Open enrollment is now underway from coast to coast for Individual & Family Plan (IFP) coverage and employer-sponsored health coverage for 2021. If you’re among those employers considering your employee benefits options for the new year, you may wonder about the amount you might pay, advantages of offering coverage, and what you can do to ensure you get the best deal. We have some tips for you.
Offering Insurance May Be Required
The Affordable Care Act (ACA) changed many of the rules about health insurance, and one of them is a requirement that Applicable Large Employers (ALEs) must offer health insurance to full-time and full-time equivalent (FTE) employees (working at least 30 hours per week) as well as their dependent children through age 26. The minimum essential coverage must be both “affordable” and provide “minimum value” to employees.
If you’re not sure if your business is an ALE, there are multiple ACA Full-Time Equivalent Employee Calculators available to help you determine your group size. The CaliforniaChoice private exchange offers one tool, as does Healthcare.gov.
A qualifying plan meeting the minimum value requirement is one designed to pay at least 60% of the total costs of medical services and includes substantial coverage for physician and inpatient hospital services. Sixty percent is equal to the cost sharing for those enrolled in ACA Bronze Tier plans, where the insured pays 40% of the costs for coverage, while the insurance company pays the remaining 60% of costs. Additional information about ACA metal tiers is available on the Healthcare.gov website.
No More Pre-existing Conditions Exclusions
One of the most significant changes brought about by the ACA is the elimination of the pre-existing medical condition limitations or exclusions. In the days preceding the ACA, it was common for insurers to limit or exclude coverage for health conditions that predated the effective date for coverage. Today, all ACA-qualified health plans will write coverage for an individual regardless of his or her health, and all persons of the same age can expect to pay the same for their coverage.
To learn more about “what’s included” in ACA-compliant health coverage, read our related post, How to Get Group Health Insurance — and What It Covers.
If you’re wondering about costs, you should know there are many factors that go into calculating your costs for employer-sponsored health insurance. These include:
- Who is covered: Do you want to offer coverage only to full-time employees, or to employees and eligible dependents?
- What coverage you choose to offer: HMO, PPO, EPO, or a combination of plans?
- Your employees’ ages: For groups of up to 100, premiums are based on each employee’s age (and the age of any dependents, if insured).
- What amount you contribute to employee premiums: A private health insurance exchange, like CaliforniaChoice, lets you decide what you want to pay by giving you the opportunity to choose your own Defined Contribution.
CaliforniaChoice lets you choose a Fixed Percentage of 50% to 100% of the cost of a specific plan and/or benefit – or a Fixed Dollar Amount for each employee. (The contribution needs to be the same for all employees.) Then each of your employees applies your contribution to the premium for the coverage he or she likes best. If the premium exceeds your contribution, the employee pays the difference. Link here to watch the CaliforniaChoice video on Defined Contribution on YouTube.
The Kaiser Family Foundation (KFF) annually publishes an employer survey on health benefits costs, which provides a detailed look at premium, cost-sharing, and other trends. Among the 2020 highlights are an average premium of $7,470 for single coverage and $21,342 for family coverage. The family premium for workers at smaller firms is slightly lower than for those at large firms ($20,483 vs. $21,691). Both single and family coverage premiums are up four percent from 2019. A detailed summary of the KFF 2020 survey is available here.
Advantages of Offering Coverage
In addition to helping you attract and retain employees, there is another big reason to consider health insurance and other benefits for your workers: tax savings.
Benefits are not taxable to employees for FICA (the Federal Insurance Contributions Act) or income tax withholding purposes, nor are they taxable for you for purposes under FICA and FUTA (the Federal Unemployment Tax Act).
According to the IRS, if an employer pays the cost of an accident or health plan for employees, including an employee’s spouse and dependents, “. . . the employer’s payments are not wages and are not subject to Social Security, Medicare, and FUTA taxes, or federal income tax withholding.”
It is worth noting, however, that the cost of health insurance benefits must be included in the wages of S Corporation employees who own more than two percent of the corporation.
Supreme Court Review of ACA
The U.S. Supreme Court heard arguments in the case challenging the constitutionality of the Affordable Care Act during the week of November 11, 2020. It’s a case that could substantially disrupt health care coverage for millions of Americans – whether they get coverage through their employers, the state and federal exchanges, Medicaid, or elsewhere.
