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Health care is not one size fits all, which is why CaliforniaChoice gives you the freedom to choose from nine different health plans in a single program. With so many options, CaliforniaChoice fits the diverse health care needs of your employees – there’s a plan for everyone.

To help you understand the key benefits of plans offered through the CaliforniaChoice program, we’re comparing each of them and highlighting what makes them unique. In this comparison we’re looking at Cigna + Oscar and Kaiser Permanente.

Cigna + Oscar

Partnering in 2020, Cigna + Oscar is designed to work for small businesses. It brings together the power of Cigna’s nationwide and local provider networks and Oscar’s member-focused experience. The companies offer affordable, seamless, fully insured health benefits for small businesses and their employees.

Cigna + Oscar Benefits Overview

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

The CaliforniaChoice Advantage

CaliforniaChoice gives you and your employees the ability to choose the health plan that meets your unique needs. For example, one of your employees could choose Kaiser Permanente because of its statewide HMO network. Another employee could select Cigna + Oscar  because of its 24/7 accessibility to nurses and doctors.

However, the advantages of CaliforniaChoice go beyond great health insurance options. There are extras for employers, too. CaliforniaChoice offers single source administration for enrollment, billing, eligibility, and customer service. You can manage all of your employees’ health insurance benefits in a single program – and pay just one monthly bill.

Check back to see additional plan comparisons, including:

Your employee benefits agent or insurance broker can help you learn more about all of the coverage options from CaliforniaChoice. If you don’t already have an agent, you can find one here.

People want choices in life – from where the live to what they wear to the car they drive. When it comes to something as important as health care, everyone deserves the freedom to find the option that meets their individual needs. That’s why we offer access to nine premier health plans in a single program.

Knowing the key benefits of each of our plans can help members decide which plan is right for them. Our CaliforniaChoice plan comparison series takes a closer look at what you can expect from each. This comparison highlights Health Net and Cigna + Oscar.

Health Net

Established in 1977, Health Net of California is among the state’s largest health insurers. It offers a range of coverage options to millions of California residents. Within the CaliforniaChoice program, you and your employees can choose from 12 different HMO options.

Health Net Benefits Overview

Cigna + Oscar

Partnering in 2020, Cigna + Oscar is designed to work for small businesses. It brings together the power of Cigna’s nationwide and local provider networks and Oscar’s member-focused experience. The companies offer affordable, fully insured health benefits for small businesses and their employees.

Cigna + Oscar Benefits Overview

The CaliforniaChoice Advantage

With CaliforniaChoice, you and your employees have more choice – and the ability to find health insurance that meets your unique needs. One of your employees might choose a PPO plan because of its broad health 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 dozens of coverage options.

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 available coverage options. If you don’t already have an agent, you can search for one here.

Beyond helping your business attract and retain top employees, offering health insurance to your staff offers other advantages, including tax benefits.

Here’s a look at four of the tax benefits of offering health insurance.

Tax Deductibility

Generally, employers are able to deduct 100% of the cost of premiums paid for health insurance for employees and/or their dependents from both their business’s federal and state income taxes.

Reduced Payroll Taxes

Offering a Section 125/Premium Only Plan (POP) to your employees can reduce your payroll taxes and give them the ability to fund their portion of their health insurance premiums on a pre-tax basis. Their portion of your group health plan premium may be less than comparable individual health coverage they could purchase on their own.

A POP also allows employees with a High Deductible Health Plan (HDHP) to reduce their taxes by the amounts contributed to Health Savings Accounts (HSAs). The combination can yield a total payroll deduction of 25% to 40%.

Employers can also usually deduct HSA contributions (on behalf of employees) from their small business’s taxes.

Some business owners may find offering Health Reimbursement Arrangements (HRAs) a more flexible option. Instead of funding a group health plan, the employer sets aside funds to reimburse employees, tax free, for plans they purchase on the individual market. Your HRA contributions are tax deductible for your business and Federal Insurance Contributions Act (FICA) and Federal Unemployment Tax Act (FUTA) payroll taxes do not apply. For employees, HRA reimbursements are excluded from their gross income and are 100% tax-free.

According to reporting by the U.S. Chamber of Commerce, Qualified Small Employer HRAs (QSEHRAs) are gaining traction because they offer employers cost control, while giving employees more choices. Additional information on QSEHRAs is available at HealthCare.gov.

ACA Tax Credits

Depending on your group size, your business could be eligible for small business health insurance through the Covered California state exchange, which is part of the federal marketplace exchange program established by the Affordable Care Act (ACA).

The Covered California for Small Business exchange offers health insurance to employers if:

If you are a sole proprietor with no employees receiving a W-2, you are not eligible for coverage through Covered California for Small Business; however, you could be eligible for individual coverage through the state exchange. More information is available here.

The tax credit available through Covered California for Small Business works on a sliding scale. If your business is small or you employ workers with a lower annual average wage, your tax credit is likely to be higher.

50% Premium Tax Credit Max: If you are a for-profit employer, the maximum tax credit available through Covered California is 50% of your premium expense for employees’ coverage. For non-profit/tax-exempt employers, the maximum tax credit is 35%. The tax credit applies to two consecutive tax years, and is only available for coverage purchased through Covered California.

