Job candidates in today’s competitive talent marketplace are looking for more. You know that from reporting on the “great resignation” during the past year. According to a MetLife survey, employees consider health insurance a “must have” benefit. They rank Dental and Vision in their top five priorities, too. Dental is a must-have or nice-to-have by 96% of employees, while Vision is viewed similarly by 94%.
That is a challenge for employers. You want to offer comprehensive benefits, but you also want to control costs for your business. CaliforniaChoice can help.
CaliforniaChoice – the multi-carrier, employee-choice private health exchange – began in 1996. It is uniquely qualified to meet and exceed your employee benefits needs. It offers you and your employees more choices than other single program in the state.
Health Insurance Plans, Dental, and Vision Benefits
CaliforniaChoice delivers everything you and your employees want in a benefits program, including:
- Eight health plans and dozens of HMO, PPO, EPO, and HSA-qualified coverage options
- Greater access to doctors, specialists, and hospitals
- Increased cost control – you choose what amount to contribute to employees’ coverage
- Dental, Vision, Chiropractic, and Life benefits
- Valued-added extras through the Business Solutions Suite and Member Value Suite
Diverse Health Choices: Choose the health insurance coverage that bests meets your individual or family health care needs. You might prefer a PPO from Anthem Blue Cross because you have access to a particular doctor or hospital in the Anthem network. One employee might prefer a local or regional HMO. You can select Sutter Health Plus, Western Health Advantage, or Sharp Health Plan. Another employee might want an HSA-compatible plan from UnitedHealthcare. A fourth might want a centralized health care system like Kaiser Permanente. With CaliforniaChoice, you and they each can have what they want. Or, you can choose options from Cigna + Oscar or Health Net.
Greater Provider Access: We offer full and limited networks, plus access to options in all four Affordable Care Act metal tiers. With multiple tiers, you can offer your employees the maximum number of health care providers.
Defined Contribution: Controlling costs is easy with CaliforniaChoice. Choose a Fixed Percentage (50% to 100% of a specific plan and/or benefits, or contribute a Fixed Dollar Amount for each employee. If an employee selects coverage that costs more than you’re contributing, the employee simply pays the difference. At renewal, you can even adjust your contribution, up or down, giving you complete control over what you’re spending on employee benefits.
Dental, Vision, and More: CaliforniaChoice offers you three great ways to offer Dental to your employees. The Dentegra® Smile Club is included at no added cost through our Member Value Suite. It features reduced fees for dental care services through a network of more than 20,000 providers.
There are Dental HMO options from SmileSaver and PPO options from Ameritas available, too. These are available as employer-sponsored or voluntary. Plus, there’s no minimum participation for voluntary plans.
Ameritas plans include Dental Rewards® if employees use only part of their annual maximum benefit during a plan year. Members can earn additional money toward their next year’s plan maximum. The Carry Over Amount on three plans is $250. The PPO Bonus is up to $150. Other Extras from Ameritas include LASIK and Hearing Care coverage.
Three Vision options are available, including one at no additional cost. The Vision One Eyecare Discount Program offers CaliforniaChoice members discounts on frames, lenses, and eye exams. You can visit America’s Best, EyeMart Express, Target Optical, LensCrafters, and participating Pearle Vision locations.
Two voluntary Vision programs are available – one through EyeMed (Ameritas) and a second through VSP. Both offer eye exams, discounts on frames and lenses, and contacts. You have access to a large network of doctors.
You and your employees can also take advantage of Chiropractic Care. Or, Chiro and Acupuncture. The monthly premium is low and there are affordable member copays.
It’s Easy to Learn More
With CaliforniaChoice, you can get more without spending more. Talk with your employee benefits broker about a custom quote for your business. If you don’t already have a broker, you can search for one on the MyCalChoice website.
The idea of offering multiple insurers through a single program was revolutionary in 1996. Nearly three decades later, CaliforniaChoice still stands apart for providing a different approach to health care. Our program offers you and your employees access to eight premier health plans — a portfolio that is the most diverse in the state.
Beyond that, CaliforniaChoice includes plans in all four Affordable Care Act (ACA) tiers. Each tier offers a different percentage of shared health care costs for you and your employees.
CaliforniaChoice offers Dental, Vision, Chiropractic & Acupuncture, and Life benefits, too. And, as a member of CaliforniaChoice, you get value-added extras like a Premium Only Plan, online HR support, Cal-COBRA or COBRA billing services, employee discounts on travel, entertainment, and other services, plus tools to compare plans, look up providers, and more.
