At CaliforniaChoice, we’ve partnered with eight top health plans to bring Californians the most extensive variety of HMO, PPO, EPO, and other benefit options to choose from. Our program includes different price points so you also have the power to control your costs.
We’re proud to offer access to the following health plans:
- Anthem Blue Cross
- Cigna + Oscar
- Health Net
- Kaiser Permanente
- Sharp Health Plan
- Sutter Health Plus
- Western Health Advantage
We’re delivering on our goal to provide access to more health care choices in 2023 by expanding our network and coverage options. CaliforniaChoice is adding two networks, giving you and your employees access to a total of 20 network options. We’re also boosting your HMO, PPO, EPO, and Health Savings Account-qualified plans, so you have 130+ options from which to select. That’s 20 more than in 2022. It’s now easier than ever before for you and your employees to find coverage that matches your unique needs.
More Coverage Is Just the Beginning
More health care choices aren’t the only way CaliforniaChoice is different. We help you stay on budget and provide value-added benefits at no cost to you.
- Cost Control: You decide what amount you want to contribute to the premium for employees. You can choose a fixed percentage (50% to 100%) of a specific plan and/or benefit. Or, you can choose a fixed dollar amount for each employee. Your employees then apply your contribution to the plans they like best. If the cost exceeds your contribution, the employees pay the difference. At renewal, you can adjust your contribution – up or down.
- Dental, Vision, Life, and Chiro: It’s easy to add SmileSaver Dental HMO coverage or Ameritas Dental PPO coverage. These plans can help employees maintain their oral health. Three options are available.
- Voluntary Vision: Choose from three Vision options, including one at no additional cost. The Vision One Eyecare Discount Program is part of the Member Value Suite. Two Voluntary Vision are available from EyeMed and VSP.
- Life Insurance: Assurity Life offers valuable benefits in case of death – plus a partial payout in case of a terminal illness diagnosis.
- Business Solutions Suite: Get HR support from Mineral, a Flexible Spending Account for employees, Cal-COBRA or federal COBRA billing, and Premium Only Plans, too. It is all available through the CaliforniaChoice Business Solutions Suite.
- Member Value Suite: Take advantage of great savings on Dental, Vision, and Hearing services, and prescription drugs. Enjoy discounts of up to 57% on Garmin, Vitamix, and Fitbit products. Start a fitness membership for $25 per month, and save big on movies, theme parks, hotels, and much more with Cal Perks.
- Consolidated Billing: Whether your business has one employee or 100, you’ll get a single, consolidated monthly bill. It lists all coverage, your contributions, and employee deductions.
Talk to a Broker to Learn More
To find out more about CaliforniaChoice – and what’s new for 2023 – talk with your employee benefits broker. If you don’t already have a broker, you can search for one on our website here.
You may have heard the term health insurance marketplace and questioned what it refers to. It actually has multiple meanings. Broadly, it refers to the entirety of the health insurance market. That includes all types of plans: individual, family, and employer-sponsored coverage.
It also refers to the federally facilitated marketplace (FFM) exchanges. These were created by the Affordable Care Act (ACA). That includes 18 state-based marketplaces and three states using the federal exchange platform. Thirty states use the FFM exchange.
California is one of the state-based marketplaces. The state’s exchange is Covered California. It’s available for Individual Family Plan (IFP) coverage. Covered California for Small Business offers coverage to employers with 1 to 100 employees.
Individuals buying IFP coverage through an FFM or state exchange may be eligible for premium subsidies. These help reduce out-of-pocket costs. As part of the American Rescue Plan Act and Inflation Reduction Act, IFP subsidies have increased. Through 2025, there is no longer a cut-off on individuals’ income at 400% of the federal poverty level. However, exchange subsidies are not available to those who get their insurance through their employers.
Employer Coverage Options
While employers are not able to take advantage of ACA premium subsidies, there are other coverage avenues available. One is purchasing coverage directly through an insurance company. Another is shopping for coverage through a broker. A third is buying coverage through a public or private exchange, with or without a broker.
