It’s December, and there’s no better time to look back on 2021’s big achievements. Let’s celebrate how far we’ve come as we look forward to the year ahead.
5. The Launch of the New Enrollment Squad
The new enrollment squad provides a personalized and fun introduction to CaliforniaChoice. New members learn about the CaliforniaChoice program in detail and the variety of choices available to them.
4. Bringing Cigna + Oscar into Our Portfolio
Cigna + Oscar joined CaliforniaChoice in 2021 – combining the power of Cigna’s health care provider networks with Oscar’s member-focused experience and technology.
3. Achieving a Significant Membership Milestone
CaliforniaChoice reached a new milestone in 2021, with an all-time high membership surpassing 339,000. This achievement is a testament to the value of providing choice for something as important as health care.
2. The Roll Out of the New Calchoice.com
CaliforniaChoice launched a new, award-winning website this year, giving employers, members, and brokers access to a customized experience and streamlined functionality. This was a key milestone in a larger digitization strategy.
1. 25 Years of Proving Health Care Choices
CaliforniaChoice celebrated 25 years of service to small businesses in California in 2021. No other single health care program in the state offers more employee choice and greater access to health care providers. Our easy-to-manage program offers access to eight health plans, 80,000+ doctors, and 400+ hospitals – and the widest selection of HMO, PPO, and EPO plans in California.
Talk to a Broker to Learn More
If you’re considering health coverage for your employees for the first time in 2022, ask your broker about CaliforniaChoice. Or, if you want to find out how you can offer more choice while still controlling your costs, talk with a broker about CaliforniaChoice. If you don’t have a broker, we make it easy to search for one here.
CaliforniaChoice started more than 25 years ago. But, our commitment to providing the most flexible program in the state for small businesses is stronger than ever. We continue to evolve our health plan portfolio to better serve the needs of our customers. That’s why 94% of our employer groups renew their benefits with us each year.
We expanded our roster of health plans in 2021 to add Cigna + Oscar. The partnership builds on Oscar’s focus on personalized care and adds Cigna’s providers in the LocalPlus® network.
Employees can now choose from 16 Cigna + Oscar EPO (Exclusive Provider Organization) plan options. Cigna + Oscar includes four EPO plans in each of the Affordable Care Act metal tiers (Bronze, Silver, Gold, and Platinum).
Two robust networks are available: LocalPlus and the Open Access Plus national network. LocalPlus offers access to 23,400+ health care practitioners and 63 hospitals in Northern California. It adds 36,700 health care practitioners and 189 hospitals in Southern California.
Employers can offer one network or both, side by side.
If an EPO from Cigna + Oscar is not the right choice for all of your employees, that’s okay. CaliforniaChoice offers seven other health plans in our program. Your employees can choose whichever health plan is right for them.
For example, one employee might choose an EPO from Cigna + Oscar or Anthem Blue Cross. Another might choose a PPO because it includes a particular doctor or hospital in its network. A third employee might select an HSA-compatible HMO from Kaiser Permanente or UnitedHealthcare, or an HMO plan from Health Net. Others might select Sharp Health Plan, Sutter Health Plus, or Western Health Advantage. Whatever your employees’ needs may be, it’s their plan choice with CaliforniaChoice.
For 2022, UnitedHealthcare is expanding its Harmony network. It now includes Alameda, Contra Costa, Marin, Santa Clara, Santa Cruz, San Francisco, San Mateo, Solano, and Sonoma counties.
The Harmony network is already available in Southern California. It combines quality care, technology, tools, and resources. That helps UnitedHealthcare members improve their patient experience and outcomes.
Employer Cost Control
Beyond offering more choice to employees, you’ll appreciate that CaliforniaChoice puts you in charge of your benefits costs. You decide just how much to contribute to employees’ health insurance premiums. You can choose a Fixed Percentage Amount (50% to 100%) toward a specific benefit. Or, you may prefer a Fixed Dollar Amount for employees.
Whatever you choose, your employees then use your generous contribution toward the cost of the plans they prefer. If they pick plans that cost more than your contribution, they simply pay the difference.
Your contribution amount is locked-in for a year. That simplifies your budgeting. If you want to, you can change your contribution at renewal next year.
The advantages to CaliforniaChoice do not stop there. CaliforniaChoice offers valuable extra benefits, too, including:
- Discount Dental and Vision care
- Discounted Hearing services
- HR support from Mineral (formerly Mammoth HR/ThinkHR)
- Wellness services, including discounted fitness center memberships
- Savings on entertainment, travel, food delivery, gifts, education, prescription drugs, and more
Ask your broker about the Business Solutions Suite and Member Value Suite.
If you’re considering health coverage for your employees in 2022, talk with a broker. A broker can deliver a custom health insurance quote for your business. Keep in mind, rates are the same whether you go through a broker or get coverage directly from a health plan.
The CaliforiaChoice program is only available through a broker. If you don’t have one, we make it easy to search for one in your area here.
