An Exclusive Provider Organization (EPO) may not be as well-known as a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO); however, with a bit of research, you might find an EPO is the perfect health insurance plan option for you and your employees.
What’s an EPO?
An EPO is a type of health plan that offers a full-network of doctors and hospitals from which to choose.
Like a HMO, an EPO gives your employees access to a select network of medical providers. If they go to a provider in-network, they have limited out-of-pocket costs. If they go outside of the network, the plan offers limited, if any, benefits and your employees’ costs are higher.
Like a PPO, your employees with EPO coverage don’t need to get a referral from a Primary Care Physician to visit a specialist, so long as the doctor is part of the EPO network.
An EPO in Action
Benefits of an EPO
The most well-known benefit of an EPO is its ability to apply the strengths of both an HMO and a PPO in a single option. An EPO offers more flexibility than an HMO because you don’t need a referral from your primary care physician (PCP) to receive specialist care. An EPO is also priced competitively, frequently offered at more affordable premiums than a PPO. For many, it’s a happy medium between an HMO and a PPO.
EPO Plans Available through CaliforniaChoice
The Anthem Blue Cross EPO coverage through CaliforniaChoice includes member access to the Anthem Prudent Buyer Network, which offers 90% of doctors and hospitals in the United States through the national BlueCard® Program. Some of the in-network premier California facilities include:
- Cedars-Sinai Medical Center
- John Muir Health
- Loma Linda University Medical Center
- Mercy General Sacramento
- Methodist Hospital of Sacramento
- Scripps Memorial
- UCSF Medical Center
Oscar Health offers EPO plans in all four metal tiers through CaliforniaChoice. Oscar’s EPO network in Southern California includes top hospitals and providers in Los Angeles and Orange counties, including:
- Good Samaritan Hospital (Los Angeles)
- USC Norris Comprehensive Cancer Hospital and Keck Hospital of USC (Los Angeles)
- Children’s Hospital Los Angeles
- Huntington Memorial Hospital (Pasadena)
- Providence St. Joseph Medical Center (Burbank)
- UCLA Medical Center
- Providence Saint John’s Health Center (Santa Monica)
- Hoag Memorial Hospital (Newport Beach)
- Mission Hospital (Mission Viejo and Laguna Beach)
Talk With an Agent to Learn More
You can get details on the EPO, HMO, PPO, and other options available to you and your business from an employee benefits agent. If you don’t already have an agent, you can look for one here.
The unemployment rate is the lowest it’s been in 50 years. Offering competitive compensation and employee benefits packages is key to recruiting and retaining top talent. Knowing what benefits other companies offer their employees is important when defining your budget and the benefits options for your business.
Health insurance is among the most-popular employee benefits offered today. The Bureau of Labor Statistics at the U.S. Department of Labor said in September 2019 that the national access rate to medical care benefits for full-time workers was 87 percent and the take-up rate was 74 percent.
The 2019 Kaiser Family Foundation (KFF) Employer Health Benefits Survey also found 82 percent of workers with a medical plan have a deductible – similar to a 2018 survey and up from 63 percent a decade ago. More than one-quarter (28%) of workers – including nearly half (45%) of those at firms with fewer than 200 workers – are in plans with a deductible of at least $2,000, up nearly four times the number from 10 years ago.
According to the Employee Benefits 2019 study by the Society of Human Resource Management (SHRM), 70 percent of organizations maintained health care benefits at existing levels in 2019, while 20 percent increased them and three percent decreased them. Eighty-five percent of organizations offered a Preferred Provider Organization (PPO) health insurance plan. High Deductible Health Plans (HDHPs) paired with a Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA) were offered by 59 percent of organizations taking part in the SHRM study.
Dental and Vision Insurance
KFF’s 2019 survey found 60 percent of firms (including 92 percent of large firms) offer separate dental coverage, while 46 percent (including 83 percent of large firms) offer separate vision insurance. Employers sometimes contribute to the cost of this coverage, but it is often voluntary – with employees paying the full cost of insurance.
