Hello!!

The Small Business Administration (SBA) has launched an online portal for businesses that received a Paycheck Protection Program (PPP) loan. The PPP began in 2020 as part of Congress’s efforts to assist small business struggling because of the COVID-19 pandemic and widespread furloughs and layoffs.

The new SBA microsite allows borrowers of up $150,000 to apply for PPP forgiveness through directforgiveness.sba.gov. It streamlines loan forgiveness processing for PPP recipients. The portal requires individuals/businesses to register to start their request. Or, registered users with login credentials can sign-in directly at the site.

Download the pdf, PPP Direct Forgiveness Platform User Guide, for additional information.

Participating lending institutions can review applications and make issue decisions using the same platform. However, not all lenders have opted in to the new SBA portal. If you received a PPP loan, it is recommended that you check with your lender to confirm whether it is participating in the portal. You can also get assistance through the SBA’s customer service line: 877-552-2692.

In related news, instances of PPP application fraud took center stage in an August academic report. The study highlights how the government’s push to provide financial aid quickly during the pandemic led to a surge in fraud. The lack of traditional lender safeguards could have led to roughly 1.8 million fraudulent loans (more than 15% of the total 11.8 million loans).

The authors of the fraud report called out financial technology firms as likely sources of dubious loans. These “fintechs” made about 29% of PPP loans, but accounted for more than half of those considered suspicious – perhaps totaling as much as $76 billion. One indicator was multiple loans going to more than one business at the same residential address.

The SBA has said that it is committed to fighting fraud in the PPP and its other programs. In March 2021, a California man pleaded guilty to submitting six fraudulent PPP loan applications and two fraudulent Economic Injury Disaster Loan (EIDL) applications.

The agency encourages individuals to report fraud by contacting the Office of Inspector General at 800-767-0385 or the National Center for Disaster Fraud Hotline at 866-720-5721.

Open enrollment is underway across California for health insurance coverage effective in Q4 and early 2022. You may be evaluating coverage options and costs. A multi-product, multi-carrier health insurance exchange is affordable and allows you to offer more choices.

In California, businesses with up to 100 employees can choose from the Covered California public exchange or the CaliforniaChoice private exchange. Both offer a variety of plans in all four Affordable Care Act (ACA) metal tiers: Bronze, Silver, Gold, and Platinum. You can choose from Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, or Exclusive Provider Organization (EPO) plans, including High Deductible Health Plans and Health Savings Account-qualified coverage.

Understanding Plan Differences

How do you know which plan type might be right for you and your employees? That depends on your needs – or the needs of your family – and whether you have specific doctors, specialists, or hospitals that you want to be able to visit.

HMOs

A Health Maintenance Organization (HMO) plan offers members:

• Access to care through a network of providers (seeking care outside the network is not permitted, except in case of a medical emergency)
• Care coordination through a Primary Care Physician (PCP)
• Required referrals to visit a specialist (an added co-pay often applies)
• Reduced premiums and lower co-pays (vs. a PPO)

PPOs

Some individuals prefer Preferred Provider Organization (PPO) coverage because it offers:

• Freedom to visit any medical provider in the PPO network
• Discounted rates for care through contracted medical providers and hospitals
• No referrals required to visit specialists
• Flexibility to use a non-network provider (although higher out-of-pocket costs, such as a separate deductible and out-of-pocket maximum, may apply)

EPOs

Often described as a sort of hybrid between an HMO and a PPO, an Exclusive Provider Organization (EPO) offers:

• Reduced costs: lower premiums than PPOs and typically no co-pays when visiting an in-network specialist
• Self-referral to in-network specialists (care outside of the network may not be covered, except in case of an emergency)

HSA-Qualified Plans

Health Savings Account (HSA) qualified coverage is available in multiple ACA tiers through HMO, PPO, or EPO plans. With an HSA plan, an individual can pay for qualified medical expenses with tax-advantaged dollars. Link here to read a Society for Human Resource Management (SHRM) article on 2021 limits for HSAs and HDHPs.

Network Availability by Plan Type

As you review your coverage options, consider your personal or family health care needs.

If it’s important to be able to keep a preferred doctor after moving to a new health plan, you’ll want to compare the networks for the plans being considered. Does at least one network include your preferred doctor(s)? Your employee benefits broker can help you search for doctors and prescriptions that are “in network” and covered by the health plan(s) you’re considering. Don’t be hesitant to ask to your broker about “who’s in” and who is not.

Each ACA metal tier and plan type offers different network access. For example, within the CaliforniaChoice private exchange program, an Anthem Blue Cross EPO plan offers access to the Small Group Prudent Buyer network in the Bronze tier; Select HMO, Select PPO, and CaliforniaCare HMO networks are added in the Silver, Gold, and Platinum tiers for HMO and PPO plans.

For Health Net, in the Bronze tier, only the CommunityCare network is available; however, WholeCare, Salud HMO, and Full network options are available in other tiers. Kaiser Permanente and Western Health Advantage both offer full network access for all of their plans through CaliforniaChoice.

