For more than a quarter-century, CaliforniaChoice has been helping small businesses in California compete more effectively in attracting and retaining employees – while helping employers like you control costs.
With CaliforniaChoice, you and your employees can choose from eight health plans – all in a single program. Whatever you or your employees’ health care needs, we have options. In fact, we offer more access to doctors, specialists, and hospitals than any other program in California.
That’s important because 56% of adults say employer-sponsored health benefits are a key factor in deciding whether to stay at their current job. Health benefits rank second behind wage increases as the biggest incentive for employee retention.
Manager of Field Sales Bryan Coppin highlights what make’s CaliforniaChoice different in this 15-minute webinar below.
If you want to learn more about how you can offer more for a cost you can afford, contact your employee benefits broker. If you don’t already have a broker, you can search for one on the CaliforniaChoice website.
Self-care and wellness therapies are front and center these days. It’s no wonder, given the uncertainty Americans (and the rest of the world) have faced since 2020, amidst the pandemic. If you and your employees are seeking a little relief from added stress, chiropractic care and acupuncture can help. The good news is CaliforniaChoice members have access to affordable treatment.
A Chiro & Acupuncture Leader
Landmark Healthplan makes high-quality, fully credentialed chiropractors and acupuncturists available at reasonable rates. There are 19,000+ accredited practitioners in the Landmark national network. That includes 1,600 providers throughout California. Plans are easy to access, with no deductibles or prior authorization requirements.
Landmark Healthplan offers a range of chiropractic, acupuncture, and combined chiropractic and acupuncture benefits:
- Relief from back, neck, leg, knee, foot, ankle, arm, wrist, shoulder, and elbow pain
- Treatment for misalignments, joint discomfort, bursitis, arthritis, and injuries
- Affordable monthly premiums for employees and families
- No deductibles or coinsurance – and low office copays
- Services available nationally through the MultiPlan NCQA accredited network
During your visit to a chiropractor, your doctor may discuss what you can do to avoid problems in the future. That could include advice about exercise, stretching, and nutrition. Beyond chiropractic, you may want to consider complementary acupuncture care. A key component of Chinese medicine, acupuncture is commonly used to treat pain. However, it has increased in use for overall wellness, including stress management.
Which Plans Have Chiropractic Coverage?
With CaliforniaChoice, you can choose from two plans: Chiropractic Only or Chiro and Acupuncture. Both offer low monthly premiums, affordable member copays, and include a range of services:
In addition to the separate benefits of the Landmark Healthplan Chiropractic and/or Acupuncture plan, some of the medical plans offered through CaliforniaChoice include chiropractic benefits.
Learn More from a Broker
After 25+ years, CaliforniaChoice still stands apart in today’s employee benefits marketplace. It uniquely meets – and exceeds – the needs of California small businesses. It offers you and your employees greater access to care than any single health program in the state.
To learn more about CaliforniaChoice, and Landmark Healthplan’s Chiropractic and Acupuncture benefits, talk with a broker. You can get details about all of the coverage options in your area plus a customized quote for your group. If you don’t already have a broker, you can search for one on the CaliforniaChoice website.
Health insurance ranks at or near the top of just about every survey on employees’ benefits. In the latest study released in 2022 by MetLife, 86% of workers said they consider health insurance a “must have” and another 10% said it’s a “nice to have” benefit. Just four percent said health insurance is not needed. That puts health insurance at the top of the employee priority benefits list.
With that in mind, you may be asking’ “What’s your best choice when it comes to offering health insurance to employees?” Is it a flexible PPO (Preferred Provider Organization) plan? Or, maybe, the low-cost HMO (Health Maintenance Organization) plan? It could even be the lesser known EPO (Exclusive Provider Organization) plan? The best choice depends on several considerations.
Here’s a snapshot highlighting the benefits of HMO, PPO and EPO plan options.
With an HMO, each insured person must choose a Primary Care Physician (PCP) to manage care. Patients need 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.
Premiums for an HMO are typically lower than for other coverage, and co-pays are typically lower than with a PPO.
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, discounted rates through contracted medical providers and hospitals. PPO members can go outside of the PPO network, although they will pay higher out-of-pocket costs. That could include a separate out-of-network deductible and out-of-pocket maximum.
An EPO is often described as a hybrid plan that offers both HMO and PPO benefits. Like with an HMO, EPO patients need to get health care through a doctor, specialist, or hospital that is part of the EPO network. Similar to members of a PPO, EPO members are able to go to a specialist without a referral, as long as the provider is in-network.
EPO premiums are typically lower than PPO premiums, although they may exceed HMO premiums. There are typically no or low co-pays when visiting an in-network EPO provider. Care outside of the EPO network may not be covered, except in case of an emergency.
A High Deductible Health Plan (HDHP) – which can be an HMO, PPO, or EPO – may offer your employees an even lower monthly premium than other HMOs, PPOs, or EPOs. The potential disadvantage with an HDHP is that the insured must pay more costs upfront before the HDHP begins to pay its share.
A potential offset is combining an HDHP with a Health Savings Account (HSA). That allows insured plan members to pay for qualified medical expenses with funds free of federal taxes. That includes deductibles, copayments, coinsurance, and related health care expenses. For more information about HSAs, visit the health care glossary on the federal HealthCare.gov website.
Maximizing Your Benefits Dollars
Making the most of your employee benefits dollars is a challenge for many employers. You want to be able to offer comprehensive benefits to your employees. But you also want to control costs for your business. CaliforniaChoice allows you to do both.