Networks and Hospitals by Region
Los Angeles and Ventura Counties
You and your employees have access to some of the nation’s leading health care providers, including:
- Adventist Health Glendale
- Cedars-Sinai Medical Center (Los Angeles)
- Community Memorial Hospital (Ventura)
- Huntington Health (Pasadena)
- Kaiser Permanente Los Angeles Medical Center
- Keck School of Medicine of USC (Los Angeles)
- PIH Health Hospitals in Downey and Whittier
- Providence Little Company of Mary Medical Center (Torrance)
- Providence Saint John’s Health Center (Santa Monica)
- Ronald Reagan UCLA Medical Center
- UCLA Santa Monica Medical Center
- Valley Presbyterian Hospital (Van Nuys)
- Ventura County Medical Center
For more information about health plans participating in CaliforniaChoice that offer coverage in Los Angeles County, visit the regional page on our website.
You and your employees have access to leading Orange County health care providers and hospitals, including:
- Anaheim Memorial Medical Center
- Hoag Hospital Newport Beach
- Kaiser Permanente Anaheim Medical Center
- Kaiser Permanente Orange County – Irvine Medical Center
- MemorialCare Orange Coast Medical Center (Fountain Valley)
- MemorialCare Saddleback Medical Center (Laguna Hills)
- Providence St. Jude Medical Center
- St. Joseph Hospital of Orange
- UC Irvine Medical Center
For more information about health plans participating in CaliforniaChoice that offer coverage in Orange County, visit the regional page on our website.
Whether in the Bay Area, San Jose, Sacramento, or outlying NorCal communities, you have great choices:
- Canopy Health
- Dignity Health (Saint Francis Memorial Hospital; St. Mary’s Medical Center; Mercy Medical Center in Mt. Shasta and Redding; and others)
- El Camino Health
- Good Samaritan Hospital (Bakersfield and San Jose)
- John Muir Medical Center (Concord and Walnut Creek)
- NorthBay Medical Center and NorthBay VacaValley Hospital
- O’Connor Hospital
- Stanford Hospital
- Sutter Health (multiple facilities and cities)
- UC Davis Medical Center
- UCSF Medical Center
For more information about health plans participating in CaliforniaChoice that offer coverage in Northern California, visit the regional page on our website.
Central Coast and Inland
You and your fellow CaliforniaChoice members have access to outstanding coastal and inland health providers, including:
- Clovis Community Medical Center
- Community Regional Medical Center (Fresno)
- Fresno Heart & Surgical Hospital
- Kaiser Permanente Fresno Medical Center
- French Hospital Medical Center (San Luis Obispo)
- Goleta Valley Cottage Hospital
- Marian Regional Medical Center (Santa Maria)
- Saint Agnes Medical Center (Fresno)
- Santa Barbara Cottage Hospital
- Sierra Vista Regional Medical Center (San Luis Obispo)
For more information about health plans participating in CaliforniaChoice that offer coverage along the Central Coast of California, visit the regional page on our website.
You have access to premier networks and medical facilities in the San Diego area, including:
- Kaiser Permanente San Diego Medical Center
- Rady Children’s Hospital – San Diego
- Scripps Memorial (multiple facilities)
- Sharp Health (multiple facilities)
- UC San Diego Medical Center
For more information about health plans participating in CaliforniaChoice that offer coverage in San Diego County, visit the regional page on our website.
You can access leading hospitals and other providers throughout Riverside and San Bernardino counties, including:
- Desert Regional Medical Center (Palm Springs)
- Desert Valley Hospital (Victorville)
- Dignity Health San Bernardino Medical Center
- Eisenhower Medical Center (Rancho Mirage)
- Kaiser Permanente Medical Centers (Fontana, Ontario, Riverside, and San Bernardino)
- Riverside Community Hospital
- St. Mary Medical Center (Apple Valley)
- Loma Linda University Medical Center (multiple facilities)
For more information about health plans participating in CaliforniaChoice that offer coverage in the Inland Empire, visit the regional page on our website.
How to Get a Quote
Talk to a broker to learn more about how CaliforniaChoice can help you offer more while maintaining control over your budget. Your broker can provide additional details about coverage options in your area and deliver a custom quote for your group. If you don’t already have an employee benefits broker, you can search for one here.
Are you looking to attract employees in today’s ultra-competitive talent market? Then it’s important for you to offer more than competitive wages. Employees expect more, including a comprehensive benefits program.
So, where do you start? It’s good to know what’s required in a benefit plan? Group size is one factor. However, when you are comparing plans, group size is not your only consideration. It’s also important to know what employees are looking for when comparing potential new jobs. For example, where does health insurance rank among “must have” benefits?
