If you own or run a small business, you have a lot on your plate. Taking on the added responsibility of shopping for health insurance for employees may seem intimidating. But, it doesn’t have to be if you’re working with the right health insurance partner.
CaliforniaChoice puts you in control by offering everything you and your employees want:
- Eight health plans – and dozens of options – through a single health program
- Cost control with Defined Contribution – you choose the amount you want to put toward your employees’ health care
- Greater access to doctors, specialists, and hospitals
- Options for Dental, Vision, Chiropractic, and Life Insurance
- Consolidated billing – one bill for all coverage (even if employees enroll in multiple health plans)
- Smart Decision Technology: an online plan comparison tool, online enrollment, doctor and hospital search tools, and a prescription drug search
CaliforniaChoice meets the diverse needs of you and your employees at a price you can afford.
The Benefits of Using a Broker
A great place to begin your comparison of health insurance programs for your employees is by talking with an employee benefits broker. At CaliforniaChoice, we work exclusively through brokers, who can counsel you about the options in your area. A broker helps you find the right coverage for your business based on your unique needs and budget.
A broker will also share information about the Metal Tier and provider network options. You can choose from medical plans in all four Affordable Care Act (ACA) Metal Tiers: Bronze, Silver, Gold, and Platinum.
ACA Metal Tiers
Each tier offers a different percentage of shared health care costs for the employee. They range from 10% to 40%. The health plan pays the other 90% to 60% of covered costs when patients visit an in-network provider.
You can offer your employees access to one, two, three, or all four metal tiers. With Defined Contribution through CaliforniaChoice, your costs could even remain the same.
Each employees receives a personalized enrollment worksheet that spells out their options, your contribution amount, and how it reduces the cost of coverage. It also shows how much they will have to pay if they select a plan that costs more than your contribution.
If you are not required to offer health insurance, it’s up to you whether you want employee-only coverage or employee and dependent coverage. If you are not sure if you’re an Applicable Large Employer, visit the CaliforniaChoice website. It has ACA Calculators to determine your group size.
You may want to make health insurance available to your full-time employees and dependents anyway. Employee benefits can help you attract and retain workers in today’s competitive market – and boost employee satisfaction, too. Read our post, 11 Reasons Why You Should Offer Group Health to Employees, which we published earlier this year for details.
Here’s a look at plan options and how they differ:
- HMO (Health Maintenance Organization) plans: Each insured must choose a Primary Care Physician (PCP) to manage their care. Patients are required to get approval from the PCP to visit a specialist. Treatment is generally not available outside of the HMO network, except in case of an emergency.
- PPO (Preferred Provider Organization) plans: A PPO offers more flexibility, although at a higher premium than an HMO or EPO. A patient can go directly to an in-network doctor, specialist, or hospital without a referral. In-network care is offered at pre-negotiated, discount rates. PPO members can go outside of the PPO network, although they will pay higher out-of-pocket costs.
- EPO (Exclusive Provider Organization) plans: An EPO is often described as a sort of a hybrid plan that offers both HMO and PPO benefits. Like an HMO, patients need to get health care through a doctor, specialist, or hospital that is part of the EPO network. Like with a PPO, members are able to go to a specialist without a referral, as long as the provider is in-network.
A High Deductible Health Plan (HDHP), which can be an HMO, EPO, or PPO, may offer a lower monthly premium. But, the insured has to pay more health care costs upfront before an HDHP begins to pay its share. Combined with a Health Savings Account (HSA), insured persons can pay for qualified medical expenses with funds free of federal taxes.
A Program with No-cost Extras
CaliforniaChoice doesn’t just offer you and your employees outstanding health insurance options. You also get value-added benefits at no extra charge through two exclusive programs.
The Business Solutions Suite saves you money and delivers valuable benefits for your business:
- Online HR support from Mineral: Get best practices, customizable handbooks, job descriptions, and more
- Premium Only Plan (POP): Reduce your payroll taxes and give employees the ability to pay insurance premiums with pre-tax dollars
- Flexible Spending Account (FSA): Employees can put away money to pay for eligible out-of-pocket health care (Available to groups of 15 or more employees)
- COBRA or Cal-COBRA Billing: Take advantage of participant invoicing, premium collection and remittance, payment tracking, and processing of eligibility changes for non-payment
The Member Value Suite offers CaliforniaChoice members outstanding savings, including:
- Discounts of up to 57% on Garmin, Vitamix, and Fitbit products
- Fitness memberships at just $25 per month
- Reduced fees on hundreds of Dental procedures at participating Dentegra® Smile Club dentists
- Discounts on frames, lenses, and eye exams at locations from coast to coast
- Up to 50% savings on brand-name hearing aids – plus discounts on testing, batteries, and more
- Rx savings on brand-name and generic prescription drugs – you can even reduce your cost to less than your co-pay with insurance
- Discounts on shopping, home services, education, travel, entertainment, and more
Taking the Next Step
If you’re ready to learn more, ask your broker about everything available through CaliforniaChoice. You can request a custom quote for the options in your area. If you do not have a broker, search for one here.
