Our Support & Resource Center

Health Reform
ACA/Small Business
Private Exchange
Cal Choice Advantage

Hello!!

Author: Alex Strautman

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:

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.

Coverage Considerations

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.

Plan Options

Here’s a look at plan options and how they differ:

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:

The Member Value Suite offers CaliforniaChoice members outstanding savings, including:

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:

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:

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.

Changing “Must-Haves”

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:

2019

2021 and 2022

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:

Plans must also include birth control coverage and breastfeeding coverage.

More information is available at the healthinsurance.org website, and at the HealthCare.gov website.

Frequently Asked Questions

Often employers have questions about Group Health Insurance, and we’ve answered some of the most frequently asked questions below.

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.

According to a 2020 survey by the International Foundation of Employee Benefit Plans, a majority of employers (87%) offered at least one voluntary, supplemental insurance product to their workers that year. This was up two percent from 2018. Among smaller organizations, the percentage was slightly lower, 76%, while nearly all (96%) of employers with 500 or more employees offered at least one voluntary benefit.

What Is Supplemental Insurance?

The recent pandemic has increased interest in supplemental and voluntary benefits. This includes products beyond employees’ traditional Major Medical insurance coverage. Dental, Vision, Life, and supplemental health insurance (i.e., Hospital Indemnity, Accident, and Critical Illness) fit in this group.

According to a 2022 report by Aon, the availability of these benefits through employers increased 41% between 2021 and 2022.

In a competitive talent market, offering the right combination of benefits to your employees can help you differentiate your business. It can help you attract new employees and retain your top performers.

Preferred Employee Benefits

So, what are employees’ most-preferred benefits? As you might expect, health insurance is the most popular. Eighty-five percent of employees say health insurance is a “must have.” Another 10% say it’s a “nice to have” benefit. Only four percent of employees responding in the MetLife 19th Annual U.S. Employee Benefit Trends Study say health insurance is not needed.

In a different survey by WTW (formerly Willis Towers Watson), 46% of workers said they would forego added pay for a more generous health plan. That figure is up from 36% just two years ago, according to an article published by the Society for Human Resource Management (SHRM).

As far as supplemental and voluntary benefits go, according to MetLife, the most-popular products include:

Looking at participation rates, Aon reports significant jumps in employee participation in the past two years. Critical Illness was up 11% in 2022, while Accident Insurance was up 10%. Hospital Indemnity was up 6%. Permanent Life was up five percent. Short Term Disability was down slightly.

How Do Supplemental Insurance Plans Work?

As the name suggests, supplemental health plans are designed to complement employees’ primary coverage like Major Medical. Some plans offer specific payments related to treatment following an accident. Other plans offer direct payments to the insured to help offset costs related to a hospital stay or specific condition diagnosis. Benefits are payable in addition to those paid by a health plan.

Where to Find Coverage

Many health insurers and health plans writing Group Health Insurance coverage in California also offer supplemental and voluntary coverage. Among others are these:

Other carriers and administrators are singularly focused, such as Delta Dental, LIBERTY Dental, and VSP® (formerly Vision Service Plan). The ChoiceBuilder ancillary benefits exchange offers Dental, Vision, Life, and Chiropractic Care (or Chiro and Acupuncture). Ameritas offers both Dental and Vision in California. MetLife offers a range of ancillary coverage, including Dental, Life, Vision, and Disability.

What are the Advantages of Offering Supplemental Health

Employers often choose to make voluntary and supplemental products available to employees so they can tailor coverage to their specific needs. It gives employees the ability to ensure they are protected against costs they would otherwise have to pay out of pocket, including deductibles, copays, and coinsurance. Again, offering voluntary and supplemental benefits can also help you set yourself apart from other businesses in employee recruitment.  

How to Learn More

If you’re ready to learn more about available supplemental options, a great place to start is to talk with your employee benefits broker. A broker will be able to discuss employer-sponsored and voluntary coverage available in your area.

If you do not already have a broker, you can search for one here.

There are many reasons to choose CaliforniaChoice for your small business. The program includes eight premier health plans and gives your employees the freedom to choose the one that’s right for them. You have the power to control your costs through Defined Contribution. Beyond that, CaliforniaChoice offers the greatest access to doctors, specialists, and hospitals in the state.

Did you know CaliforniaChoice isn’t just an ideal health care solution for your business? It also provides access to other benefits, like Dental, Vision, Chiropractic, and Life Insurance.

Group Dental Coverage

With CaliforniaChoice, you can choose from a discounted Dental service program, two Dental HMOs, and four Dental PPOs. Dentegra® Smile Club is included at no additional cost. It’s one of the many value-added benefits in the CaliforniaChoice Member Value Suite.

Members can also take advantage of reduced fees on hundreds of dental procedures. Plus, they can access a network with thousands of participating dentists in California.