The ACA challenge brought by Republican attorneys general is based on an argument that the ACA’s individual mandate provision was made unconstitutional by a 2017 tax change by Trump administration. Under that update to tax law, Congress reset the ACA penalty for not having health insurance to zero effective in 2019. How – or when – the Court will rule on the constitutionality of the ACA is unknown at this time. Watch for more news on the matter in future posts on our site.
Learn More by Talking to a Broker
To get more information about how you might implement an employee benefits program, talk with a broker. A broker can provide a customized quote for you, your business, and your employees. If you’re not currently working with a broker, we can help you find one here. If you want coverage to begin in January, you’ll want to act soon.
The 2020 holiday season will be unlike any other you and your workers have experienced thanks to COVID-19. That doesn’t mean you should skip celebrating the upcoming holidays with your employees. In fact, coming together – even virtually – is important to building and maintaining team morale. Be sure, though, you do it in a safe and comfortable way for all.
Here are several ideas to consider.
Start by Decorating
Everyone likes a festive office. If your employees have returned to work, even for reduced days, a decorated space sets a positive tone. You may also want to give awards for individually decorated cubicles or offices. This will add some friendly competition to the mix. If your workforce is mostly remote, you can base your contest on home decorations.
Get the Trees Involved
Decorating does not have to be limited to the office or home. Whether your employees celebrate Christmas or not, they may still enjoy a tree-decorating contest. This can happen on site or remotely. On-site workers can decorate on a staggered schedule to uphold social distancing. Remote workers can compete against each other with their home-decorated trees.
Classic Ugly Sweater Contest
The ugly sweater contest never seems to gets old. It’s a chance for your team to be creative. Define categories – funniest, ugliest, and most festive – and have employees vote on each one. Prizes can go to the winner in each category. This competition is particularly easy to coordinate whether staff is on- or off-site.
Holiday Party with a Twist
Unfortunately, a big, in-person holiday party is probably not an option this year. If you do attempt a socially distant party, all employees should wear masks. Many companies are opting for virtual holiday parties this year. You could get together on a video conference platform like Zoom, Skype, or Microsoft Teams, and play holiday-themed games and music.
Virtual Gift Exchange
Something else you can do virtually is a gift exchange. You can ask employees to share a short list of gift items or gift cards they would like, and then draw names among those who volunteer to take part. (It’s a good idea to make the whole thing voluntary, since some staff may not celebrate Christmas.) You can ask that all items be mailed to your office and then redistribute them to employees’ home addresses, share addresses so employees can mail items directly to their coworkers, or limit gifts to e-cards that can be sent via email. The folks at Teambuilding.com offer other Secret Santa ideas here.
We offer tips on streamlining your gift giving using Cal Perks here. ADD LINK TO OTHER POST FOR DECEMBER
Start Planning Now
If you haven’t started planning, now is the time. Don’t wait to announce your plans. Give your employees something to look forward to – and a chance to prepare for your holiday activities.
You and your employees know that having choices is important. We do, too – “choice” is part of our name. CaliforniaChoice gives you the freedom to choose from eight different health plans in a single employee benefits program.
However, having choices is not enough if you don’t understand how each of the health plans we offer differ from one another. You need to understand the advantages offered by each. Our ongoing series of plan comparisons breaks it down for you.
The comparison below looks at Anthem Blue Cross and Sutter Health Plus, two of the statewide health plans available through CaliforniaChoice.
Anthem Blue Cross
Among the top insurers in the state, Anthem Blue Cross delivers health insurance coverage to millions of Californians. The insurer offers health improvement programs, simplified administration, and flexible, innovative benefits.