Where Covered California for Small Business is a public exchange for health insurance coverage, CaliforniaChoice is a private exchange. Both the public and private exchanges offer coverage from multiple health plans. Covered California for Small Business offers five health plans and CaliforniaChoice includes eight in its program.
CaliforniaChoice began in 1996 based on the principle that small businesses should be able to choose from a variety of employee health insurance options. For 2023, CaliforniaChoice members can choose from 130+ HMO, PPO, EPO, and HSA-qualified plan options. That’s 20 more than in 2022. There are also two added networks – for a total of 20.
Plus, CaliforniaChoice delivers value-added benefits. Among the no-extra-charge benefits are online HR support and Cal-COBRA or COBRA billing. You and your employees also get Flexible Spending Accounts (FSAs) and Premium Only Plans (POPs). Discounted Dental, Vision, and Hearing services are available, too. Plus, there are discounts on wellness products, fitness, and savings on entertainment, travel, and more.
Talk With a Broker to Learn More
If you want to find out more about the health insurance marketplace, a good place to start is by talking with a health insurance broker. Your broker can share information about your employee benefits options and the plans available in your area. If you don’t already have a broker, you can search for one here.
Health insurance premiums are starting to climb after years of moderate increases. You’re likely wondering how you can keep your costs under control. If you are a small business owner looking for health insurance, here are five tips to help you get the best price on coverage for your employees.
Health Insurance for Small Business Owners
1: Ask yourself if you are an ALE
If your business is an Applicable Large Employer (ALE), you are probably aware of the implications. However, if your business started small and has grown, you may not know about your ALE responsibilities. Under the Affordable Care Act (ACA), an ALE is any employer with an average of at least 50 full-time employees or “full-time equivalents” (FTE). You must determine your ALE status annually based on the average size of your workforce during the prior year. If you had at least 50 full-time employees, on average last year, your business is most likely an ALE for the current calendar year.
ALE status means your business is subject to the ACA’s employer-shared responsibility provisions. That means offering minimum essential coverage to at least 95% of full-time employees and their dependents. If you don’t offer qualifying coverage, you could be subject to penalties. You must also report your offering to the IRS. For more information, visit the Internal Revenue Service website.
If you are uncertain of your ALE status, CaliforniaChoice offers an ACA Full-Time Equivalent calculator on our website to help you.
2: Consult a broker
Contrary to what you might think, using a health insurance broker does not cost you more. In fact, it could save you money on your group health coverage. Brokers have insight into the most popular plans in your local market. They also know what doctors and hospitals are included in each plan’s provider network. A broker works for you, not the insurance company. The focus is on finding a plan or program that best serves you and the needs of your employees while helping you control costs. A broker can help with your group’s enrollment and provide help throughout the year if there are service or claims-related issues.
3: Compare plan types, copays, and provider networks
There are several types of health plans available. They include HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organization), EPOs (Exclusive Provider Organizations), and HDHPs (High Deductible Health Plans). Frequently an HMO or EPO is offered with an HSA (Health Savings Account). An HSA is an account that allows employees to set aside money on a pre-tax basis to pay for qualified medical expenses. For more details, visit health care.gov.
Out-of-pocket costs vary by plan type. Most plans do include a deductible that the insured must pay before plan benefits begin. Copays and coinsurance may also apply. For example, if a patient visits an in-network doctor, the copay may be $25, which applies for each office visit. Other plans may have a coinsurance percentage that applies. For example, rather than a copay, the plan may pay 60% of the office visit cost. The insured pays the remaining 40%. When comparing plans, consider all costs: the deductible, copays, coinsurance, and out-of-pocket max.
Each type of health plan offers a different provider network. For HMOs and EPOs, going outside of the provider network for treatment can come at considerable expense. Some plans may offer no out-of-network coverage (except in cases of emergency). That means the insured will likely pay all treatment costs.