SHRM found the vast majority (83%) of employers taking part in their 2019 study offer Accidental Death & Dismemberment (AD&D) insurance, 71 percent offer long-term disability, 61 percent offer short-term disability (STD), and 27 percent offer accident insurance. Accident insurance was down by nearly half from 2015, when 51 percent of employers offered coverage.
Benefits Bundle Options
With a multi-carrier, private exchange like CaliforniaChoice, your employees can choose from eight different health plans for the medical coverage that best meets their unique needs. One employee might choose a PPO or Exclusive Provider Organization (EPO) plan from Anthem Blue Cross because of a particular doctor or hospital in their network. Another employee who rarely visits the doctor might choose an HMO from Kaiser Permanente. A third employee might choose an HSA-compatible plan from UnitedHealthcare because of cost and tax considerations. An added plus, all of these different health plans — and others — available through CaliforniaChoice are billed together, and you have just one monthly bill for all of your employees’ coverage.
In addition, CaliforniaChoice offers you and your employees access to value-added extras through the Member Value Suite at no cost. That includes discount dental services, savings on vision care, employee discounts on entertainment (like movies, theme parks, sporting events, travel, and more), hearing services savings, and a prescription drug card that can reduce your cost to less than your Rx co-pay with insurance.
You can learn more from your employee benefits agent. If you don’t have an agent, you can find one here.
According to the federal National Health Interview Survey and the Kaiser Family Foundation (KFF), nearly 60 percent of America’s non-elderly population have health insurance through their employers. There’s no doubt, health insurance is highly sought after by employees. However, many employers are still unclear as to how group health plans provide distinct advantages to their business.
Here are 5 reasons why businesses choose Group Health Insurance for employees:
1. Employee benefits help in recruiting new employees.
A survey by the Harvard Business Review found that 88% of respondents would choose a job that offers a lower salary with better health, dental, and vision insurance over an opportunity with a higher salary but lesser benefits. Providing employee benefits sends an implicit message to job candidates that your business is competitive and financially stable – and it also shows you care about your employees, which can further set you apart in your recruitment efforts.
2. Benefits affect current employee retention.
Fifty-six percent of U.S. adults taking part in a 2018 SHRM survey said that a favorable opinion of their health coverage is a key factor in deciding whether to stay in their current job. Forty-six percent said health insurance was either the deciding factor or a positive influence in choosing their current job. Clearly, health benefits are among the most critical components of job satisfaction – second only to compensation.
3. Group Health Insurance helps reduce stress in the workforce and improve morale.
The Affordable Care Act (ACA) mandates that 10 essential health benefits be included in ACA-qualified health coverage:
- Ambulatory patient services
- Emergency services
- Pregnancy/maternity/newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Lab services
- Preventive and wellness services and chronic disease management
- Pediatric services (including oral and vision care)
Having comprehensive health care services can make a huge difference in the lives of your employees. The Annual U.S. Employee Benefit Trends Study by Metlife found that 74% of employees agree that having insurance provides peace of mind for the unexpected. It has been well-documented that happy employees are more productive and use less sick time, in addition to staying with a company longer.
4. Group Health Insurance offers tax benefits for employers.
Generally speaking, your expenses related to providing health insurance for your employees and their dependents are 100% tax deductible as an ordinary business expenses on your state and federal income taxes. Ask your employee benefits agent about the added benefits of a Premium Only Plan, which can reduce your payroll taxes and give employees the ability to pay their share of premiums with pre-tax dollars.
5. Group Health beats Blanket Health and Individual Health Insurance.
Group Health Insurance is, often, a better choice for your business and your employees than so-called Blanket Health policies because Group Health offers protection that is more comprehensive. As mentioned above, ACA-qualified plans include coverage for essential health benefits that are not part of Blanket Health plans. Typically, a Blanket Health policy offers coverage in connection with accidental injury. If it does cover broader health benefits, a Blanket Health policy may limit the amount it pays toward treatment or services – perhaps limiting coverage to $5,000, $10,000, or $50,000 for the life of the plan. The ACA prohibits health insurers from limiting coverage annually in qualified Group Health plans.