According to the MetLife 20th Annual U.S. Employee Benefit Trends Study 2022, a comprehensive benefits package is a “must have” for two-thirds (66%) of employees when accepting a new role. The same study found health, dental, vision, life, and disability insurance are five of the top seven priorities for employees.
Affordable Care Act Requirements
There are also certain coverage requirements that, if not followed, could lead to penalties. The Affordable Care Act (ACA) was signed into law by President Barack Obama in 2010. Federal and state health insurance exchanges began in 2013. They offered coverage effective January 1, 2014. That’s when insurance companies became required to provide health insurance to any American adult ages 19 to 64 who applied for ACA-compliant coverage.
To discourage people from waiting to get coverage until they got sick, the ACA required all Americans to buy coverage or face a fine. That ACA individual mandate was rescinded and no longer applied after 2018.
The Employer Shared Responsibility Provision continues to require Applicable Large Employers (ALEs) to provide minimum value coverage to 95% of full-time employees and dependent children. If an ALE does not offer affordable, comprehensive coverage, the employer is subject to penalties.
Compliant health plans must cover 10 categories of care. The complete Essential Health Benefits (EHB) list includes:
- 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 (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; and
- Pediatric services, including oral and vision care (however, adult dental and vision coverage are not essential health benefits).
Beyond the ACA requirements, there are state-required Essential Health Benefits Benchmark Plans. For information, visit the Centers for Medicare & Medicaid Services (CMS) web page on benchmark plans. The page includes links for California’s required benefits and information for 2017-2023.
If your business is an Applicable Large Employer (ALE) as set forth in the ACA, you’re subject to the employer mandate. ALEs are organizations employing a monthly average of 50 or more full-time or full-time equivalent employees (FTEs). Each employer is required to make an annual ALE determination based on the business workforce during the prior year.
If an employer has fewer than 50 FTEs, on average, the business is not an ALE for the current calendar year. If that includes your business, you are not subject to the employer mandate or employer ACA reporting requirements.
In contrast, if you had at least 50 full-time employees, including FTEs, during the prior calendar year, your business is an ALE for the current calendar year.
As noted earlier, the ACA requires minimum health insurance coverage to 95% of full-time employees and dependent children.
If you do not offer coverage, your business is subject to ACA penalties. In 2022, a penalty of $2,750 applies for each of your full-time employees minus the first 30. For example, if you have 150 employees and do not offer health insurance to full-time employees and dependents, your penalty would be $330,000. That’s 120 employees times $2,750.
If coverage is not affordable or does not offer Minimum Value, a different penalty applies. In determining affordability, your employee’s cost cannot exceed 9.61% of income in 2022. Minimum Value means the plan covers at least 60% of the total allowed cost of benefits expected under the plan.
The “B” penalty (under Section 4980H(b) is $343.33 per month ($4,120 annualized) for each full-time employee with subsidized coverage through the marketplace.
If you’re unsure about your ALE status, CaliforniaChoice offers three ACA calculators on its website:
- ACA Full-Time Equivalent Calculator
- ACA Penalties Calculator
- ACA Safe Harbor Calculator
You can also download the Employer Mandate Reporting Guide through the CaliforniaChoice website (using the link above).
Beginning in 2020, California was among six jurisdictions with an individual mandate for health insurance coverage. The mandate does not apply to employers, but rather to residents, who must either:
- Have qualifying health insurance coverage;
- Obtain an exemption from the requirement to have coverage; or
- Pay a penalty when they file their state income tax return.
Penalties are due for each month an individual or family went without health insurance during the tax year. For example, in filing in 2022 for 2021, the penalties are at least $800 per adult and $400 per dependent child under 18 in the household. A family of four without insurance for a full year would face a penalty of at least $2,400.
For additional information on the state health care mandate, including the exemptions, visit the California Franchise Tax Board web page. Again, it’s important to note that penalties are paid by individuals, not employers, when filing state income tax returns.
Beyond What’s Required
CaliforniaChoice makes it easy for you to offer what’s required and deliver more to your employees.
In addition to offering health insurance from eight health plans and a variety of HMO, PPO, EPO, and HSA-compatible choices, you can offer your employees Dental, Vision, and Chiropractic care. Plus, CaliforniaChoice offers value-added extras like a Premium Only Plan, online HR support, and employee discounts on travel, entertainment, and more.
Consult a Broker
Shopping for the right coverage for employees can be overwhelming. An employee benefits broker is a great resource. A broker will help you explore your options to ensure you find the coverage that meets the requirements for your group size and addresses the diverse needs of employees.
If you are not already working with an employee benefits broker, you can search for one here.