The Centers for Disease Control and Prevention (CDC) routinely reminds Americans – through print, radio, television, and other means – that vaccines can greatly reduce or eliminate the risk of infectious diseases.
Beyond the COVID-19 vaccine, which has been spotlighted for the past 15 months, pharmaceutical companies promote other vaccines on a regular basis. Among them are Hepatitis, Human Papillomavirus, Influenza, and Shingles.
As part of the Affordable Care Act (ACA), all ACA-compliant plans must include coverage for certain vaccines without a copayment or coinsurance when provided by an in-network health care provider. This is even true for patients who have not yet met their annual plan deductible.
What Vaccines Does Health Insurance Cover?
While dosage and availability vary by patient age and health conditions, most health plans include insurance coverage for the following vaccinations:
- Hepatitis A
- Hepatitis B
- Herpes Zoster (Shingles)
- Human Papillomavirus (HPV)
- Influenza (Flu)
- Measles, Mumps, and Rubella (MMR)
- Meningococcal (MenB)
- Pertussis (Whooping Cough)
- Tetanus (Lockjaw)
- Varicella (Chickenpox)
The top 10 causes of death in the United States – all exceeding 50,000 lives – are due to the following health conditions:
- Heart disease (nearly 700,000 annually)
- Cancer (602,000+)
- COVID-19 (350,000+)
- Accidents/unintentional injuries (200,000+)
- Stroke/cerebrovascular diseases 160,000+)
- Chronic lower respiratory disease (150,000+)
- Alzheimer’s disease 134,000+)
- Diabetes (102,000+)
- Influenza and Pneumonia (50,000+)
- Nephritis, Nephrotic Syndrome, and Nephrosis (52,500+)
Health plans participating in the CaliforniaChoice private health insurance exchange offer vaccines through physicians’ offices as well as participating retail pharmacies. For more vaccine information, refer to these web pages:
Anthem Blue Cross
Cigna + Oscar
Sharp Health Plan
Sutter Health Plus
Western Health Advantage
To learn more about preventive care services and other benefits and services offered to members through CaliforniaChoice, talk with your employee benefits broker. If you do not already have a broker, you can search for one on the MyCalChoice website.
The rules of business are different today than they were just two years ago. Employees are expecting more from their employers. When they don’t get it, there’s a good chance they will leave. The U.S. Department of Labor says 47 million people quit their jobs in 2021.
It’s a competitive talent marketplace. To attract and retain workers, a comprehensive benefits program is more important than ever. A single health plan offering is not enough. It’s not what employees want or expect.
What Are Employee Benefits?
Employee benefits can include a wide range of things that employees are looking for. While health insurance ranks high among “must have” employee benefits, workers are also looking for other things in their employee benefit package. Based on the MetLife 19th Annual U.S. Employee Benefit Trends Study, released in 2021, employees often value other benefits, including:
- A 401(k) or other retirement plan – viewed as a must have or nice to have by 95% of employees
- Dental Insurance – viewed as a must have by 71% of employees and a nice to have by another 25% of employees
- Vision Insurance – considered a must have by 70% of employees and a nice to have by another 25% of employees
- Life Insurance – viewed a must have by 61% of employees and a nice to have by another 30% of employees
- Disability Insurance – considered a must have or nice to have by 90% of employees
- Health Savings Account (HSA) – considered a must have or nice to have by 85% of employees
- Flexible Spending Account (FSA) – considered a must have or nice to have by 83% of employees
CaliforniaChoice empowers you to offer health care freedom and flexibility to your employees. And, you can stay focused on your business. Our unique program provides the greatest access to doctors, specialists, and hospitals in the state and includes:
- Eight health plans: Anthem Blue Cross, Cigna + Oscar, Health Net, Kaiser Permanente, Sharp Health Plan, Sutter Health Plus, UnitedHealthcare, and Western Health Advantage
- 100+ HMO, PPO, EPO, and HSA-qualified options
- A choice of full and limited networks
- Greater employer cost control with Defined Contribution (you decide what you want to contribute to employees’ health care
- Single source administration (one website to manage benefits, one toll-free number for customer care)
- Value-added extras such as health, fitness, entertainment, travel, and other discounts; HR support from Mineral; FSAs for employees; COBRA or Cal-COBRA administrative services; a Premium Only Plan that lets employees increase take-home pay using pre-tax dollars to pay their share of insurance premiums; and more
Employee Benefit Advantages
Offering a comprehensive benefits package can help you set your business apart from other employers because:
- Employees value benefits and feel better about their jobs
- Benefits reduce absenteeism – healthy employees are more focused and productive, and are less injury-prone
- There are a reduced costs – even when employees are contributing to the cost of their health insurance, their share is typically lower than what they might pay for individual coverage
For you and your company, another benefit is deductibility. You can usually deduct the full cost of premiums as an ordinary business expense. That includes costs for employees’ and dependents’ health insurance.