Group coverage may also beat individual insurance for two of the same reasons: no maximum benefits and continuous protection. Once you sign up, coverage will continue for one year as long as you pay the premium.
Finding What’s Right for Your Business
To learn more about the advantages of Group Health, talk with your insurance agent.
Decoding the Affordable Care Act (ACA) employer mandate can be difficult for the average small business owner. For some businesses, offering health insurance coverage is required. For others, it’s a choice. We’re breaking it down and shedding light on what you need to know to ensure your business is ACA compliant.
Do employers have to offer benefits to full time employees?
Applicable Large Employers with 50 Employees or More
The Tax Cuts and Jobs Act of 2017, signed by President Trump on December 22, 2017, eliminated the ACA individual mandate penalty (for not having health insurance). However, it did not affect the employer mandate, which applies to Applicable Large Employers (ALEs) with 50 or more full-time employees and/or full-time equivalent (FTE) employees. The ACA employer mandate remains in force. If your business employs 50 or more full time employees, offering health insurance is required.
Depending on how you staff your organization, calculating the number of full-time employees (including FTEs) can be complex. If you’re unsure of your group size, visit the Healthcare.gov website to use a group size calculator. When considering your group size, employees working 30 or more hours per week are considered full-time.
Employers that qualify as ALEs are subject to the ACA’s shared responsibility provisions and the reporting requirements concerning minimum essential coverage. ALEs must offer health insurance that is “affordable” and provides “minimum value” to 95% of full-time employees and their eligible children up to age 26. If you are an ALE and do not offer ACA-compliant coverage, you are subject to penalties. For 2019 employer penalty information, consider reading this article by the Society for Human Resource Management.
If your business had, on average last year, fewer than 50 full-time employees (including FTEs), you are not an ALE for the current calendar year. Still, it’s important that you evaluate your potential ALE status annually.
While non-ALEs are not required to offer health coverage to employees, you can voluntarily do so. In fact, many employers not subject to the employer mandate offer health insurance and other employee benefits because it helps them compete in an increasingly competitive talent market.
Qualifying for Group Health Insurance
If you offer full-time employees health coverage, you must make it available to all employees, regardless of any pre-existing medical conditions. Health insurers will write groups with as few as two insured persons (the business owner and an employee). However, many carriers will not write a policy for a husband and wife group if both are owners of the business, or if it is a sole proprietorship. LLC, S-Corp, C-Corp, and Partnerships where a spouse is a W-2 employee are acceptable to most insurers. Ask your employee benefits agent for more information on qualifying for group health insurance.
Cost of Coverage
If you choose to purchase health insurance for your employees, the next step is determining how much you want to contribute toward the premium. With Defined Contribution, available from the CaliforniaChoice multi-carrier private exchange, you can choose a Fixed Percentage Amount (from 50% to 100% of the cost of a selected coverage level) or a Fixed Dollar Amount. Whatever amount you choose applies to each employee, and your cost is locked-in for a full year. At renewal, you can adjust your contribution up or down and lock it in for another 12 months.
Finding a Plan
You can choose to purchase coverage directly from an insurance company, or you can use an independent agent to help you shop multiple plans. A multi-carrier exchange like CaliforniaChoice or the state’s ACA exchange, Covered California, can expand your employees’ options without increasing your costs.
CaliforniaChoice also allows you to choose one or more ACA metal tiers for your employees. This gives you and your staff greater access to doctors, hospitals, and other providers offered by the eight health plans available across the state from CaliforniaChoice. The networks for CaliforniaChoice include 84,355 individual health care providers and 389 hospitals (as of August 2019).
To learn more about the health plan options available for your group, contact your employee benefits agent. If you don’t already have one, we can help you find an agent.
Health Care Benefits Don’t Have to Be One Size Fits All
Each of your employees is different, and those differences extend to their health care needs. Traditional “one size fits all” health plans can prove limiting. As an employer, you may have wondered whether you can offer different health care benefits to your employees. You can, with CaliforniaChoice. Our multi-carrier private health insurance exchange includes eight different health plans across California.
