Impact at Home

Trends in Employee Benefits

What is being over looked by 401 (k) participants today

Future workplace imagined

Employees getting the most of out enrollment

California Group Health Care Updates

1 in 5 in San Diego with COVID-19

Fauci Debunks COVID-19 Conspiracies

We know health insurance is a hot topic generating many questions in the minds of business owners. Among the most-frequent questions are:

We’d like to help by offering some answers and sharing some resources you may find useful. Let’s look at answers to frequently asked questions:

What can I expect to pay for employees’ health insurance?

Your costs for employer-sponsored group health insurance depend on many factors, including:

Some employers offer coverage only to employees working full time. Others include options for part-time employees. The choice is yours. Depending on the insurer or health plan you select, you may also have a choice in the percentage of the premium you pay for employees’ coverage.

The 2019 Kaiser Family Foundation (KFF) Employer Health Benefits Survey found that employers were contributing an average of 77% of a plan’s cost. However, that 77% is not uniform across the board.  For a more in-depth analysis on the expected costs of health insurance, read How Much Should a Business Pay for Employee Health Insurance?

Do I have to offer health insurance to my employees?

Before the Affordable Care Act (ACA) was enacted, health insurance coverage for groups was based on the size of the group, the health of the participants, past claims experience, and other factors. Rates were banded, which means employees in the same age band (for example, 20 to 29) would pay one rate, while employees in other bands (30-39, 40-49, etc.) would pay a different rate. Today, for groups of up to 100 employees, rates are based on the specific age of each employee, spouse, and child covered.

Another change with the ACA is the elimination of pre-existing medical condition exclusions (which, pre-ACA, could influence rates). Today, all employees in an ACA-qualified group health plan can get coverage regardless of their health. All persons of the same age are charged the same premium for the same plan.

If you are what the ACA defines as an Applicable Large Employer (ALE), you are required to offer health insurance to full-time or full-time equivalent (FTE) employees and their dependent children through age 25. The ACA’s Shared Responsibility Provision (also referred to as the Employer Mandate) says employers with an average of at least 50 full-time or FTE employees working at least 30 hours per week must offer minimum essential coverage that is both “affordable” and provides “minimum value” to employees.

A health plan meets the minimum value requirement if it’s designed to pay at least 60% of the total costs of medical services for a standard population, and it includes substantial coverage for physician and inpatient hospital services.

If you’re uncertain whether your business qualifies as an ALE, you can use a ACA Full-Time Equivalent Employee Calculator to help you determine your group size. This tool is among many employer resources on the CaliforniaChoice website. (Click on “ACA Calculators” in the lower-right section of the web page.) Additional resources are available on the HealthCare.gov website, which includes a section specifically addressing employer questions.

How can I control my costs and still offer health insurance to my employees?

What you contribute to the cost of coverage for your employees is up to you. As mentioned before, though, if you’re an ALE, you must contribute enough toward each employee’s cost so that coverage remains “affordable.” For 2020, the IRS says the threshold for determining affordability is whether the cost of coverage for the employee is less than 9.78% of household income. This number is updated annually and was 9.86% in 2019; in 2021, it will be 9.83% according to published reports.

An ACA Safe Harbor Calculator can be useful in helping you determine whether the plan(s) you’re considering fit the criteria for affordability under any of the safe harbor tests. You can find such a calculator on the CaliforniaChoice website (link above), with additional guidance on the IRS website.

With the CaliforniaChoice multi-carrier private health exchange, you establish your own Defined Contribution toward employee coverage. You can choose a Fixed Percentage of 50% to 100% of the cost for a specific plan and/or benefit, or you can choose a Fixed Dollar Amount for each employee. The choice is yours. Then, each of your employees applies the contribution you make toward the cost of the coverage he or she wants. If an employee selects a plan that costs more than your contribution, he or she pays the difference. You can learn more about Defined Contribution in this CaliforniaChoice video on YouTube.

How can I keep my workers and customers safe in the era of COVID-19?

Employee and customer safety is of paramount concern to employers across California and the country.

The Centers for Disease Control and Prevention (CDC) suggest several steps business owners and managers can implement to protect employees and limit business disruption:

These additional tips can further help protect workers and customers:

For more guidance on keeping your employees and customers safe during the era of COVID-19, check out the resources and tools offered by SHRM, the Society of Human Resource Management.

If you want information about how you can implement a group health program for your business, talk with an employee benefits broker. The services of a broker are typically available at no cost – and using a broker can save you money, as compared to shopping for insurance on your own. If you don’t already have a broker, we can help you find one here.

When it comes to something as important as health insurance, having a choice should be a given. CaliforniaChoice provides you with that choice. Our program offers the freedom to choose from eight different health plans in a single program.

To help guide your decision, we’re highlighting the unique offerings for each of our eight plans [link to hub]. Let’s compare Sharp Health Plan and Sutter Health Plus, two regional health plan options available through CaliforniaChoice.