HMOs and some EPOs require a Primary Care Physician (PCP) selection by the member. The PCP serves as a gateway for members who need a referral to a specialist. Other EPOs may allow members to self-refer, as long as the specialist is part of the EPO network. PPOs give members the greatest flexibility. Those with PPO coverage can self-refer to any health care provider – in or out of the PPO’s provider network. However, out-of-network care does come with higher copays and coinsurance.
To make sure your preferred doctors are part of the plans you’re considering, you can use online provider directories to look them up. All plans offer directories on their websites. If you use a broker to shop plans, you can ask your broker for help. If you have employees who travel frequently, keep that in mind when selecting coverage.
4: Look beyond benefits
Health plans often offer members added benefits. These can include free or discounted gym memberships, prescription drug savings, and fitness and wellness discounts. Some may offer savings on tickets to movies, sporting events, and entertainment venues.
Other value-adds may include savings on travel, home and office services, food delivery, online learning, and warehouse club memberships. CaliforniaChoice includes a variety of discounts for members as well as access to the Business Solutions Suite, which offers online HR support, a Premium Only Plan (POP), Flexible Spending Accounts for employees, and COBRA billing services. When comparing plans, look at the “total package” to determine the best value.
5: Don’t overlook exchange options
You might consider coverage through a public or private health exchange. The state exchange, Covered California for Small Business, was previously known as the Small Business Health Options Program (SHOP).
The CaliforniaChoice private exchange has been offering group health coverage to California small businesses since 1996. It provides you and your employees with access to eight health plans and 130+ coverage options.
With CaliforniaChoice, you decide what amount you want to contribute to your employees’ health insurance. You can choose a Fixed Percentage (50% to 100%) of a specific plan and/or benefits. Or, you can select a Fixed Dollar Amount for each employee. Your employees then apply your contribution to the health plan and benefits they like best.
You or an employee might choose from several options:
- An HMO plan from Anthem Blue Cross, Health Net, Kaiser Permanente, UnitedHealthcare, or a regional plan like Sharp Health Plan, Sutter Health Plus, or Western Health Advantage
- a PPO plan from Anthem Blue Cross
- an EPO plan from Cigna + Oscar or Anthem Blue Cross
- an HSA-qualified plan
With CaliforniaChoice, it’s the employee’s choice. If the plan an employee prefers costs more than your contribution, the employee pays the difference. It’s that simple.
Learn more about your options
To get more information about health insurance coverage for your employees, request a custom quote from your employee benefits broker. If you don’t have a broker, you can search for one here.
4 Tips to Planning Your Employee Benefits Budget
According to the Kaiser Family Foundation (KFF), the average annual premium for single health coverage in 2021 was $7,739. It was $22,221 for family coverage. These were the average amounts for all plan types. That includes HMO, PPO, High-Definition Health Plans (HDHPs), and Point-of-Service (POS) plans. Both figures were up 4% over 2020.
Historically, the average family premium has increased 47% in a decade and 22% in the five-year period 2016-2021.
Group Health Insurance Cost Sharing
Most employees share the cost of their coverage premium with their employer. On average, covered workers contribute 17% of the premium for single coverage and 28% of the premium for family coverage. Workers at smaller firms on average contribute a higher percentage for family coverage: 24% as compared to 37% for those at larger firms.
Twenty-nine percent of covered employees at smaller firms are in a plan where the employer pays the entire premium. That contrasts with nearly one-third (31%) of small firm workers who contribute more than half of the premium for family coverage. At larger firms, just five percent of covered workers make similar contributions to their family coverage premium.
Covered workers in 2021 contributed on average $1,299 toward single coverage and $5,969 toward family coverage. Both amounts are similar to contributions made by workers in 2020. KFF will release its 2022 employer health benefits survey results in November.
Planning Employees’ Health Insurance
As you think about your employees’ future health insurance coverage, what should you consider?
1: Use available benchmarks: KFF numbers are a good gauge of what others are paying for employees’ health coverage. Recognize that these figures are across the range of available plans. On average, HDHPs offer the most-affordable premium, followed by POS, HMO, and PPO plans.