Coverage Choice Wherever You Are
With CaliforniaChoice, you and your employees have access to Anthem Blue Cross, Health Net, Kaiser Permanente, and UnitedHealthcare statewide. If you are located in Northern California, you also can choose coverage from Sutter Health Plus and Western Health Advantage. Southern California businesses have added health plan options from Oscar Health in Los Angeles and Orange counties and Sharp Health Plan in the San Diego area. Combined, there are nearly 90 options available, so you and each of your employees can easily find coverage that’s right for their individual or family health care needs.
The provider network for CaliforniaChoice is unparalleled. Each health plan offers a diverse roster of physicians, medical groups, and hospitals. In total, there are 84,355 unique individual health care providers and 389 unique hospitals across the state.
CaliforniaChoice gives your employees the freedom to choose the health plan that’s right for them. One of your employees might select a PPO from Anthem Blue Cross because it includes a favorite doctor or hospital in its network. A second employee might choose coverage from Health Net. Another employee who is looking for a lower copay might select an HMO from Kaiser Permanente or UnitedHealthcare. A fourth employee might prefer a regional plan like Sutter Health Plus, Western Health Advantage, Oscar, or Sharp Health Plan. With CaliforniaChoice, it’s their choice. As an added perk for you, the coverage selected by all of your employees is included in a single bill each month.
Tools to Find the Right Plan
CaliforniaChoice offers several tools to help match your needs to the health plans available through our multi-carrier exchange.
- Automated Choice Profiler: Thisonline assistant give users the ability to review premiums, deductibles, and other out-of-pocket costs (like copays and co-insurance) to get a total estimated cost of coverage. Employees can view side-by-side plan comparisons based on costs, risk, and quality.
- Online Provider Search: This tool takes the guesswork out of finding the right doctor by helping employees find out in advance whether a preferred doctor is part of any of the health plans offered through CaliforniaChoice. It’s easy to search by city or ZIP Code, doctor’s name or gender, health plan, hospital affiliation, language(s) spoken, and distance from a targeted city or ZIP Code (like home or office).
- Online Rx Search: You and your employees can use this tool to match your prescription drug needs to available plans. It’s easy to look up medications alphabetically, by brand or generic drug name, therapeutic class (prescriptions for pain, infection, or treatment of the heart), or health condition.
Employer Cost Control
Beyond giving your employees more options from which to choose, CaliforniaChoice helps you control your employee benefits expenses, too. With Defined Contribution, you choose how much you want to contribute to your employees’ health insurance premium. It’s up to you if you want to choose a Fixed Dollar Amount or a Fixed Percentage Amount (50% to 100%) toward a specific benefit. The contribution for each employee does need to be the same.
Your employees then use your contribution toward the cost of coverage for the plans they like best. It’s like a health care voucher. If employees choose coverage that costs more than you’re contributing, the employees simply pay the difference. The amount you choose is locked-in for the plan year, and you can change it at renewal if you choose.
Get Help from an Agent
A health insurance agent can help you set your contribution amount and discuss available options. Best of all, there’s no cost for an agent’s service. If you do not already have an agent, you can search for one here. You can find additional information on this subject in our prior post, 6 Things to Consider When Choosing an Insurance Agent for Your Business.
If you’re a small business owner, spending time building your company brand may not be at the top of your priority list. In reality, though, businesses of every size need to think about how they can brand themselves to gain an edge in today’s competitive market.
Brand Building Tips1. Determine Your Voice
The first step in creating your brand is selecting your voice. Think about who you are as a company and what you are known for. If you were meeting someone for the first time, how would you describe what your organization does?
If you already have a mission statement and core values, you’re off to a good start. If not, it may take a little more thought, but it’s well worth the effort. Your approach – and how you “sound” – play an important role in your branding.
You want to be able to develop a tone and message that will help create a connection with your prospects and customers, while also helping differentiate you in your local market and business space.2. Add Some Visual Flair
If you are just starting your business, and you don’t already have a name and logo, you may want to engage help in selecting one or both. You can talk with friends or other small business owners about their recommendations or look online for a naming or logo design resource.