Perhaps best of all, there are no claim forms or other paperwork. There are no waiting periods. Your employees can enjoy immediate savings after joining the program.

Two low-cost SmileSaverSM plans are available: Dental 3000 HMO and Dental 1000 HMO. These plans offer free office visits, oral exams, X-rays, and two cleanings per year. Oral surgery, restorative, endodontics, periodontics, crowns, and prosthodontics are available with co-pays. Orthodontics is available, too.

Either plan can be added as a voluntary option with no minimum employee participation. Members are required to live in the participating dentist’s service area. You can view the SmileSaver Online Provider Directory through a link at CalChoice.com or by visiting the MetLife website.

Four Ameritas® PPO plans are available: PPO 3000, PPO 3500, PPO 4000, and PPPO 5000. A range of different in- and out-of-network annual maximums and deductibles is available.

All four Dental PPO plans include core services. That includes Preventive, Basic, Major, and Endo/Perio benefits. Different benefit levels apply for in- and out-of-network services.

A Waiting Period applies to Major Services for groups of 10 or fewer employees. It also applies to those without 12 months of uninterrupted Dental coverage under a prior plan. A 24-month Waiting Period applies for Orthodontia under the Ameritas PPO 3500, 4000, and 5000 plans. (Ortho is not part of PPO 3000.)

Besides outstanding Dental benefits, PPO 3500, PPO 4000, and PPO 5000 enrollees get access to Dental Rewards® by Ameritas. Members who visit a dentist and use only a portion of their annual maximum benefit in a year are rewarded with additional benefits the following year.

Ameritas PPO coverage is also available as Voluntary, with the full premium paid by employees. For complete plan information, view the Ameritas PDF summary at CalChoice.com.

Dental Health Benefits Matter to Employees

A comprehensive employee benefits package can help you set your business apart. That’s especially important in today’s competitive talent market. To learn more about your options from CaliforniaChoice, talk with your broker. If you don’t already have a broker, we can help you search for one.

Contrary to what you might expect, using a broker won’t cost you more. It could save you and your business money. That’s because a broker will help you find coverage your employees will appreciate, while helping you stay within your budget.

If you’re shopping for Group Health Insurance for your employees, you’re likely wondering what you can expect to spend. You’re not alone and the answer isn’t a simple one. That’s why we’re taking a closer look at the cost of Group Health Insurance and the factors that influence it.

Your Group Health Insurance Cost Depends On:

Some plans – like the CaliforniaChoice private multi-carrier, employee-choice exchange – offer added benefits like Dental, Vision, Chiropractic (with or without Acupuncture), and Life Insurance. Other benefits, such as discounted services, fitness and wellness, and more may be available at no added cost.

The higher the metal tier, the higher the percentage paid by the plan for in-network-covered services. For example, a Bronze plan pays 60% for in-network covered services, with the employee paying the remaining 40%. A Silver plan pays 70%, with covered insureds paying 30%. A Gold plan pays 80% for in-network covered services, with insureds paying 20%. A Platinum plan pays 90% toward covered services, in-network, while the insured pays 10%. Depending on your plan and carrier selection, you may be able to offer employees a single ACA tier, multiple tiers, or all four tiers.

“De-Minimis” variations: Federal law allows states to broaden or reduce the federal ACA standard for actuarial values within metal tiers. While changed several times over the years, current law allows states to enhance or reduce a plan’s actuarial value within each metal tier by -4/+2%.  For example, this means a Gold plan could have a 76% to 82% actuarial value instead of the standard 80%. Each plan varies. 

Average Group Health Insurance Costs

According to the Kaiser Family Foundation (KFF) 2021 Employer Health Benefits Survey, nationally the average annual premium was:

Workers at small firms, on average, contribute a larger percentage for Family coverage than those at bigger firms, 24% as compared to 37%.

As you might expect, premiums for an HDHP (High Deductible Health Plan) with a savings option were the lowest. PPO premiums were on the higher side.

Nearly a third (29%) of covered employees at smaller firms enjoy the benefit of their employers paying the entire premium for Single coverage. That contrasts with just five percent of employees at larger firms.

For those employees with Family coverage, nearly one-third (31%) at small firms must contribute more than half of their Family coverage premium. That compares to just five percent of covered employees at large firms.

Based on plan type, the average employee and employer contributions for Single and Family coverage for 2021 were as follows:

Average Cost for Health Insurance

KFF found PPOs attracted nearly half (46%) of insured employees in 2021. More than one-quarter (28%) enrolled in HDHPs with a saving option. Sixteen percent chose an HMO, nine percent enrolled in a Point of Service (POS) plan, and one percent chose an indemnity plan. This breakdown is similar to 2020 enrollments.

