Health insurance and employee benefits can be complicated. To make your life just a little easier, we’ve compiled some of the most-frequently asked questions from business owners who already offer employee benefits, but who are still left wondering what’s going to happen in Washington, DC, regarding repeal or changes to the Affordable Care Act (ACA). Hopefully, you’ll find these answers helpful to you, your business, and your employees.
Q1. Do I still have to offer health insurance for my employees even though Obamacare might be going away?
The ACA is still the law of the land, and that means some employers are required to offer health insurance benefits to their full-time and full-time equivalent employees. While this mandate generally applies to businesses with more than 50 employees, many other employers with fewer workers choose to offer health insurance as part of their broader employee benefits and retention program. Ask your employee benefits broker – or connect with a CaliforniaChoice broker – to find out if your business is subject to the ACA’s Employer Shared Responsibility Provision. (Click here for information from the Kaiser Family Foundation on employer penalties under the ACA for not offering coverage.)
Q2. What’s the best way to shop for employee benefits even though I’m already offering health insurance to my employees?
The best way to look for benefits is always to connect with a health insurance broker. They will provide information and guidance to you at no cost and answer your benefits questions, discuss the cost-controls benefits of Defined Contribution, and help you make sense of all the buzzwords and changing health care regulations under the ACA.
Q3.How do I avoid annual premium increases for my employees’ health insurance? Are there ways for me to control my costs?
Using an employee benefits broker can help you avoid premium increases and find alternative options. Your broker will also be able to discuss different approaches you can take to gain greater over your benefits budget. That could include switching from your current funding strategy for benefits to a Defined Contribution strategy.
At CaliforniaChoice, we offer you flexible budget options and up to 12 different ways to define your employee benefits budget. And you can take comfort in knowing the rates for your employees are locked in for 12 months.
Q4. If Obamacare gets repealed, how will my benefits change? What are the differences between Obamacare and Trumpcare?
Nothing has changed yet. So, it’s important your business continue to comply with the ACA (if you’re an Applicable Large Employer subject to the employer mandate).
Several different measures have been introduced in the U.S. House of Representatives and U.S. Senate. The White House would like to see a full repeal of the ACA; however, that seems less likely after the Republican-controlled Senate failed three times during the week of July 24 to approve different proposals.
Here’s a snapshot of some of the differences between Obamacare and Trumpcare. Keep in mind, though, right now no one knows for sure what changes could, ultimately, be approved by Congress and signed into law by the president.
50+ Groups Must Offer Coverage to Full Time and Full-Time Equivalent Employees
Coverage Required for Most Americans or They Must Pay a Penalty to IRS
No mandate to have coverage; no penalty for not having insurance
Essential Health Benefits
The ACA has 10 categories of services that health insurance plans must cover; these include doctors’ services, inpatient and outpatient hospital care, prescription drugs, pregnancy and childbirth, mental health services, and others.
|Yes; same Essential Health Benefits apply nationwide; no state variations
No; states would be allowed to scale back conditions that must be covered by plans sold within their borders
Pre-existing Conditions Covered
|Yes; the ACA requires that premiums be set without regarding to whether a person has a pre-existing health condition (people with and without health issues are charged the same)
Not necessarily. Because states can opt-out of Essential Health Benefits (described above), a person with a current health condition could have to pay more to get coverage for a pre-existing condition.
|Older Consumers Charged More Than Younger Enrollees
|Yes; insurers can charge older consumers no more than three times the rate for a younger insured
Yes; insurers can charge older consumers no more than five times the rate for a younger insured
Q5. Can I change health plans for my business at any time – or do I have to wait for open enrollment?
Yes, you can make changes to your plan at any time. However, you will likely have to change carriers if you make a coverage change. With most insurers, you cannot change within the same program before your schedule renewal date.
The best time to shop and compare your options is in the 45-60 day period before your next scheduled open enrollment (ahead of when your current plan is slated to end). That gives you time to speak with a broker and actively look at the market and all of your available coverage options for the next year.
Many employers like the CaliforniaChoice multi-carrier, employee-choice program because it gives you access to dozens of options from seven different health insurance carriers: Anthem Blue Cross, Health Net, Kaiser Permanente, Sharp Health Plan, Sutter Health Plus, UnitedHealthcare, and Western Health Advantage.
And you get a 12-month rate lock on your premium, so you’ll be better able to manage your employee benefits budget. CaliforniaChoice is a program that grows with you, so you’re free to shop and compare at any time, and if you want to make a change, you and your employees can still stay within the CaliforniaChoice program.
Q6. If I offer multiple health plan options for my employees, will I get bills from different companies?
That depends. If you purchase coverage directly from the carrier, you’ll get a monthly invoice from each carrier for your employees’ benefits. However, if you select CaliforniaChoice, you’ll receive a single invoice for all of your employees’ coverage, no matter how many different health plans in which they are enrolled.
Q7. Do my employees and I pay more if my business buys coverage through a broker?
No. When you work with a broker you pay nothing for their services. They actually get paid from the program you decide to go with, so it makes sense for you to always use a broker during the decision making process.
Q8. How do I add more people to my group coverage?
If you are currently insured, whether your coverage is written directly through a carrier or through a multi-carrier program like CaliforniaChoice, when you have a change in coverage (such as a new hire or a current employee has a baby, gets married or divorced, etc.), you’ll probably use a New Quote Request form or Change Request form. Ask your carrier or broker for details. CaliforniaChoice forms can be found here.
Q9. How can I find out more about offering a multi-carrier program to my employees?
You can get more information about the CaliforniaChoice multi-carrier, employee-choice program from your employee benefits broker. He or she will want to get a current employee census that includes each employee’s birth date (and the birth date for insured dependents if you offer spouse and dependent coverage). The more information you provide, the more accurate your quote will be.
If you don’t already have a broker, we can help you find a CaliforniaChoice broker to speak with about a quote for your employee benefits.