A good name and visual identity are important to creating a strong brand. Think about the logos of the organizations you know, locally, regionally, and nationally. Some organizations, like McDonalds or Nike, can be identified by a logo alone.3. Go Your Own Way
You may be tempted to borrow from what you think is working for a competitor, or a large, regional or national brand. Don’t do it. Think about what makes your organization different, and why a prospect should choose your company over another. Your independence may be a differentiator that helps you attract and retain customers.4. Consistency Is Key
Some businesses – large and small – make a mistake in branding and use a different approach depending on who they are communicating with and what vehicle they’re using (say, for example, an ad versus social media). That can undermine your efforts, because your prospects and customers can be confused by your mixed messages. It’s more effective to be consistent in your approach. Familiarity is important, and it can help you build trust.5. Deliver on Your Promise
You can create long-term relationships with your prospects – and turn more of them into customers – by delivering on your promises. Be clear about what you do, and what your customers can expect from you. Then make sure you work to follow through. You can earn their trust and generate positive word of mouth. Customer service is vital.
It can be helpful to learn from others’ brand-building missteps. Click here to read Five Branding Mistakes That Could Put Your Small Business Out of Business, published by Crowdspring, or check out this article, You May Be a Small Business, But You Can Still Focus on Building a Big Brand Image!, from Espresso.
The Affordable Care Act (ACA) has a long list of requirements for small businesses. To help you keep track, we created an ACA Compliance Checklist.
- Use a Group Size Calculator to determine whether your business had an average of 50+ full-time (FT) plus full-time equivalent (FTE) employees in the prior year. If so, your business is an Applicable Large Employer (ALE) subject to the ACA Employer Mandate during the next business year. An FTE Calculator is available from your agent or on the Healthcare.gov website.
- If your business is an ALE, you can use an Affordability Calculator to determine whether your health coverage meets one of the ACA Affordability Safe Harbor guidelines. If it does not, your business is subject to an ACA penalty. More information on the ACA’s Affordability Safe Harbors is available here.
- Collect accurate Dates of Birth for dependents under age 21. Effective 1/1/2018, insurance carriers can charge one single rate for dependent children ages 0 to 14 years old and unique rates for dependents ages 15-20. Carriers may only charge for the three oldest dependent children under age 21.
- If your business just reached the 50+ FT plus FTE threshold for the first time, ask about eligibility for transition relief from the employer penalty, if you offer Minimum Essential Coverage with Minimum Value to your employees.
- Confirm you are not paying directly or reimbursing employees for individual health plans, unless you sponsor a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA).
- Review the impact of upcoming minimum wage increases on your employees’ affordability of coverage calculations and your overall company budget.
Health Plan Administration
- Verify your waiting period does not exceed the 90-day limitation.
- If you have an orientation period prior to your waiting period, confirm it is no longer than one month.
- If you have 50+ FTEs with variable hours who may or may not work full-time, it is important to consider the lookback measurement method as well as administrative and stability periods. Click here for guidance on the IRS website.
- Review Health Flexible Spending Account (FSA) documents to make sure they reflect the current limit ($2,700 in 2019) and include any grace period/carryover provision.
- If your business has difficulty meeting carrier participation guidelines, you may want to talk with your agent about the ACA’s annual one-month Special Open Enrollment Window (SEOW), when eligible small groups can enroll in coverage without having to meet standard employer-contribution and/or employee-participation ratios. The SEOW occurs November 15-December 15 each year, allowing groups to enroll for coverage effective January 1.
- Confirm you are applying a 30-hour full-time definition to determine employee eligibility for coverage.
- Confirm you have not changed employees to 1099 status to avoid the ACA employer mandate.
- Determine if use of Professional Employer Organization (PEO) or staffing agency personnel increases your group size to 50+ FTEs due to IRS common law employee rules.
- Deliver Department of Labor Mandated Notice (New Health Marketplace Coverage Options and Your Health Coverage) to new employees within 14 days of hire.