If you take advantage of the Premium Only Plan (Section 125/POP) mentioned above, you can also reduce your company’s payroll taxes. Added savings are possible for a High Deductible Health Plan or if you contribute to a qualified Health Savings Account (HSA).
Talk with a broker about to learn more about your health care options. Working with a broker won’t cost you more. In fact, it may save you money because a broker will help you find coverage your employees will appreciate, while helping you stay within your budget.
An Important Reminder for Employers with 5-49 Employees
If you have five or more employees of any type (full-time, part-time, or seasonal), and you don’t already sponsor an employee-retirement plan, be aware of an approaching deadline. You must enroll your employees in the state-run CalSavers program by June 30, 2022. Link to the CalSavers website to learn more. Employers with 50-99 employees had a prior registration deadline of June 30, 2021.
Before the Affordable Care Act (ACA), “full time employees” were generally defined as those working a 40-hour workweek. Those working fewer hours – whether 10, 25, or another number – were part-time.
However, under the ACA, full-time workers are those working an average of at least 30 hours per week, or at least 130 hours per month. That discrepancy has prompted many employees to ask, “What is full-time? Does my employer have to offer benefits to me if I work 30 or more hours?”
The answer is, “It depends.”
Employers with 50 or more full-time or full-time equivalent (FTE) employees – are required to offer health care benefits to those working at least 30 hours a week or at least 130 hours a month. If an employer does not offer employee benefits, the business is subject to a tax penalty.
For small employers – those with fewer than 50 full-time employees – offering employee benefits is discretionary. There’s no requirement to offer benefits. The decision is left up to the employer.
Seasonal workers do not have to be included in the employer’s full-time equivalent employee calculation.
If a smaller employee not subject to the ACA employer mandate does choose to offer health coverage to its employees, that coverage must meet certain ACA specifications.
If you have a workforce of full-time and part-time employees, and you are unsure about how to calculate your group size, visit HealthCare.gov or CalChoice.com to use the ACA calculators offered on those sites.
While many employers with fewer than 50 FTE equivalent workers choose to offer employee benefits, there’s no requirement that they do so. The only requirement is that employers be equitable in their treatment of employees. The same standards apply to all employees when determining benefits eligibility. If the employer sets a 30-, 35-, or 40-hour requirement, it applies to all workers. Offering benefits to one employee who works 36 hours, and requiring others to work 40 hours to be benefit-eligible could trigger a discrimination lawsuit.
In a competitive talent marketplace, many smaller employers choose to offer employee benefits because it helps them attract and retain their top employees. Workers appreciate those benefits, too – especially health insurance. In the 2021 MetLife Annual Benefit Trends Study, 85% of employees put health insurance at the top of their “must have” list – and another 10% say health insurance is “nice to have.”
Talk With a Broker to Learn More
If you want to find out if you’re getting the most value for your benefit dollars – or if you want to add employee benefits for your employees – talking with a broker is a great place to start. Most brokers offer their services at no cost to you. If you don’t have a broker, you can search for one on the MyCalChoice website.