Making changes to your health insurance coverage isn’t limited to your annual open enrollment. If you experience what the Affordable Care Act (ACA) calls a “life event,” you and your employees can also make changes to your coverage.
What Is a Life Event?
There are several different “triggers” that could make your employees eligible to change their coverage, including:
- Marriage or domestic partnership: A change in an employee’s marital status (e.g., divorce or separation) or domestic partnership.
- New family member: Adding a dependent child through adoption or birth.
- Late enrollment or involuntary loss of coverage: If an employee previously waived coverage (and did not enroll when first eligible because of other coverage), he/she/they can enroll late and/or change benefits if that other coverage ends due to death of the spouse (who maintained it) or loss of eligibility for benefits due to reduced work hours or job loss.
- Remove coverage or dependents: A covered employee can remove existing insurance or dependents from his/her/their CaliforniaChoice coverage. For example, when a dependent child reaches age 26.
- Moving: If an employee moves to a new place of residence (and out of the existing health plan’s service area), that qualifies, too.
When Can I Make Changes to my Group Health Plan?
Making Coverage Changes
Employees have a limited window – 60 days from a qualifying/triggering event – to make changes.
At CaliforniaChoice, we want to make these changes easy for members. If an employee wants to add coverage for a newborn or newly adopted child or remove a dependent from coverage, they simply take the following steps:
- Visit calchoice.com, click on “Life Events” and then “New Family Member” or “Remove Coverage or Dependents” to submit a Change Request online.
- Download, complete, and submit a Change Request Form, along with proof of adoption or a newborn) to the group contact. Or, send it via email to the CaliforniaChoice Customer Services team.
Effective Date of Changes
Changes requested will be effective on the first day of the month following receipt of a completed request. For example, if an employee submits a request/application on May 10, the change would be effective on the first of June. (If the employee submits a request through you, it’s important you forward it to CaliforniaChoice as soon as possible, so as not to delay the effective date.)
If new ID Cards are issued in connection with the request, they will be sent within 7-10 business days after the processing is complete.
Help When You or Your Employees Need It
While there are many actions you and your employees can take online concerning your bill, account changes, coverage, and benefits, the CaliforniaChoice team is available to offer support by email or phone. Our Customer Service team is available Monday through Friday, 8:00 a.m. to 5:00 p.m., Pacific Time.
Today’s workforce is vastly different from environments of the past. It’s more diverse than ever before, which means broader perspectives, increasingly varied opinions, and more inclusion of previously underrepresented groups.
Bringing a diverse group of people together has a wealth of benefits, but it can pose challenges for business owners trying to meet a variety of employee needs, especially when it comes to health care.
The Expectations of Today’s Employee
The challenge for employers is offering an employee benefits program that can address the needs of a varied group. The 20th Annual MetLife Employee Benefits Trends Study released this year finds workers today expect their employers to recognize the importance of their lives – on the job and away from work.
As MetLife notes, “Forward-thinking HR leaders are looking at benefits and beyond to adopt a more holistic view of employee needs.” That’s because it is what’s needed to serve today’s broad employee population.
The pandemic of the past two years has prompted employees to rethink their priorities, and reconsider their “must have” benefits when it comes to making a job change. Here’s a comparison of views pre-pandemic (in 2020) and today (in 2022).
The priorities of employees when it comes to benefits stayed the same from 2021 to 2022, but are a bit different from 2019. The top insurance-related “must have” or “nice to have” benefits during this period are as follows, according to MetLife’s studies in the three-year period:
- Health Insurance
- Prescription Drug
- Dental Insurance
- Vision Insurance or Discount Program
- Life Insurance
- Disability Insurance
- Accident Insurance
- AD&D Insurance
- Critical Illness
2021 and 2022
- Health Insurance
- Dental Insurance
- Vision Insurance or Discount Program
- Life Insurance
- Disability Insurance
- Critical Illness
- Accident Insurance
- Hospital Indemnity
- Cancer Insurance
An enduring trend – year after year — is that Health Insurance is among the most desired employee benefits. And, thanks to the Affordable Care Act (ACA), Health Insurance coverage offered through ACA-compliant plans offers a comprehensive range of care.
What Is Group Health Insurance?
Group Health Insurance most often refers to an employer-sponsored, Affordable Care Act (ACA) compliant health insurance plan that provides benefits for employees’ and dependents’ care. To qualify as ACA compliant, plans have to include 10 Essential Health Benefits (EHBs), including:
- Ambulatory patient services (outpatient care you get without being admitted 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 (this includes 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 (but adult dental and vision coverage aren’t essential health benefits)
Frequently Asked Questions
Often employers have questions about Group Health Insurance, and we’ve answered some of the most frequently asked questions below.
- How can I be sure I am getting the best deal on health insurance for my business and my employees?
- One of the best ways to ensure you’re getting the most for your employee benefits dollars is to engage an employee benefits broker to help you shop and compare the marketplace. Your broker will be able to provide you with quotes for multiple plan types from different insurers and/or available exchange programs.