In contrast, as previously mentioned, employers are generally able to deduct 100% of the cost of premiums paid for employees’ health insurance on both their business’s federal and state income taxes, if they purchase coverage through an insurer or the CaliforniaChoice private health exchange marketplace.

Tax Credit Considerations: Several factors influence your possible ACA tax credit, including the number of employee, average employee wages, and your contribution toward the cost of coverage for your employees. To be considered for a tax credit, you must have 25 or fewer full-time equivalent employees. (Owners and family members are not counted when calculating your tax credit.) You must contribute a minimum of 50% to the premium for employee coverage. For additional information, refer to the Tax Credits page of the Covered California website.

Potential Added Tax Savings

Offering paid medical leave to employees could also provide you with a tax credit ranging from 12.5 to 25 percent. Under the Consolidated Appropriations Act of 2021, employers offering medical leave that meets certain requirements can take a general business tax credit through 2025. It applies to family and medical leave of up to 12 weeks per taxable year. More details are available on the Mercer website.

Employees Appreciate Benefits

Year after year, employee surveys have found that workers value health insurance, and they appreciate when it’s offered through their employer. In fact, according to a survey by Glassdoor, more than half of employees (57%) say benefits and perks are a key factor in deciding whether to pursue a particular job. MetLife’s 19th Annual U.S. Employee Benefit Trends Study released in 2021 found 85% of employees put health insurance at the top of their “must have” benefits list.  

While offering benefits may appear a stretch for your company budget, it’s important to consider the potential cost of employee turnover, as top-performing employees exit to join an employer that offers benefits. Replacing an employee can cost 20% of the employee’s salary, according to the website, Clutch.co.

Ready to Compare Plans?

If you want to shop employee benefits available to your business – including all of the coverage options available through a private health exchange – a good place to start is to talk with a broker. The services of a broker are typically available at no cost, and consulting a broker can save you money.

A local broker will know your marketplace, the coverage options in your area, health care providers in each health plan’s network, and value-added benefits that may be available. If you don’t already have a broker, we can help you find one here.

At CaliforniaChoice, it’s our mission to offer more health care choices. As part of that mission, we’ve added a new health plan for coverage effective July 1, 2020, Cigna + Oscar. Now, with CaliforniaChoice, you and your employees can choose from nine health plans across the state.

How Cigna + Oscar Is Different

CaliforniaChoice welcomed Oscar to its portfolio in 2018. The addition of Cigna + Oscar is an expansion of Oscar’s network access. Cigna and Oscar collaborated to bring Cigna’s LocalPlus® network and Oscar’s tech-driven approach to customer and care navigation.

Cigna + Oscar offers four Exclusive Provider Organization (EPO) plans in all four of the Affordable Care Act’s metal tiers (Bronze, Silver, Gold, and Platinum). That means 8 Cigna + Oscar plan options are available across the state.

With Cigna + Oscar, there’s no Primary Care Physician referral needed to visit a specialist. Because of Oscar’s focus on technology, members get access to virtual urgent care – 24/7 – and a $0 copay on all plans via the Oscar mobile app. A personalized care team to help members manage their care and access to Cigna’s behavioral health network are also included.

Other Coverage Options

CaliforniaChoice also offers access to Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), EPO, and Health Savings Account-qualified plans from eight other health plans:

With CaliforniaChoice, your employees have the freedom to choose the health plan that meets their unique needs. For example, one employee might choose a PPO from Anthem Blue Cross because of a particular doctor or hospital in its network. Another employee might choose an Exclusive Provider Organization (EPO) plan from Anthem, Oscar, or Cigna + Oscar. A third employee, who rarely visits the doctor, might choose an HMO from Kaiser Permanente, Health Net, one of the three available regional options. Whatever your employees’ needs may be, coverage is their choice with CaliforniaChoice.

Learn More by Talking With a Broker

To get information about how CaliforniaChoice can help you offer more choice to your employees, talk with an employee benefits broker. If you don’t currently have one, you can search for one here.

CaliforniaChoice recognizes the importance of having choices when it comes to something as important as health care. That’s why we’ve created the most diverse portfolio of health benefits on the market. We give you and your employees the freedom to choose from nine different health plans in a single program.

We’re highlighting the key offerings of each available health plan in our plan comparison series. This comparison features Sutter Health Plus and Western Health Advantage, both available regionally in Northern California.

Sutter Health Plus

Not-for-profit Sutter Health Plus offers competitively priced HMO health plans in the Greater Central Valley, Sacramento, and San Francisco 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

Western Health Advantage

Since 1996, Western Health Advantage (WHA) has been a reliable health care partner to Northern Californians. Through its HMO network, WHA serves employers (and their employees) and individuals in Sacramento, Yolo, Solano, Napa, Sonoma, and Marin counties as well as parts of Placer and El Dorado counties. Supporting communities is one of WHA’s core values.