- Deliver Summary of Benefits and Coverage (SBC) and Uniform Glossary to employees at enrollment, renewal, and to new hires.
- Deliver 60-day notices of modification, if you make plan changes outside of renewal.
- If you had average of 50+ FT plus FTE employees in 2018, prepare to give copy of IRS Form 1095-C (for 2019) to FT employees by 1/31/2020.
While not all of the items apply to every small business, this Checklist may be useful in determining how you can stay in compliance with the ACA.
More Help Available
If you have additional ACA compliance-related questions, talk with your employee benefits agent.
Despite Congressional efforts and numerous lawsuits, the Affordable Care Act (ACA) is still the law of the land. This means your business may be subject to the ACA employer mandate. If so, there are several requirements for your business to stay within the law.
Where Do You Stand?
First, find out if the law requires your business to provide health benefits. Currently, if you own or manage a business with 50 or more full-time employees or full-time equivalent (FTE) employees, you are an Applicable Large Employer (ALE). That makes you subject to the ACA employer mandate. If you are unsure if your business is an ALE, visit the IRS website to help determine your status.
What You Need to Do as an ALE
Under its employer shared responsibility provisions, the ACA requires ALEs to either offer minimum essential coverage that is “affordable” and provides “minimum value” to full-time employees and dependents or pay a penalty to the IRS. ALEs can require employees to share in the cost of their health coverage. However, as of 2019, the employee cost cannot exceed 9.86 percent of an employee’s household income. The ACA further requires ALEs to report annually on coverage offered (or not offered) to employees using forms 1094-C and 1095-C.
Determining the Penalty
If an employer does not provide adequate coverage to at least 95 percent of employees and eligible dependents, and one full-time employee receives a premium tax credit to enroll for health coverage through a state health exchange (like Covered California), the IRS imposes a no-coverage penalty. In 2019, the no-coverage penalty is $2,500 ($208.33 per month) times the total number of full-time employees minus the first 30. There is no penalty for not offering health insurance to part-time employees. A greater penalty, $3,750 for 2019, applies if coverage is not affordable and does not provide minimum value.
The IRS calculates your penalty separately for each month during which you offer no coverage. Therefore, if you offer coverage for some months during the year, but not all, you pay for only those months you offer no coverage.
Businesses with fewer than 50 full-time equivalent employees in 2018 are not subject to the ACA’s employer mandate in 2019. That doesn’t necessarily mean you shouldn’t provide coverage. Many small businesses offer employee benefits, including health insurance coverage, to support recruitment and retention efforts. Keep in mind, your contributions to group health are tax deductible. Moreover, when you set up a Premium Only Plan (POP), your employees can pay their share of the premium with pre-tax dollars. A POP also means reduced payroll taxes for your business.
Controlling Health Care Costs
Cost is a huge factor for employers looking at options for health insurance. CaliforniaChoice allows you to control costs and offer employees more health care choices. With Defined Contribution, you choose the amount you want to contribute toward benefits and your employees apply those dollars toward the health plan they like best.
You can contribute a Fixed Percentage (50% to 100%) of a specific plan type, OR you can choose to contribute a Fixed Dollar Amount. If an employee selects a plan that costs more than your contribution, he or she simply pays the difference.
At renewal, you have the option to adjust your Defined Contribution – up or down – and lock it in for another 12 months.
Proposed California Legislation
In January, the state legislature introduced California Senate Bill (S.B.) 175 imposing a penalty on any California resident without health insurance. This proposed measure is working its way through the State Senate and is before the Committee on Governance and Finance. If it becomes law, we’ll outline the implications for your business.
How to Learn More
For specific details about selecting employee health benefits for your business, consult a health insurance agent. An agent will educate you about the process and provide information to help you choose what’s right for you and your employees.
If you’re considering health insurance and employee benefits for the first time, you may not know what to expect. Here are five of the most common questions that employees ask about employee benefits and insurance coverage. Knowing how to respond can make a big difference in successfully attracting and retaining employees.
1. Who selects my plan?
Traditionally, you (as the employer) select the health plan you want to offer to employees. However, let’s face it, the chances of one health plan satisfying the needs of every employee are not likely.