For Cigna + Oscar, the LocalPlus network is available for all plans and tiers. Sharp Health Plan offers two network choices: Premier and Performance; access varies by HMO plan. The same Sutter Health Plus network is offered on all plans. UnitedHealthcare offers four networks (SignatureValue, Advantage, Alliance, and Harmony) for plans offered through CaliforniaChoice in the Silver, Gold, and Platinum tiers.

Talk With a Broker to Learn More

To get more information about what plans are available in your local area – and what providers are in each plan network – talk with a broker. He or she can deliver a customized quote for your business and your employees. If you don’t already have a broker, we can help you find one here.

An EPO (Exclusive Provider Organization) may not be as well-known as a HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) (PPO), but it’s often a money- and time-saving coverage option.

What is an EPO?

An EPO is a health plan that offers a full-network of doctors and hospitals from which to choose.

Like a HMO, an EPO gives you and your employees access to a select network of medical providers. When you go to an in-network provider, you’ll have limited out-of-pocket costs. If you go outside of the network, the plan offers limited, if any, benefits and costs are higher.

Like a PPO, employees with EPO coverage don’t need to get a referral from a Primary Care Physician (PCP) to visit a specialist, as long as the doctor is part of the EPO network.

An EPO in Action

Benefits of an EPO

An EPO combines the strengths of a HMO with a PPO in a single option. It offers more flexibility than a HMO because there’s no need for a referral from your PCP to receive specialist care. An EPO is competitively priced, too. It frequently offers more affordable premiums than a PPO. For many, an EPO is a happy medium between an HMO and a PPO.

EPO Plans Available through CaliforniaChoice

You and your employees can choose from a variety of EPO plans through CaliforniaChoice. Multiple options are available from Anthem Blue Cross and Cigna + Oscar.

The Anthem Blue Cross EPO coverage through CaliforniaChoice includes member access to the Anthem Prudent Buyer Network. The Prudent Buyer Network offers 90% of doctors and hospitals in the United States through the national BlueCard® Program.

Some of the in-network premier California facilities include:

• Cedars-Sinai Medical Center, Los Angeles
• Children’s Hospital Los Angeles
• John Muir Health, Northern California
• Goleta Valley Cottage Hospital and Santa Barbara Cottage Hospital, Santa Barbara
• Loma Linda University Medical Center, Inland Empire
• Long Beach Memorial Medical Center
• Providence Saint Joseph Medical Center, Burbank
• Sutter Medical Center, Multiple Locations in Northern California
• Scripps Memorial Hospital, San Diego
• UCSF Medical Center, San Francisco

Cigna + Oscar offers EPO plans in all four metal tiers through CaliforniaChoice. Its plans include top hospitals and providers in the LocalPlus® and Open Access Plus provider networks.

Some of the in-network premier California facilities include:

• Adventist Health Glendale and White Memorial Los Angeles
• Cedars Sinai Medical Center, Los Angeles
• Children’s Hospital Los Angeles
• Children’s Hospital Orange County
• Glendale Memorial Hospital and Health Center
• Goleta Valley Cottage Hospital, Santa Barbara
• Good Samaritan Hospital, San Jose
• Hoag Memorial Hospital Presbyterian, Newport Beach
• Huntington Memorial Hospital, Pasadena
• Keck Hospital of USC, Los Angeles
• Packard Children’s Hospital, Palo Alto
• Providence Queen of the Valley Medical Center, Napa Valley
• Providence Saint Joseph Hospital of Orange
• Providence Saint Joseph Medical Center, Burbank
• Ronald Reagan UCLA Medical Center, Los Angeles (Open Access Plus only)
• Santa Barbara Cottage Hospital, Santa Barbara  
• Shriners Hospitals for Children, Pasadena and Sacramento
• UC Davis Medical Center, Sacramento
• University of California Irvine Medical Center, Orange
• USC Norris Cancer Hospital, Los Angeles

You can view the full provider directory on the CaliforniaChoice website. Searches are available by city or ZIP Code as well as hospital affiliation and other criteria.

Talk With a Broker to Learn More

Learn more about EPO, HMO, PPO, and other options available to you and your employees from your health insurance broker. If you don’t already have a broker, you can look for one here.

CaliforniaChoice helps California small businesses expand employee benefit options for employees. The program, known for its freedom and flexibility, is also affordable for employers. Beyond health care, CaliforniaChoice offers employers business management services at no added cost.

The CaliforniaChoice Business Solutions Suite includes:

• Human resources support
• Flexible Spending Accounts (FSAs) for employees
• Premium Only Plans (POPs) for employees
• Cal-COBRA or Federal COBRA billing

In addition, CaliforniaChoice provides Payroll Services through Heartland Payroll Solutions, Inc. that you can integrate with your benefits for free.

ONLINE HR SUPPORT CENTER

The Online HR Support Center incudes 24-hour access to information on critical state and federal employment laws. It also features a database of frequently asked questions and answers to common human resources issues.