Anthem Benefits Overview
- Contracted with more than 90% of hospitals in California, including 400 acute care hospitals
- One of the largest PPO networks in the country with access to thousands of doctors and specialists and more than 60,800 doctors and specialists in California
- Strong network contracting with an average 60% hospital discount and 48% average provider discount
- Online cost and care finder tools and via the Anthem mobile app; it’s easy to compare costs for common services and procedures; you can also check the quality of health care providers through member reviews and ratings
- PayForward gives you an opportunity to earn cash back shopping at thousands of retailers; a Special Offers program includes discounts on health products and services
- Wellness programs and tools to help keep you active and fit
Sutter Health Plus
A not-for-profit health plan, Sutter Health Plus serves the Greater Central Valley, Sacramento, and San Francisco Bay Area areas of Northern California, offering competitively priced HMO health plans. With Sutter Health Plus, you have 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
- Competitively priced coverage offering members access to a broad network of providers
- Convenient locations for primary care, specialty care, X-ray and diagnostic imaging, hospital services, lab, and more
- Welcome calls to help members better understand benefits and coverage – and assist in facilitating initial appointments
- Coverage anywhere in the world for emergency and urgent care
- Access to a mail-order pharmacy program and conveniently located retail pharmacies
- My Health Online (not offered by all providers) to schedule appointments, email doctors, view test results, and access medical records
- A 24/7 nurse advice triage line
The CaliforniaChoice Advantage
You can offer your employees coverage from eight health plans through CaliforniaChoice – so it’s easy to find one that best meets their unique health care needs. For example, one employee might select Anthem Blue Cross because it includes a preferred doctor, while another employee might choose Sutter Health Plus because of its premier regional provider network. With CaiforniaChoice, they both get what they prefer, while other employees have access to six additional regional and statewide health plan options.
CaliforniaChoice offers other advantages, too. Like one monthly bill for all employees’ coverage, a Member Value Suite with discounts on gym memberships and fitness gear, a Business Solutions Suite that includes a no-cost Premium Only Plan, and a single email and toll-free phone number for customer care.
Visit our website again to see other CaliforniaChoice plan comparisons, including:
- Health Net
- Kaiser Permanente
- Oscar Health
- Sharp Health Plan
- Western Health Advantage
For additional information about CaliforniaChoice and its Member Value Suite and Business Solutions Suite, talk with your employee benefits agent or health insurance broker. If you don’t already have one, we can help you find one here.
CaliforniaChoice gives you and your employees the freedom to choose coverage from eight different health plans in a single program. “Choice” is a part of our name – and we have been offering more health plan options to Californians since 1996.
Choice is important, but having information to help you understand the advantages offered by each of your health plan options is essential, too. That’s why we launched this ongoing series of comparisons to break it down for you.
The comparison below looks at UnitedHealthcare, available statewide, and Sharp Health Plan, which serves the San Diego area.
UnitedHealthcare of California provides access to quality care and helps you manage your family’s health care costs. The insurer’s large California HMO network includes local physicians and health care professionals in your community. Offering a combination of benefits, quality care, wellness programs to help keep you and your family healthier, and award-winning customer service makes UnitedHealthcare the smart choice for your family’s health care coverage needs.
UnitedHealthcare Benefits Overview
- A broad network of quality local doctors and hospitals
- A member website, uhcwest.com, providing online tools and resources
- Health and wellness programs
- Preventive care for covered family members
- Fitness reimbursement program
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
- HMO Platinum, Gold, Silver, and Bronze plans
- High Deductible Bronze HMO and Health Savings Account (HSA) plans
- High-performance health care network with more than 600 Primary Care Physicians, 1,100 specialists, and 13 local hospitals
- Sharp Nurse Connection after-hours nurse advice line
- Global emergency service program operated by Assist America
- Treatment for minor illnesses and injuries available at CVS MinuteClinic® locations nationwide
The CaliforniaChoice Advantage
With CaliforniaChoice, you and your employees can find a health plan that best meets your individual needs. One of your employees might choose UnitedHealthcare because of its statewide provider network. Another employee might prefer the benefits of a “hometown” health care provider like San Diego-based Sharp Health Plan. With CaliforniaChoice, they both get what they want – plus the option to choose from six other plans, too.
The advantages of CaliforniaChoice are not just for your employees. There are benefits for you, too — like the ability to manage all of your employees’ health insurance benefits in a single program and pay just one monthly bill. CaliforniaChoice also offers single source administration for enrollment, eligibility, and customer service.
Check back to see additional CaliforniaChoice comparisons for these health plans:
- Anthem Blue Cross
- Health Net
- Kaiser Permanente
- Oscar Health
- Sutter Health Plus
- Western Health Advantage
An employee benefits agent can help you learn more about all of the advantages and coverage options from CaliforniaChoice. If you do not have an agent, we can help you can find one here.