Self-Funded and Level-Funded Plans

Many firms, especially larger firms, choose to self-fund employee health coverage. KFF found nearly two-thirds (64%) of workers enrolled in self-funded plans. That includes 21% of covered employees at small firms and 82% covered at larger firms. Again, these numbers are similar to 2020.

Deductibles and Cost-Sharing

Eighty-five percent of covered workers have an annual deductible that must be paid before many services are covered under their health plan. The average deductible is $1,669 for Single coverage (across all plan types), with some variance for group size. At small firms, the average is $2,379 as compared to $1,397 at larger firms. The average Single plan deductible was up 13% in 2021, when compared to the prior five years – and up 68% over the last 10 years.

Copays also apply for most covered workers. These are due when visiting a doctor, being admitted to the hospital, or having outpatient surgery. Average copayments in 2021 were $25 for primary care and $42 for specialty care. The coinsurance amount for primary care was 19%, 20% for specialty care.

Coverage Availability

Nearly two-thirds (59%) of employers offered benefits in 2021 to at least some workers, although it varied by firm size. Among those with three to nine workers, less than half (49%) offered health coverage. In contrast, virtually all employers with 1,000 or more workers offer health coverage to at least some workers. KFF says that among employers that offered health coverage in 2021, 77% of employees choose to enroll.

Find Coverage for Your Group

If you’re interested in comparing options for your employees, the best place to start is with a broker. Your broker can discuss the plans and coverage options available in your area. If you don’t already have an employee benefits broker, you can get a quote from one of our CalChoice preferred brokers today.

The Centers for Disease Control and Prevention (CDC) routinely reminds Americans – through print, radio, television, and other means – that vaccines can greatly reduce or eliminate the risk of infectious diseases.

Beyond the COVID-19 vaccine, which has been spotlighted for the past 15 months, pharmaceutical companies promote other vaccines on a regular basis. Among them are Hepatitis, Human Papillomavirus, Influenza, and Shingles.

As part of the Affordable Care Act (ACA), all ACA-compliant plans must include coverage for certain vaccines without a copayment or coinsurance when provided by an in-network health care provider. This is even true for patients who have not yet met their annual plan deductible.

What Vaccines Does Health Insurance Cover?

While dosage and availability vary by patient age and health conditions, most health plans include insurance coverage for the following vaccinations:

The top 10 causes of death in the United States – all exceeding 50,000 lives – are due to the following health conditions:

Health plans participating in the CaliforniaChoice private health insurance exchange offer vaccines through physicians’ offices as well as participating retail pharmacies. For more vaccine information, refer to these web pages:

Anthem Blue Cross

COVID-19 Resource Center

General Vaccine Information

Cigna + Oscar

COVID-19 Resource Center

Frequently Asked Questions

Kaiser Permanente

Your Guide to COVID-19

Vaccine Safety

Health Net

COVID-19 Resource Center

Preventive Health Guidelines

Sharp Health Plan

COVID-19 Resource Center

Keeping Up With Vaccinations

Sutter Health Plus

COVID-19 Coverage, Cost, and Access to Care

What Is Preventive Care?

UnitedHealthcare

COVID-19 Resource Center

What’s a Vaccine?

Western Health Advantage

Coronavirus (COVID-19) Disease

Search Results for “Vaccine”

To learn more about preventive care services and other benefits and services offered to members through CaliforniaChoice, talk with your employee benefits broker. If you do not already have a broker, you can search for one on the MyCalChoice website.

The rules of business are different today than they were just two years ago. Employees are expecting more from their employers. When they don’t get it, there’s a good chance they will leave. The U.S. Department of Labor says 47 million people quit their jobs in 2021.

It’s a competitive talent marketplace. To attract and retain workers, a comprehensive benefits program is more important than ever. A single health plan offering is not enough. It’s not what employees want or expect.

What Are Employee Benefits?

Employee benefits can include a wide range of things that employees are looking for. While health insurance ranks high among “must have” employee benefits, workers are also looking for other things in their employee benefit package. Based on the MetLife 19th Annual U.S. Employee Benefit Trends Study, released in 2021, employees often value other benefits, including:

CaliforniaChoice empowers you to offer health care freedom and flexibility to your employees. And, you can stay focused on your business. Our unique program provides the greatest access to doctors, specialists, and hospitals in the state and includes:

Employee Benefit Advantages

Offering a comprehensive benefits package can help you set your business apart from other employers because:

For you and your company, another benefit is deductibility. You can usually deduct the full cost of premiums as an ordinary business expense. That includes costs for employees’ and dependents’ health insurance.

If you take advantage of the Premium Only Plan (Section 125/POP) mentioned above, you can also reduce your company’s payroll taxes. Added savings are possible for a High Deductible Health Plan or if you contribute to a qualified Health Savings Account (HSA).

Talk with a broker about to learn more about your health care options. Working with a broker won’t cost you more. In fact, it may save you money because a broker will help you find coverage your employees will appreciate, while helping you stay within your budget.