Western Health Advantage Benefits Overview

The CaliforniaChoice Advantage

You can offer your employees coverage from nine health plans through CaliforniaChoice – so it’s easy to find one that best meets their unique needs. For example, one employee might select Sutter Health Plus because it includes a preferred doctor, while another employee might choose Western Health Advantage because of its strong regional provider network. With CaliforniaChoice, they both get what they prefer, while other employees have access to seven 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:

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.

Small businesses – and employers across America – continue to await a decision by the U.S. Supreme Court on whether the individual mandate in the Affordable Care Act (ACA) is unconstitutional. A decision is expected before the Court’s term ends in June. In the interim, the ACA remains the law of the land – affecting what employers are required to offer health insurance to employees.

Below, we’ve summarized ACA requirements that could affect your business in 2021.

ACA Employer Mandate

The employer mandate requires Applicable Large Employers (ALEs) to offer their full-time employees and eligible dependents “Minimum Essential Coverage” (MEC). An ALE is generally a business with at least 50 full-time and full-time equivalent employees, on average, during the prior calendar year. If you’re not certain if your business qualifies as an ALE, there’s a useful Full-Time Equivalent Employee Calculator on the HealthCare.gov website.

If you are subject to the employer mandate and you fail to offer “affordable” MEC coverage to 95% of your eligible full-time employees and their children, then you are subject to the Employer Shared Responsibility Payment Penalty. This is sometimes referred to as the “pay or play provision.”

The 2021 penalty is $2,700 for each full-time employee minus the first 30. For example, if you are an employer with 100 employees and you do not offer health insurance to full-time employees and their dependents, and at least one of your employees goes to the Covered California public exchange for tax-subsidized health insurance, your penalty will be $189,000 (100 – 30 = 70 x $2,700).

Essential Health Benefits

To comply with the ACA, qualifying health coverage must include 10 Essential Health Benefits (EHBs):

Most group plans you may be considering are likely compliant with ACA guidelines; however, it’s a good idea to discuss your available options with a licensed employee benefits broker.

Determining Affordability

If you offer health insurance coverage to your employees, but their share of the cost for 2021 is greater than 9.83% of their annual household income, the coverage is not considered affordable. Offering “unaffordable” ACA-compliant coverage to your subjects your business to a different ACA penalty. Because employers rarely know their employees’ total household income, you can take advantage of several “safe harbors” set forth by the IRS. The Society of Human Resource Management published an article in 2020 that discusses the 2021 affordability threshold and available safe harbors.

Minimum Value

According to the IRS, an employer-sponsored health plan offers minimum value if it covers at least 60% of the total allowed cost of benefits expected to be incurred under the plan. That requirement would be met by offering a Bronze-level ACA-compliant plan.

Under the ACA, four metal tiers of coverage are available: Bronze, Silver, Gold, and Platinum. A higher metal tier offers a greater percentage of covered costs. For example, at the Bronze tier, the plan covers 60% of health care costs and the insured pays 40%; a Silver plan covers 70% of health care costs, with the insured paying 30%; and a Gold plan covers 80% of health care costs, while the insured pays 20%. Finally, a Platinum-level plan covers 90% of health care costs, and the insured pays 10%. Higher metal tier plans have higher premiums, but a higher tier plan can cost a patient less in the long term if medical care is needed.

No Requirement for Non-ALEs

If your business is not an ALE, you are not required to offer ACA-compliant health coverage to your employees. However, there are several reasons why you might want to consider it.

California Health Care Mandate

Although California has a Minimum Essential Coverage (MEC) mandate for individuals, it’s not something about which employers need to be concerned. It does not require businesses to play a role to ensure employees have coverage; it only mandates that most California residents have health insurance, obtain a qualifying exemption, or pay a fine to the California Franchise Tax Board (CFTB) when taxes are filed. A penalty estimator and more information is available on the CFTB website.

Qualifying coverage can be in any of several forms, including:

If you offer health insurance coverage to your employees, and you provide them with information on that coverage each year using IRS Form 1095-C, your employees can confirm they are in compliance with the California MEC Health Care Mandate.

Shopping for Group Plans

One important thing to know is that your cost as an employer does have not be influenced by the coverage your employee selects. You can help control your costs using Defined Contribution, which is available from the CaliforniaChoice multi-carrier, employee-choice health insurance exchange.

With CaliforniaChoice, you can choose a Fixed Percentage contribution of a specific plan and/or benefit, or you can to contribute a Fixed Dollar Amount for each of your employees. (The contribution needs to be the same for each.) Your employees then apply your generous contribution to whichever health plan and benefits they like best. CaliforniaChoice offers dozens of coverage options from nine different health plans across the state. If an employee selects a plan that costs more than your contribution, he or she simply pays the difference.

If you are interested in learning more about the employee benefits options available to you and your employees, one of the best ways to do so is to talk with an employee benefits agent or broker. Services are typically available at no cost, and consulting a broker can actually save you money.

That’s because a local broker will know your marketplace, the HMO, PPO, and other coverage options in your area, health care providers that are part of each health plan’s network, and any value-added benefits that may be available. If you do not already have a broker, we can help you find one here.