As an employer, you may be wondering if your employees are eligible for Group Health Insurance. Under the Affordable Care Act (ACA), more individuals than ever are eligible for coverage. Federal law now requires that qualified small businesses provide their employees access to health insurance coverage.
The current health of your employees isn’t a factor in that requirement. The ACA ensures all have the ability to enroll. If the business meets the legal entity requirements and the group meets underwriting and other guidelines, coverage is likely available through multiple health plans.
Even if a group does not meet a carrier’s enrollment and premium contribution rules, it may still be eligible to enroll employees for coverage. The ACA’s Special Open Enrollment Window occurs annually from November 15 to December 15.
Consumer Protection and Coverage Standards
The ACA expanded health insurance access and increased consumer protections. It established coverage standards for Individual and Small Group plans. And, it created a coverage mandate for Applicable Large Employers (ALEs).
Whether a business is an ALE is determined annually based on the average size of the employer’s workforce during the prior year. If an employer has fewer than 50 full-time employees, on average during the prior year, the business is not an ALE. It is not subject to the ACA’s employer shared responsibility provisions. (This is often referred to as the employer mandate.)
If an employer has at least 50 full-time employees, including full-time equivalents, on average during the prior year, the business is an ALE for the current year. That means the business is subject to the employer shared responsibility provisions as well as annual employer reporting requirements.
If you’re unsure of your ALE status, an ACA Full-Time Equivalent calculator is available on the CaliforniaChoice website. Also available are ACA Penalties and ACA Safe Harbor calculators and HR Calculators for absenteeism, cost per hire, and employee turnover. More information on ALEs is on the IRS website.
Deciding Who to Cover
If you are not an ALE, it’s up to you who’s covered by your health plan. You can make coverage available to:
- All full-time employees
- Full-time employees and their eligible dependents
- Full-time and part-time employees (subject to insurer rules)
- Full-time and part-time employees and dependents
You must make coverage available to all who qualify under your benefits guidelines. If you include full-time and part-time employees and dependents, you have to offer coverage to all equally. You can set your own minimum work hours per week for benefit-eligible part-time employees. Just be sure your rules work within insurer participation guidelines.
What you put toward the premium for full-time employees, part-time workers, and dependents can be different. Many employers pay 50% or more of full-time employees’ premiums. An employer may pay less (or a flat amount) for dependents and part-time workers.
Who May Not Qualify
If you operate a business on your own, without other employees, you do not qualify for group health coverage. But, you should be able to purchase coverage on your own. You can get it directly through an insurer, a broker, or the Covered California public exchange.
If you run a family business, and you work with other members of your family (such as a spouse, in-law, son or daughter, or a combination), you may qualify as a group. It depends on if all employees are members of your family, or if family members are a part of your group’s total enrollment.
The ACA established a standard for Health Insurance offered to individuals and small groups. All plans considered ACA-compliant must include 10 essential health benefits (EHBs), including:
- Ambulatory patient services (outpatient care without admittance to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (including counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (not deemed essential for adults)
Coverage for birth control and breastfeeding must also be included.
Ask About Value-Adds
Be sure to look for or ask your broker about any value-added benefits. For example, CaliforniaChoice includes a range of free products and services for you, your business, and your employees.
The CaliforniaChoice Business Solutions Suite and Member Value Suite include:
- Dental Care: The Dentegra® Smile Club offers instant savings, no waiting period, and no claim forms. It includes a nationwide network of more than 20,000 providers.
- Discount Vision: The EyeMed Vision One plan offers savings on frames, lenses, and eye examinations. You can visit participating LensCrafters, Pearle Vision, or Target Optical stores.
- EPIC Hearing Program: Enjoy discounts of up to 50% on hearing-related products and testing.
- HR Support: Get online human resources support from Mineral (formerly Mammoth HR/ThinkHR). Download customizable forms and get updates on regulations affecting your business and employees.
- Active&Fit Direct®: Access 4,000+ digital workout videos, lifestyle coaching, and fitness center membership at just $25 per month at 10,000 participating centers nationwide.
- Cal Perks® Discounts: Save on movie, theme park, or sporting event tickets, travel, food delivery, and more.
- California Rx Card: Get up to 80% savings on prescription drugs at more than 68,000 pharmacies nationwide. Includes CVS, Safeway, Vons, Kroger, Ralphs, Rite Aid, Walgreens, and others.
If you’re considering Group Health Insurance for your business and employees, you can:
Shop on your own
- Go directly to one or more health plans for a quote
- Compare plans on the state’s public exchange website
Shop using a broker
- Ask your broker to research and compare plans and provide you with one or more quotes
- Get a quote from a single health plan
- Get a quote from multiple group health plans
- Get a quote for coverage through the state’s public exchange
- Get a quote from and offer many plans to employees through the CaliforniaChoice private exchange
How you research your options is up to you. Using a broker can help simplify the process and won’t cost you more. A broker will know the benefits, provider networks, and health plans available in your area, and can help you sort through the details. If you don’t have a broker, you can search for one here.