A Willis Towers Watson survey found employers are anticipating a six percent increase in costs next year. That follows a five percent increase in 2022. Seven in 10 employers are expecting moderate to significant health care costs increases during the next three years.
2: Budget forecasting: The U.S. Bureau of Labor Statistics (Sept. 2022) shows benefits comprise about 29.5% of total compensation for private industry workers. For businesses with 1-49 workers, the percentage was 24.8%. For establishments with 500 or more workers, the stat was nearly six percent more – at 35%.
Zippia offers another look at costs in its analysis from August 2022. Investopedia published guidance on the topic in March 2022.
3: Review all coverage options: Shopping the full marketplace will help you find the best possible deal. That will allow you to provide more choices to employees, while still controlling your costs.
CaliforniaChoice offers you and your employees access to eight health plans and dozens of coverage options. CaliforniaChoice also gives you more control over your costs thanks to Defined Contribution. You choose what amount you want to contribute to employees’ health care costs. You can contribute a fixed percentage (50% to 100%) of a specific plan and/or benefit OR a fixed dollar amount for each employee. Your employees then apply your generous contribution to whichever health plan and benefits they prefer. Best of all, once you set your budget, you know what your costs per employee will be for the year.
You can offer employees health plans in one, two, three, or all four of the Affordable Care Act (ACA) metal tiers. By selecting “Total Choice,” you can significantly increase the number of plans, doctors, and specialists available to you and your employees. And your costs remain the same.
4: Don’t overlook value-adds available: It’s also smart to consider any value-added benefits that might be available from plans you’re considering. For example, with CaliforniaChoice, you get the no-added-cost benefits of the Business Solutions Suite. They include online HR support; Flexible Spending Accounts (FSAs) for employees; COBRA or Cal-COBRA billing; and initial set-up of Premium Only Plans.
The Member Value Suite offers outstanding savings on Dental, Vision, and Hearing services; fitness and wellness (including low-cost gym memberships); prescription drug savings; discounted movie, theme park, and water park tickets; travel; and much more.
Talk With a Broker to Learn More
An insurance broker can help you compare benefit options for your employees. The good news is using a broker won’t cost you more. In fact, it could save you money because a broker will have insights into the provider networks and benefits of the plans available in your area.
If you are not already working with an employee benefits broker, you can search for one online.
CaliforniaChoice is a flexible health insurance option for employees. But, that’s not where it ends. You can also take advantage of value-added benefits beyond health care.
Among them is 24-hour access to human resources support from Mineral.
The HR Support Center in the CaliforniaChoice Business Solutions Suite offers you:
- Free access to human resources (HR) professionals
- An online library of downloadable materials, including:
- employee handbooks
- company policies
- job descriptions
- human resources (HR) forms
- Summaries of state and federal laws affecting employers and employees
- A database of more than 2,500 questions and answers; subjects range from benefits to compensation, labor relations, and recruitment
- A glossary of commonly used HR terms and definitions
- Information specific to Leave of Absence, Hiring, Performance Management, and Termination
- Great pricing on HR posters, books, and training videos
- A subscription to the monthly e-newsletter HR Advisor
- Articles written by HR professionals – get tips, information, and best practices to help you better manage your business and employees
HR and compliance don’t have to be complicated. The resources Mineral provides can help eliminate guesswork for you and your employees.
If you’re already a CaliforniaChoice member, you can access your HR resources by logging in at calchoice.com. Or, if you want to learn more about offering CaliforniaChoice to your employees, talk with your employee benefits broker. If you don’t have an employee benefits broker, we can help you find one here.
Halloween is just around the corner. Do you feel like it creeps up on you every year? Well, we’ve got you covered with several spooky ideas for virtual or in-office parties to get your employees in the Halloween spirit.
Virtual or In-Office Halloween Decorations
If you’re in the office even a few days a week, you can encourage employees to compete against one another within the same department or across your entire organization.