The HR Support Center backed by Mineral includes:

• A library of employee handbooks, company policies, job descriptions, and HR forms
• Summaries of state and federal laws that may affect your staff
• A glossary of commonly used HR terms and definitions
• Tools and information specific to Leave of Absence, Hiring, Performance Management, and Termination

FLEXIBLE SPENDING ACCOUNTS (FSAs)

For groups of 15 or more employees, CaliforniaChoice offers you no-cost FSAs. An FSA allows your employees to set aside a part of their salary, on a pre-tax basis, to pay for eligible health care-related expenses. Employees pay less in taxes, while also lowering your required FICA contributions.

Items eligible for reimbursement or payment through an FSA include:

• Medical expenses like copays, coinsurance, and deductibles
• Dental exams, cleanings, x-rays, and braces
• Vision exams, contact lenses and supplies, eyeglasses, and laser eye surgery
• Prescription drugs and insulin
• Chiropractic and acupuncture services
• Qualified over-the-counter health care items like athletic and orthopedic braces and support, blood glucose monitors and testing strips, blood pressure monitors, pregnancy and fertility kits, thermometers, walking aids and wheelchairs, and more

PREMIUM ONLY PLANS (POPs)

Section 125 Premium Only Plan services are available, too. CaliforniaChoice covers your initial set-up cost for your POP. Employees can then pay their share of premiums for their Medical and Dental coverage with pre-tax dollars. This lets employees take home more of their paycheck dollars. In turn, your taxable payroll decreases – saving you on FICA and Workers’ Compensation expenses.

COBRA BILLING SERVICES

With CaliforniaChoice, COBRA-related activities are also included at no cost.

Based on your group size, you’ll receive Cal-COBRA services (for groups with 1-19 employees), or federal COBRA services (for groups of 20 or more employees), when an eligible enrollee loses coverage because of a qualifying event, including:

• Employment termination
• Employee death
• Reduction of work hours
• Divorce or legal separation
• Eligibility for Medicare
• Loss of dependent child status

Services available include COBRA participant invoicing, premium collection and remittance, and processing eligibility changes for non-payment of premium.

PAYROLL SERVICES

Heartland Payroll Services can be combined with your health benefits. Any payroll changes you make are communicated in real time to CaliforniaChoice. This allows you to:

• Reduce administration
• Avoid premium overpayments on terminated employees
• Avoid missed coverage windows for new hires

Available payroll services include:

• Direct deposit: A secure, convenient, and cost-effective alternative to paper checks
• Free employee payroll portal: A secure platform to view and print pay stubs and W-2s, update information, and access important company documents
• Outstanding service from a dedicated payroll specialist
• Customized payroll reports: Get regular Payroll Summaries, Registers, Tax Reports, and Employee Pay Stubs; create custom reports the way you want
• Liability elimination: Generate tax, quarterly, and annual reports; take advantage of guaranteed-accurate and timely deposits, filings, and promptly returned calls

HOW TO LEARN MORE

CaliforniaChoice offers affordable health insurance coverage and more. It’s available to employers in California with up to 100 employees. To get a quote for your business, talk with your health insurance or employee benefits broker. If you don’t already have a broker, we can help you find one.

When you offer the CaliforniaChoice to your employees, they get more than their choice of leading health plans. They also have access to Active&Fit Direct® through the ChooseHealthy® Program.

ChooseHealthy is available to all CaliforniaChoice members at no added cost. It offers you and your employees discounts on a variety of health and fitness brands, including Fitbit®, Garmin®, Vitamix®, PRO Compression®, and others. It also includes discounted fitness center memberships and other benefits through the Active&Fit Direct program.

Active&Fit Direct offers all CaliforniaChoice members access to:

• Fitness center memberships at just $25 a month (plus applicable taxes) at 10,000 participating fitness centers nationwide
• 4,000+ digital workout videos
• Classes from world-class organizations and instructors, including FitFusion by Jillian Michaels, GAIAM, Strong by Zumba, and Yoga Fit
• Lifestyle coaching to help you reach your health goals
• Activity tracking with 250+ wearable trackers and apps
• Easy online search for a location near your work or home
• A guest pass to find a fitness center that’s right for you – and the freedom to change centers anytime, based on your individual needs

In addition, as CaliforniaChoice members, you and your employees can also get:

• Vision Care Savings: The EyeMed® Vision One Eyecare Program offers discounts on frames, lenses, and eye exams at LensCrafters, Pearle Vision, Target Optical, and other locations.
• Dental Care at a Discount: Enjoy reduced fees at Dentegra^® Smile Club dentists across California and nationwide, with instant savings and no waiting period or claim forms.
• Rx Discounts: The California Rx Card delivers up to 80% savings on brand name and generic prescription drugs at 68,000 locations nationwide – often reducing your cost to less than your prescription drug copay with insurance.
• Hearing Services Savings: Hearing loss is a common health problem, but the EPIC Hearing Service Plan offers savings of up to 50% on hearing aids plus discounts on testing and batteries.

Your health insurance broker can provide you with more information about all of the benefits of CaliforniaChoice – as well as a custom quote for your small business employees. If you don’t have a broker or agent, we’ll help you search for one here.