An Important Reminder for Employers with 5-49 Employees
If you have five or more employees of any type (full-time, part-time, or seasonal), and you don’t already sponsor an employee-retirement plan, be aware of an approaching deadline. You must enroll your employees in the state-run CalSavers program by June 30, 2022. Link to the CalSavers website to learn more. Employers with 50-99 employees had a prior registration deadline of June 30, 2021.

Before the Affordable Care Act (ACA), “full time employees” were generally defined as those working a 40-hour workweek. Those working fewer hours – whether 10, 25, or another number – were part-time.

However, under the ACA, full-time workers are those working an average of at least 30 hours per week, or at least 130 hours per month. That discrepancy has prompted many employees to ask, “What is full-time? Does my employer have to offer benefits to me if I work 30 or more hours?”

The answer is, “It depends.”

Employers with 50 or more full-time or full-time equivalent (FTE) employees – are required to offer health care benefits to those working at least 30 hours a week or at least 130 hours a month. If an employer does not offer employee benefits, the business is subject to a tax penalty.

For small employers – those with fewer than 50 full-time employees – offering employee benefits is discretionary. There’s no requirement to offer benefits. The decision is left up to the employer.

Seasonal workers do not have to be included in the employer’s full-time equivalent employee calculation.

If a smaller employee not subject to the ACA employer mandate does choose to offer health coverage to its employees, that coverage must meet certain ACA specifications.

If you have a workforce of full-time and part-time employees, and you are unsure about how to calculate your group size, visit HealthCare.gov or CalChoice.com to use the ACA calculators offered on those sites.

Employer Discretion

While many employers with fewer than 50 FTE equivalent workers choose to offer employee benefits, there’s no requirement that they do so. The only requirement is that employers be equitable in their treatment of employees. The same standards apply to all employees when determining benefits eligibility. If the employer sets a 30-, 35-, or 40-hour requirement, it applies to all workers. Offering benefits to one employee who works 36 hours, and requiring others to work 40 hours to be benefit-eligible could trigger a discrimination lawsuit.

In a competitive talent marketplace, many smaller employers choose to offer employee benefits because it helps them attract and retain their top employees. Workers appreciate those benefits, too – especially health insurance. In the 2021 MetLife Annual Benefit Trends Study, 85% of employees put health insurance at the top of their “must have” list – and another 10% say health insurance is “nice to have.”

Talk With a Broker to Learn More

If you want to find out if you’re getting the most value for your benefit dollars – or if you want to add employee benefits for your employees – talking with a broker is a great place to start. Most brokers offer their services at no cost to you. If you don’t have a broker, you can search for one on the MyCalChoice website.

The world of group health insurance can be difficult to navigate for small business owners – beginning with the quote itself. Whether you’re looking for coverage for the first time or considering changing your plan, here are some insights that will help you understand your CaliforniaChoice health insurance quote.

Here’s a snapshot of the sections you’ll find in your quote for health insurance:

1. Introduction

The first section provides an overview of how the CaliforniaChoice program works:

2. Census

Your proposal includes a copy of the census provided to us for your group. All of the information in your quote is based on this census, including any coverage for dependents. If you need to update your group census, talk with your broker.

3. Setting Your Health Care Budget

There are two ways to contribute to your employees’ benefits from CaliforniaChoice. You can select a Fixed Dollar Amount or a Percentage of Premium.

Regardless of your choice, the amount must equal or exceed 50% of the lowest plan premium. For example, if the lowest premium is $2,000 per month per employee, your fixed-dollar premium for each employee must be at least $1,000.

Your quote includes a summary for multiple Affordable Care Act (ACA) tiers – Bronze, Silver, Gold, and Platinum – as well as Total Choice, which includes plans in all four tiers. Different columns on your summary in this section include:

You can work with your broker to calculate different percentage contributions to premiums. With CaliforniaChoice, the choice is yours.

4. Ancillary Rate Summary

If you and your broker discussed Ancillary coverage – for Dental, Vision, Chiropractic & Acupuncture, and Life and AD&D coverage, the premiums (for employees and dependents) are shown in this section.

5. Employee Worksheet

Here you’ll find a sample Worksheet showing the plan options available to your employees. The Worksheet shows the monthly premium prior to your contribution and the cost per pay period to the employee.

It breaks down HMO, PPO, EPO, and other options from which employees can choose.

Information about CaliforniaChoice’s Smart Decision Technology is also summarized in this section.

6. Administration

Your quote summarizes the consolidated administration available to you and your employees through CaliforniaChoice, including:

A sample invoice is also included in this section of your proposal, along with Employee and Dependent Rates, Medical Benefit Summaries, and Ancillary Benefit Summaries.

Talk With a Broker

Getting a custom quote for CaliforniaChoice starts with your broker. If you don’t have a broker, we can help you find one.