If employees work remotely, they can still join in on the fun. You can encourage them to decorate their home offices and select separate winners for a virtual competition. Themes always help get the creative juices flowing and prizes encourage participation.
Halloween is on a Monday this year so keep that in mind in your planning.
Here are some popular decorating themes to get you started:
- Seasonal themes: graveyard, haunted house, witches, Frankenstein’s lab, mummy’s tomb, spider’s web, skeletons, scarecrows, ghosts, zombies, and morgue/funeral home
- Other ideas: Where’s Waldo, circus, carnival, zoo, and disco
Costume Competitions: Halloween and costumes are synonymous but if you hold a contest, it’s a good idea to set and share rules for your competition. The idea is to be engaging and encourage creativity, without exceeding standards for good taste while at work.
You can have different competitions for individuals and groups, awarding prizes for most original/creative, scariest, worst, and best. You may be surprised by the results. Some of your employees who seem shy may be the ones to go all out.
Virtual or In-Office Costume Ideas
- TV shows: Brady Bunch, Gilligan’s Island, The Munsters, The Addams Family, Schitt’s Creek, Friends, The Office, Yellowstone, Game of Thrones, Grey’s Anatomy, Modern Family, Seinfeld, Big Bang Theory/Young Sheldon, Ted Lasso, Friday Night Lights, Parks and Recreation, Marvelous Mrs. Maisel, Real Housewives of _______________, That 70s Show, Mad Men, Queer Eye, Sesame Street, The Muppets, Power Rangers, Gilmore Girls, Stranger Things, The Golden Girls, Saved by the Bell, Orange Is the New Black, Bridgerton, and countless others
- Movies: Willy Wonka, Beetlejuice, Mary Poppins, Alice in Wonderland, Wizard of Oz, 101 Dalmatians/Cruella, Harry Potter, Rocky Horror, The Addams Family (again), Snow White, any of several Disney characters (e.g., Princesses, Minions, toys from Toy Story), Grease, The Breakfast Club, Hocus Pocus, Teenage Mutant Ninja Turtles, It, Ghostbusters, Queen’s Gambit, Dark Shadows, Scooby-Doo, The Matrix, Star Wars, Star Trek, or anything from Dr. Seuss
- Superheroes and Villains: Spiderman, The Flash, Batman, Superman, Wonder Woman, Captain Marvel, Supergirl, Batgirl, Thunder, Robin, Green Lantern, Wasp, Hulk, Thorn, Iron Man, Deadpool, Poison Ivy, Black Panther, Wanda Maximoff (from WandaVision), Catwoman, SheHulk, Black Canary, Black Widow, Storm, Iron Lady, Starfire, Black Cat, Gamora or another from Guardians of the Galaxy, Joker, Penguin, Riddler, or others
- Random themes: Where’s Waldo, circus, carnival, zoo, and Hollywood stars
- Commercials: Jake from State Farm, Flo from Progressive, Bob’s Big Boy, Captain Crunch, Tony the Tiger from Kellogg’s Frosted Flakes, Toucan Sam from Froot Loops, Snap or Crackle or Pop from Rice Krispies, Colonel Sanders, Geek Squad member, Jack in the Box, Michelin Man, Mr. Peanut from Planter’s, Pringles Man, Poppin’ Fresh Doughboy from Pillsbury, Keebler Elf, Ronald McDonald, Wendy (from Wendy’s), Jolly Green Giant, Energizer Bunny, Kia Soul Hamsters, Mr. Clean, Mayhem man from Allstate, Lucky the Leprechaun (from Lucky Charms), and countless others
Virtual or In-Office Celebration Ideas
While it may be more fun to have an in-person competition, hosting one virtually also works.
Pumpkin Carving Contest: You can ask your employees to carve their pumpkins off-site and bring them to work ready for judging, or you can have employees compete on-site and raise the stakes by limiting the window in which they must do their carving.
If carving takes place at work, be sure you supply all the tools needed – along with a de-seeding station. If everyone guts their pumpkins in the same place before taking them to a “carving table,” you can limit the mess.