CaliforniaChoice offers a different approach to employee benefits. With our program, you no longer have to select one health plan; instead, you can offer eight different health plans from which employees can choose.
For example, one might choose an HMO plan from Kaiser Permanente, while another finds a PPO from Anthem Blue Cross is a better fit for the needs of his or her family. It’s their choice.
If your workforce is scattered across California, your employees can choose from three of the state’s leading regional health insurers: Sharp Health Plan in the San Diego area and Sutter Health Plus and Western Health Advantage in Northern California.
With CaliforniaChoice, you can offer your employees access to one, two, or three Affordable Care Act (ACA) metal tiers:
- a single tier (Bronze, Silver, Gold, or Platinum)
- two adjoining metal tiers (Bronze & Silver, Silver & Gold, or Gold & Platinum)
- three tiers (Silver, Gold, and Platinum)
Your decision does not affect your costs, since you’re able to lock-in your benefits budget using Defined Contribution. (See below.)
Because CaliforniaChoice offers eight health plans statewide and both full and limited networks, our program offers your employees more choice when it comes to doctors, specialists, and hospitals than any single health plan.
2. How much will my coverage cost?
The cost of health insurance for your employees ranges quite a bit, depending on the type of coverage you offer. Typically, you base what you spend on a percentage of the cost of the insurance or you pay a fixed amount.
One of the advantages of the CaliforniaChoice program is you get to choose what you want to spend. You define what you can contribute toward employee benefits, then each employee can take those dollars and use them toward the health plan they like best. Employees aren’t forced to choose something.
We call this budgeting approach Defined Contribution:
- You can contribute a Fixed Percentage (50% to 100%) of a specific plan type, OR you can choose to contribute a Fixed Dollar Amount.
- You decide whether you want to contribute to coverage for your employees’ dependents as well.
If an employee selects a plan that costs more than your contribution, he or she simply pays the difference. At renewal, you have the option to adjust your Defined Contribution up or down, giving you complete control over what you spend on your employees’ benefits.
If you contribute only to employee coverage, enrollees will pay more if they choose to add dependent coverage. If you contribute to employee and dependent coverage, employees will pay less when enrolling eligible family members.
It is important to note, though, that if your company is what the ACA defines as an Applicable Large Employer (ALE), you must include dependent child coverage (through age 25) for children of full-time or full-time equivalent employees. You are not required to offer spouse coverage, nor do you have to include coverage for a stepchild, foster child, or a child who is not a U.S. citizen. For more information, refer to the Q&A on the Healthcare.gov website. (Note: rules could change if there’s a future ruling in the pending court challenge to the ACA.)
3. When am I eligible to enroll?
You, as the employer, determine when your employees are eligible for health insurance and other benefits. Under ACA guidelines, for plan years beginning on or after January 1, 2015, employers cannot apply a waiting period exceeding 90 days for group health insurance. More information is available in the archives of the Federal Register.
Many employers choose to have coverage on the first of the month following 30 days of employment. For example, if an employee began work on February 10, 2019, he or she would be eligible for benefits on April 1, 2019. Other businesses might choose the first of the month following 60 days of employment. Using this same hypothetical new hire, who starts on February 10, 2019, he or she would be eligible for benefits starting May 1, 2019.
Consider what other employers in your area or your industry are using as a standard for benefits eligibility when establishing your waiting period.
4. Is my current doctor in the network?
If you offer CaliforniaChoice to your employees, there’s a good chance their current doctors are part of one or more of the provider networks offered by the eight health plans that are part of CaliforniaChoice.
It’s easy to determine your doctor’s network status by using the Provider Search tool on the CaliforniaChoice website. It allows you, your employees, and their dependents to look up California medical providers by name, gender, city or ZIP Code, distance from your home or office, affiliated health plans, language(s) spoken, hospital, or medical group. The Provider Search is one of several online tools from CaliforniaChoice to help you and your employees compare plans and find the one that’s right for your health care needs.