- How can I be sure the plan or plans I am considering include the doctors and hospitals my employees and I want?
- If CaliforniaChoice is among the options you’re considering, there’s a valuable Plan Comparison Tool online. You can easily compare plans based on monthly premium, health plan, metal tier, plan type, or preferred doctors.
- Once coverage begins, is it easy for employees to make changes? If, for example, they move, get married or divorced, adopt a child, or have a baby.
- Absolutely. Many “life event” changes can be made at calchoice.com or by submitting paperwork through the website.
- If an employee has a pre-existing health condition, is he/she/they still able to apply for and get Health Insurance coverage?
- Under the ACA, health insurers can no longer refuse coverage or charge an applicant more because of a pre-existing health condition. If you’re buying an ACA-compliant Group Health plan for your small business, all of your employees should be able to get coverage.
- If I have a new hire or an employee termination, is it easy for me to make changes?
- It’s very easy to make changes online whenever your staff changes. Just login at calchoice.com, select Manage My Account and request a new hire quote or employee coverage termination. You can also get help through Customer Service.
- If an employee is enrolled in an HMO, can he/she/they change doctors?
- If you or your employees are enrolled in an HMO (or an EPO [Exclusive Provider Organization]) plan, you are usually required to select a Primary Care Physician (PCP) to help guide your care. Most plans allow you to change your PCP whenever you wish, although there may be frequency limits. For example, you may be able to change only one per month.
- If I am enrolled in an HMO, can I switch to a PPO?
- Unless you move out of your health plan’s coverage area, or you experience a qualifying life event, you are usually locked-in to your health plan until your next enrollment period. At that time, you can change plans or move from an HMO to another plan type.
Coverage and Eligibility
The employer mandate in the ACA requires Applicable Large Employers (ALEs) to offer Minimum Essential Coverage (MEC) to full-time employees and eligible dependents. An ALE is a business with at least 50 full-time employees, including full-time equivalent employees, on average during the prior calendar year.
If your business is an ALE, and you fail to offer your eligible employees “affordable” coverage that provides minimum value to 95% of your full-time employees and their children (up to the end of eligibility when they turn age 26), you are subject to ACA penalties.
If you are not subject to the employer mandate, you can choose to cover full-time employees only, full-time employees and eligible dependents, or full-time and part-time employees (with or without dependents). Depending on your selected carrier and plan, there may be eligibility guidelines for participants. Ask your broker for details.
Selecting Your Contribution Amount
If you select coverage from the CaliforniaChoice multi-carrier, private exchange, you decide what you want to contribute to your employees’ health insurance costs. It’s called Defined Contribution. You can select a Fixed Percentage (50% to 100%) of a specific plan and/or benefit. Or, you can choose a Fixed Dollar Amount for each employee. (The amount has to be the same for all employees.)
Your employees then apply your generous contribution to whichever health plan and benefits they prefer. If an employee selects a plan that costs more than your contribution, he or she simply pays the difference.
When you renew your CaliforniaChoice coverage, you have the option to adjust your contribution – up or down – giving you complete control over what you spend on employee benefits.
Finding the Right Coverage
If you’re shopping for Group Health Insurance for your employees, what can you do to offer more to your employees? How can you give them the ability to personalize their benefits? Depending on the options available from your broker, you might be able to package together a program involving multiple insurers and benefits administrators. Or, you might consider the multi-carrier CaliforniaChoice exchange.
Your employees can choose from eight different health plans: Anthem Blue Cross, Cigna + Oscar, Kaiser Permanente, Health Net, Sharp Health Plan, Sutter Health Plus, UnitedHealthcare, and Western Health Advantage.
There are plans available at different price points, too. Health Maintenance Organization (HMO) plans are generally the least expensive, followed by Exclusive Provider Organization (EPO) plans and Preferred Provider Organization (PPO) plans. There are multiple Health Savings Account (HSA) qualified plans among the offerings.
CaliforniaChoice also offers added benefits like Dental, Vision, Chiropractic (with or without Acupuncture), and Life Insurance. Plus, you and your employees have access to fitness and wellness products and services, discounts through the Cal Perks program, and more.
Greater Access to Doctors
One of the reasons so many small businesses in California prefer CaliforniaChoice is that it offers a choice of full and limited provider networks. That gives you and your employees access to more doctors, specialists, and hospitals than any single health plan in California.
You can offer plans in a single Affordable Care Act (ACA) metal tier, multiple tiers, or all four ACA tiers (Bronze, Silver, Gold, or Platinum). Each tier offers a different percentage of shared health costs for employees. They range from 10% to 40% (with the health plan paying the other 90% to 60%). This can significantly increase the number of plans, doctors, and specialists available to your employees.
Talk With a Broker
To get more information – or a custom quote for your group – talk with an employee benefits broker. Your broker can share details about the plans in your area, as well as options to help you address the diverse needs of your employees. If you don’t already have an employee benefits broker, you can search for one here.