A table with paint, glitter, feathers, and related accoutrements will give all competitors an equal opportunity to win. You can avoid the mess entirely by limiting your pumpkin contest to jack o’ lanterns decorated with a Sharpie.
Start Planning Now
It’s not too early to begin planning. If you’re considering a costume or decorating contest, you want to be sure to give your team members time to prepare. Whatever you do, have fun and Happy Halloween!
The “Great Resignation” and “Quiet Quitting” are getting quite a bit of media attention of late. As a business owner, you may be spending more of your time looking for ways to retain your employees. Offering the right combination of employee benefits can set your business apart from others in your area. Here are three easy ways to promote your benefits to current and prospective employees.
1: Communicate Often
There are many ways you can communicate the value of your employee benefits program. It doesn’t matter whether you’re talking to current staff or those you want to join your workforce.
Here are eight methods to consider.
- Offer Letter: Your offer letter needs to touch on all of the important aspects of the employment offer you are making. It should include:
- expected work hours
- work location (especially if you have a remote-friendly or hybrid work arrangement)
- an overview of your employee benefits – and when they will begin
This “big picture” summary shows new employees what they can expect, and how you’re offering them more than just “a job.”
- New Employee Orientation: Some employers and employee roles may not have a formal process for new hires. Others may provide an employee handbook or binder, depending on the organization, benefits overview, photo ID Card, etc. If your employee benefits don’t begin right away, you can delay sharing details until nearer to enrollment. However, you won’t want to pass up the opportunity for employees to ask questions to be sure they know what’s available and how to sign up.
- Open Enrollment Meetings: Depending on your group size and whether benefits are employer-sponsored or voluntary, you may hold a company-wide open enrollment. This meeting – whether in-person, virtual, or recorded – gives employees a closer look at what their options may be. This can be especially important as compared to their initial hire date or your prior open enrollment.
- Intranet: Many companies operate an internal communications platform online. This can be through Slack or Microsoft Teams, or as part of a human resources program (like UKG). You may be able to customize yours to remind employees of their benefits.
- Kitchens and Break Rooms: Don’t overlook bulletin boards or office whiteboards. You can post news or reminders of what’s in your benefits package – or your next enrollment date. If employees are getting lunch or coffee, they can also get a refresher on what makes your business different – and why they should stick around.
- Health Fairs: Some of your benefits partners may want to come into your office to host a health fair or benefits awareness event. The past couple of years have been challenging for workers and family members, so you may want to include your Employee Assistance Program (EAP) vendor as well as health care partners.
- Lunch & Learns: If you don’t want to host a big event, you might consider a series of presentations during lunchtime. These can be in-person or virtual. This will allow you to focus on one aspect of your benefits program. For example, a retirement program sponsor or your EAP. You can do these quarterly or more frequently depending on space availability. You could even bring in experts to discuss topics to help employees at work and at home – like grief management/emotional wellness, funding for a child’s education, nutrition, and sleep.
- Emails or Newsletters: The tried-and-true method of reaching employees is email or a newsletter. Each message can focus on a different aspect of your benefits package. For example, PTO (vacation/holidays) in one message. That could be followed by health care options in the second. Retirement might make a good third topic. Your employee recognition programs (e.g., bonuses or events) could be message four.
2: Track Benefits Utilization
If your health plan(s) and other benefits partners offer information on utilization, use that data. For example, if you offer Dental, it’s likely a majority (or even a super-majority) of your employees access these benefits.
The Centers for Disease Control and Prevention (CDC) reports nearly two-thirds (63%) of adults ages 18 and over visited a dentist in 2020. For children, ages 2-17, the rate was 20+ percent higher – 86.9%. How does that compare to your employee Dental plan participants?