5. Can I get Dental, Vision, and other coverage?
CaliforniaChoice offers a comprehensive array of optional employee benefits, including Dental, Vision, Chiropractic & Acupuncture, and Life Insurance. CaliforniaChoice also offers discounted health care services, human resources support, COBRA billing services, Rx Discounts, and more available to you and your employees at no added cost through the Member Value Suite and Business Solutions Suite.
Get a Custom Quote
If you and your employees have questions of your own, your employee benefits agent can provide you with answers. He or she can also deliver a custom CaliforniaChoice quote for your business.
It’s tax season, so it’s a good time to look at some known and lesser-known ways to reduce the tax burden on your business. You may be able to take advantage of one or more of these tax benefits.
Employer-Sponsored Health Insurance
Generally, business owners can deduct most (if not all) of the cost of employee health insurance. The Internal Revenue Service (IRS) says if an employer pays for accident and health insurance – including an employee’s spouse and dependents – the employer’s payments are not considered wages and are not subject to Social Security, Medicare, and FUTA (Federal Unemployment Tax Act) taxes or federal income tax withholding. This exclusion also applies to qualified Long Term Care Insurance.
Unfortunately, for employees of S (or Subchapter) corporations, which are taxed in much the same way as partnerships, the cost of health insurance benefits must be reported as income if the employee owns more than two percent of the corporation. More information can be found on the IRS “Employee Benefits” web page.
Health Insurance Tax Credit: The Affordable Care Act (ACA) allows small businesses that provide health benefits for employees to take advantage of a tax credit as long as they contribute at least 50% toward employees’ health premiums.
For most employers, the maximum available tax credit is 50% of the cost of health coverage. Tax-exempt employers are permitted a 35% tax credit.
Generally, the Small Business Health Care Tax Credit is available to employers that:
- Have fewer than 25 full-time equivalent employees
- Pay an average annual wage of less than $50,000
- Pay at least half of employee health insurance premiums (for employee-only coverage, not family or dependent health coverage)
Employers with fewer than 10 FTE employees with wages averaging less than $25,000 annually are eligible for the maximum tax credit.
To claim the Small Business Health Care Tax Credit, you are required to purchase a qualifying health plan through the Small Business Health Options (SHOP) marketplace. In California, that means you have to purchase coverage through Covered California for Small Business. More information is available on the state exchange website.
Paid Leave Tax Credit
One of the added benefits of the Tax Cuts and Jobs Act of 2017 is a provision that allows employers to receive a tax credit if they provide 50% or more compensation to employees taking leave in 2018 or 2019 under the Family and Medical Leave Act (FMLA).
To take advantage of the tax credit, an employer must:
- Have a written leave policy covering all qualifying employees
- Provide at least two weeks of annual paid family and medical leave for each full-time qualifying employee and at least a proportionate amount of leave for each part-time qualifying employee (customarily work fewer than 30 hours per week)
- Provide leave pay of at least 50% of the qualifying employee’s wages
The government offers a 12.5% credit of the cost of the leave benefit to businesses when an employee receives at least 50% of his or her normal wages while on leave. The maximum tax credit is 25% of the benefit’s cost when an employee receives full compensation while on leave.
More information on the paid leave tax credit is available in this article from the Society for Human Resource Management (SHRM).
Qualified Business Income Deduction
Also enacted as part of the 2017 Tax Cuts and Jobs Act, the Qualified Business Income Deduction permits taxpayers to deduct up to 20% of qualified business income (QBI) for a business operated as a sole proprietorship or through a partnership, S corporation, trust, or estate. (The deduction is not allowed for C corporations.)
According to the Journal of Accountancy, the deduction is generally available to business owners whose taxable income is below $315,000 for joint returns and $157,500 for other taxpayers. The IRS offers a Q&A on the Tax Cuts and Jobs Act and the Qualified Business Income Deduction.
Find Out If You Qualify
Your accountant, auditor, or tax advisor can offer you guidance about whether any of these tax benefits might be available to you and your business. Your employee benefits agent can also provide you with information on the tax advantages of providing employee health insurance.