For more than a quarter-century, CaliforniaChoice has offered small businesses in California the opportunity to offer more, while helping them control costs. CaliforniaChoice puts you in control by offering everything you and your employees want:
- Eight health plans – and dozens of coverage 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)
CaliforniaChoice meets the diverse needs of you and your employees at a price each of you can afford. You might prefer a PPO from Anthem Blue Cross because you or your spouse will have access to a particular doctor or hospital in the Anthem network. Someone else in your group might prefer a local or regional HMO. With CaliforniaChoice, you can select coverage from Sutter Health Plus, Western Health Advantage, or Sharp Health Plan.
Another person might want an HMO operating across the state like Health Net or UnitedHealthcare. Someone may want to save with an HSA-compatible plan. Or, some employees might want an HMO from a centralized health care system like Kaiser Permanente. With CaliforniaChoice, you and they each can have what you want, including EPO options from Anthem or Cigna + Oscar.
With Defined Contribution from CaliforniaChoice, you can select a Fixed Percentage (50% to 100% of a specific plan and/or benefits) or a Fixed Dollar Amount contribution to coverage 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 adjust your contribution, up or down, giving you complete control over what you’re spending on employee benefits. You can even switch from Fixed Percentage to Fixed Dollar Amount, if that works better for your budget at renewal.
Plan Comparison Tool
If it’s important for employees and family members to be able to keep a preferred doctor when moving to a new health plan, they will want to compare the provider networks for the plans being considered.
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. Or, you and your employees can use a valuable online tool at the CalChoice website to compare plans, networks, and coverage.
A Broker Can Help You Shop
A great place to begin a comparison of health insurance options for your employees is by talking with an employee benefits broker. CaliforniaChoice works exclusively through brokers, who can discuss the available options in your area. Using a broker does not cost you anything. In fact, a broker may save you money because of their expertise in networks and plans in your specific area.
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 here.
Two years ago, California joined the ranks of jurisdictions with an individual mandate for health insurance coverage. The five others with a mandate in place in 2020 were the District of Columbia, Massachusetts, New Jersey, Rhode Island, and Vermont.
Below are five things employers should know about the California mandate.
1. The State Requirement Differs from Fed
The “Individual Shared Responsibility Provision” of the Affordable Care Act (ACA) required most Americans to maintain health insurance or pay a fine. However, the fine for not having insurance was removed by Congress as part of the Tax Cuts and Jobs Act of 2017. The tax penalty was reduced to zero after the end of 2018. People without insurance are no longer assessed a federal individual mandate penalty. There are still employer mandates under the ACA’s Employer Shared Responsibility Provision. (See section 5, below.)
Effective in 2020, the California state health insurance individual mandate requires all residents, with some exceptions, to obtain Minimum Essential Coverage (MEC).
A penalty applies if a resident does not have coverage for a minimum of nine months during each calendar year.
The state mandate does not affect employers; it applies to residents.
2. Pay or Play – Or Get an Exemption
Under the California Minimum Essential Coverage Individual Mandate, all state residents must either:
- Have qualifying health insurance coverage;
- Obtain an exemption from the coverage requirement; or
- Pay a penalty when filing their state income tax return.
Penalties are due to the State of California Franchise Tax Board with annual tax returns. They apply for each month residents are without health insurance.
Residents out of compliance with the requirement are subject to one of two penalties, whichever is highest:
- a flat penalty per household member, or
- 2.5% of gross household income (above the state filing threshold).
In 2022, penalties were at least $800 per adult and $400 for each dependent child under age 18 in the household. A family of four without insurance for a full year faces a penalty of at least $2,400.
Amounts due in 2023 (for 2022 taxes) are not yet known, although they are expected to be greater.
Health insurance providers not reporting coverage information to the Franchise Tax Board by March 31 are subject to a $50 penalty per individual.
3. Qualifying Coverage and Exemptions
To avoid a penalty, California residents need Minimum Essential Coverage for each month of the year, including:
- Personal qualifying health coverage
- Qualifying coverage for a spouse or domestic partner, if applicable
- Qualifying coverage for dependents, if any
Residents can satisfy the requirement in a variety of ways, including having qualifying health insurance coverage:
- Provided through an employer-sponsored plan
- Purchased through the Covered California public exchange or directly from an insurer
- Through Medicare (Parts A and C)
- Through Medi-Cal (California Medicaid plans)
Any insurance plan that meets ACA requirements complies with California’s MEC mandate. Additional information is available on the California Department of Managed Health Care website.
4. How to Avoid Individual Penalties
California residents can also avoid an individual mandate penalty if they have income below the state’s filing threshold or they are:
- Uninsured for three consecutive months or less during the year
- Native American
- In the U.S. illegally
- Members of a health care sharing ministry
Residents are also exempt if coverage is considered unaffordable and exceeds the income guideline applicable for the tax year.
Hardship exemptions are also available to those facing personal or family difficulties. That includes homelessness, domestic violence, bankruptcy, eviction, or consequences related to a natural disaster (e.g., a wildfire, earthquake, etc.). More information about exemptions is available on the Franchise Tax Board website.
5. State Individual Mandate Vs. Federal Employer Mandate
The California Individual Mandate does not affect the federal employer mandate. The requirement that employers with 50 or more full-time or full-time equivalent employees offer affordable, minimum value health insurance to full-time employees and eligible dependents still apply. The penalty amount due depends on whether coverage is offered, affordable, and available to all who are eligible.
The federal employer mandate penalties are payable by employers.
The state mandate penalties are payable by individuals (not their employers).
How to Learn More
If you want to offer health insurance and other benefits to your employees, a great place to start is by talking with a broker. A consultation is free and could end up saving you money in the long run. If you don’t already have a broker, you can search for one online.