What about stats for your group’s Health Insurance utilization? Ask your plan(s) partner(s) if data is available. According to the U.S. Census Bureau, 91.4% of Americans had health insurance coverage for all or part of 2020. Nearly half (48%) of Californians got their 2019 coverage through their employer, according to the Kaiser Family Foundation. The CDC says 84% of adults visited a doctor or other health care professional in 2020. Among children, the rate was 94%. Of course, not all had health insurance.
Consider a “Did you know?” message to your employees. Sharing plan information can boost employee awareness of the benefits in your program. That increased awareness can drive greater employee satisfaction. That will help you attract and keep your most-valued employees.
3: Conduct Employee Surveys
Ask your employees – at least annually – how they feel about what’s in your benefits program. That will give you a better sense of what they like and what they would like to see in the future. There are numerous tools available to help you. Among them are:
- Zoho Survey
Ask employees about stories where their benefits really made a difference in their lives. Their testimonials can be very persuasive and empowering.
A Final Thought
Whatever methods you embrace, it’s important your communications be honest, open, positive, and frequent. Your employees need to know that you want to hear from them. That you are open to all feedback – positive and negative. While you may not be able to act on every suggestion or message you receive, you need to acknowledge all comments . . . even if you cannot discuss all ideas and their practicality of implementation in an open forum. If you receive suggestions to add benefits, research whether they can be offered on a voluntary basis.
Offering CaliforniaChoice to your employees gives them more choice. And they get value-added extras at no added cost to your business. To get a customized quote for your business and employees, talk with your employee benefits broker. If you don’t have one, we’ll help you find a broker here.
The Inflation Reduction Act (IRA) signed into law by President Biden in August will have a significant impact, most of which will be on individuals enrolled in Medicare. However, there are provisions that could affect employer-sponsored health plans. Here’s a look at key areas and highlights.
Prescription Drug Pricing
The IRA gives the Centers for Medicare & Medicaid Services (CMS) new negotiation abilities. It allows CMS to negotiate with pharmaceutical firms for Medicare plans for the first time. It puts a $2,000 annual limit on out-of-pocket costs for seniors enrolled in Medicare Part D, the federal drug coverage program.
The Kaiser Family Foundation (KFF) says this new limit will benefit more than 100,000 Californians. This figure is based on Part D participants with high out-of-pocket costs in 2020. Nationwide, about 1.4 million seniors spent $2,000 or more on prescription medications in 2020.
Initially, CMS’s negotiations will affect 10 drugs in 2026 – those on which Medicare spent the most money during the prior year. Fifteen drugs will be added in 2027. By 2029, the list expands to an additional 20 drugs. Drug makers that won’t negotiate with CMS could face a tax penalty. The Congressional Budget Office estimates savings over a decade could be more than $100 billion. The new law also mandates rebates from drug makers if they raise prices faster than the rate of inflation.
There is concern among some employer groups that this could result in a cost shift to commercial plans. But others have suggested the pharmaceutical industry does not need the bad press that could come from such an action. That could bring on more legislation.
Because of the way the IRA is written, it will affect only drugs that have no generic equal or biosimilar product. Molecular drugs must be on the FDA approved list for nine years. To be eligible for negotiation, biologics need to be on the list for 11 years. The impact will not be on drugs that are new to the marketplace.
The Act caps the price of insulin for seniors enrolled in Medicare Part B at $35 per month beginning in 2023. More than one-fifth of California residents with diabetes are 65 or older, so such a change will provide relief for many. The goal of Democrats was to include an insulin cap for commercial health plans, too. The Senate parliamentarian struck down that proposal. The rationale was that it did not follow the Byrd rule, which restricts what can be included in “reconciliation” legislation.
Reconciliation allows Congress to expedite budget-related legislation and avoid filibuster rules. A filibuster requires a 60-vote majority for passage. The IRA passed along a party-line vote, 51-50. Vice President Kamala Harris delivered the tie-breaking vote. It’s unknown if Congress can agree on separate legislation for an insulin cap for individual or group health plans during the current term.