Sharp Health Plan

Sharp Health Plan is the only local, commercial health plan, serving San Diego since 1992. As a non-profit company, Sharp Health Plan gives back to the community by providing access to affordable health care of the highest quality, serving a variety of organizations ranging from small businesses to large employers to municipalities.

Sharp Health Plan Benefits Overview

Sutter Health Plus

Not-for-profit Sutter Health Plus offers competitively priced HMO health plans in the Greater Central Valley, Sacramento, and Bay Area. When you choose Sutter Health Plus, you gain access to a high-quality provider network that includes many of Sutter Health’s nationally respected and recognized hospitals, doctors, and other health care services – all at an affordable price.

Sutter Health Plus Benefits Overview

The CaliforniaChoice Advantage

With CaliforniaChoice, you and your employees have more choice – and the ability to find insurance that meets your unique needs. One of your employees might choose a plan because of its broad PPO network. Another employee might select HMO coverage from a regional or statewide plan. With CaliforniaChoice, they both get what they need – while other employees have the option to choose from six other plans.

There are benefits for you, too – like a single monthly bill for all of your employees’ coverage and single-source administration for enrollment, eligibility, and customer care.

Check back to see additional comparisons on other CaliforniaChoice plans, including:

An employee benefits agent can provide you with more information about the advantages of CaliforniaChoice and the coverage options available. If you don’t already have an agent, you can search for one here.

Having choices when it comes to health insurance is important. After all, health care is not “one size fits all.” We knew that when we started CaliforniaChoice in 1996, and it’s equally important today. CaliforniaChoice gives you and your employees the freedom to choose from eight different health plans in a single health insurance program.

Choice is important, as is having information to help you choose the health plan that is right for you. We’re breaking it down and comparing key benefits of each of our eight participating health plans in a comparison series. Below, we compare the benefits of Kaiser Permanente and Oscar Health, two popular health plans available through CaliforniaChoice.

Kaiser Permanente

Kaiser Permanente was founded in 1945 and was one of the nation’s first health programs to offer comprehensive health care services on a prepaid basis.

Headquartered in Oakland, California, Kaiser Permanente’s innovative spirit drives the country’s largest non-profit health care organization – guided by physicians and focused on providing high-quality care to members.

Kaiser Permanente Benefits Overview

Oscar Health

Oscar is the country’s first technology-driven health insurer focused on improving the member experience through easy, personalized service.

Oscar for Business was launched to bring the same Oscar experience that individuals already love to the employer market.

Oscar Benefits Overview

Oscar’s mobile app makes it easy to manage benefits, find great care, and see everything in one place. You can easily search for doctors in your network, track your deductible, understand your claims, see lab results and prescriptions, access your digital member ID card, message your Concierge team, and talk to a doctor via Doctor on Call.

The CaliforniaChoice Advantage

With CaliforniaChoice, you can offer your employees coverage from eight health plans (with dozens of coverage options), so they can easily find the one that best meets their unique needs. For example, one employee who travels frequently in the state could choose a plan based on its vast network of providers across California, while another employee might select a plan with an integrated approach to health care through its own facilities. With CaiforniaChoice, they can both get what they want, while other employees have access to six other statewide and regional health plan options.

CaliforniaChoice offers more than great health insurance. You get one monthly bill for all of your employees’ coverage, value-added benefits like the Member Value Suite and Business Solutions Suite, and a single email and toll-free phone number for enrollment, eligibility, and customer care.

Check back to see other comparisons for CaliforniaChoice plans, including:

For additional information about all of the advantages offered by CaliforniaChoice, talk with your employee benefits agent or insurance broker. If you don’t have one, we can help you find one here.

Health care is not one size fits all, which is why CaliforniaChoice gives you the freedom to choose from eight different health plans in a single program. While everyone loves choices, understanding the options and selecting a health plan that is right for you and your family can be a confusing process. So, we’re breaking it down and comparing key benefits of each of our eight participating health plans. We are kicking off our comparison series with Anthem Blue Cross and Health Net.

Anthem Blue Cross

Anthem Blue Cross is among the state’s top insurers, delivering health insurance coverage to millions of Californians. The insurer offers flexible, innovative benefits, health improvement programs, and simplified administration.

Anthem Benefits Overview

Health Net

Founded in 1977, Health Net of California is one of the largest health insurers in California – offering a range of plans to millions of California residents, including 12 HMO options through CaliforniaChoice.

Health Net Benefits Overview

The CaliforniaChoice Advantage

With CaliforniaChoice, your employees can choose the health plan that meets their unique needs. For example, one employee could choose Anthem Blue Cross because of its large PPO network. Another employee could select Health Net because of its 24/7 accessibility to nurses and doctors.

There are benefits for employers, too. You can manage all of your employees’ benefits in a single program and pay just one monthly bill. CaliforniaChoice offers a single source of administration for enrollment, billing, eligibility, and customer service.

Check back to see additional plan comparisons, including:

Talk with your employee benefits agent or insurance broker to learn more about all of the advantages and coverage options from CaliforniaChoice. If you don’t already have an agent, we can help you find one here.