HDHP Safe Harbor
There’s a new safe harbor for employers offering High Deductible Health Plans (HDHPs). Plan participants previously could lose eligibility to contribute toward a Health Savings Account (HSA) if expenses (other than preventive care) are reimbursed before meeting the deductible. But the IRA amends IRS provisions for plan years beginning after December 31, 2022. An HDHP participant will not lose HSA eligibility if the plan does not apply a deductible for selected insulin products. The term “selected insulin products” means “any dosage form (such as vial, pump, or inhaler dosage forms) of any different type (such as rapid-acting, short-acting, intermediate-acting, long-acting, ultra-long-acting, and premixed) of insulin.”
Potential Boost for ICHRAs
For employers moving away from group health, an individual coverage health reimbursement arrangement (ICHRA) could be an option. ICHRAs allow employers to reimburse employees for some or all of the premiums they pay on their own for health insurance. Consult your benefits professional for details.
The IRA also includes climate, energy, and tax provisions affecting employers and workers. Among them are incentives to buy energy-efficient appliances, expanded tax credits for construction of energy efficient commercial buildings and homes, electric vehicle charging infrastructure, penalties for companies that don’t pay prevailing wages, and credits for creating new jobs in manufacturing, construction, and renewable energies.
Tax code changes to ensure all corporations pay their fair share is another provision. A surcharge on corporate stock buybacks and almost $80 billion in IRS funding are there, too. More than half will go toward enforcement. That could mean more retirement plan audits, so say some benefits attorneys.
Talk With an Accountant or Broker
You should talk with an accounting professional about what provisions of the IRA might offer advantages to your firm.
As it relates to health care, your insurance broker can help you understand the many advantages of offering employee benefits. Using a broker won’t cost you more than if you were to go to an insurance company directly. In fact, a broker could save you money. That’s because a broker will be able to discuss the provider networks and benefits of the plans available in your area.
Your broker can also share the advantages of a multi-carrier, employee exchange like CaliforniaChoice. The multi-carrier exchange gives you access to eight health plans and more than 100 coverage options for employees.
If you are not already working with an employee benefits broker, you can search for one online.
Offering your employees health insurance through CaliforniaChoice is a wise decision. They get great health benefits and access to discounts through the Member Value Suite and ChooseHealthy® program.
With ChooseHealthy from American Specialty Health, you and your employees can:
- Take advantage of discounts of up to 57% on popular health and fitness brands like Fitbit®, Garmin®, Vitamix®, and PRO Compression®
- Enroll in the Active&Fit DirectTM program
- Choose from 11,500+ fitness centers nationwide for just $25 a month
- Access 5,000+ premium exercise studios and fitness centers at 20%-70% discounts
- Search online for a fitness center located near your home or office
- Use a guest pass to find a location offering services you want
- Enjoy the freedom to switch centers anytime, based on your individual needs
- Take advantage of online fitness tracking, apps, and exercise equipment
- Watch your choice of 7,600+ digital workout videos
- Access online health classes and articles offered at no cost
Through the CaliforniaChoice Member Value Suite, you also get these valuable benefits:
- Discount Dental Care: Reduced fees at Dentegra® Smile Club dentists across California and nationwide. Get instant savings with no waiting period or claim forms.
- Vision Care Savings: The EyeMed Vision One Eyecare Program offers discounts on frames, lenses, and eye exams. Choose from LensCrafters, Pearle Vision, Target Optical, and participating independent provider locations.
- Prescription Discounts: The California Rx Card saves you up to 80% on brand name and generic prescription drugs at 68,000 locations nationwide. You can often reduce your cost to less than your Rx copay with insurance.
- Hearing Services Discounts: Hearing loss is a common health problem. The EPIC Hearing Service Plan offers savings of up to 50% on hearing aids, and discounts on testing, batteries, and more.
Offer the ChooseHealthy program and Member Value Suite to your employees. Get them through your membership in CaliforniaChoice, the multi-carrier, small business health insurance exchange. There is no added cost to you or your business. Talk with your employee benefits agent to learn more. If you do not have an agent, we can help you find one here.
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.