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Author: Alex Strautman

An EPO (Exclusive Provider Organization) may not be as well-known as a HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) (PPO), but it’s often a money- and time-saving coverage option.

What is an EPO?

An EPO is a health plan that offers a full-network of doctors and hospitals from which to choose.

Like a HMO, an EPO gives you and your employees access to a select network of medical providers. When you go to an in-network provider, you’ll have limited out-of-pocket costs. If you go outside of the network, the plan offers limited, if any, benefits and costs are higher.

Like a PPO, employees with EPO coverage don’t need to get a referral from a Primary Care Physician (PCP) to visit a specialist, as long as the doctor is part of the EPO network.

An EPO in Action

Benefits of an EPO

An EPO combines the strengths of a HMO with a PPO in a single option. It offers more flexibility than a HMO because there’s no need for a referral from your PCP to receive specialist care. An EPO is competitively priced, too. It frequently offers more affordable premiums than a PPO. For many, an EPO is a happy medium between an HMO and a PPO.

EPO Plans Available through CaliforniaChoice

You and your employees can choose from a variety of EPO plans through CaliforniaChoice. Multiple options are available from Anthem Blue Cross and Cigna + Oscar.

The Anthem Blue Cross EPO coverage through CaliforniaChoice includes member access to the Anthem Prudent Buyer Network. The Prudent Buyer Network offers 90% of doctors and hospitals in the United States through the national BlueCard® Program.

Some of the in-network premier California facilities include:

Cigna + Oscar offers EPO plans in all four metal tiers through CaliforniaChoice. Its plans include top hospitals and providers in the LocalPlus® and Open Access Plus provider networks.

Some of the in-network premier California facilities include:

You can view the full provider directory on the CaliforniaChoice website. Searches are available by city or ZIP Code as well as hospital affiliation and other criteria.

Talk With a Broker to Learn More

Learn more about EPO, HMO, PPO, and other options available to you and your employees from your health insurance broker. If you don’t already have a broker, you can look for one here.

CaliforniaChoice helps California small businesses expand employee benefit options for employees. The program, known for its freedom and flexibility, is also affordable for employers. Beyond health care, CaliforniaChoice offers employers business management services at no added cost.

The CaliforniaChoice Business Solutions Suite includes:

In addition, CaliforniaChoice provides Payroll Services through Heartland Payroll Solutions, Inc. that you can integrate with your benefits for free.

ONLINE HR SUPPORT CENTER

The Online HR Support Center incudes 24-hour access to information on critical state and federal employment laws. It also features a database of frequently asked questions and answers to common human resources issues.

The HR Support Center backed by Mineral includes:

FLEXIBLE SPENDING ACCOUNTS (FSAs)

For groups of 15 or more employees, CaliforniaChoice offers you no-cost FSAs. An FSA allows your employees to set aside a part of their salary, on a pre-tax basis, to pay for eligible health care-related expenses. Employees pay less in taxes, while also lowering your required FICA contributions.

Items eligible for reimbursement or payment through an FSA include:

PREMIUM ONLY PLANS (POPs)

Section 125 Premium Only Plan services are available, too. CaliforniaChoice covers your initial set-up cost for your POP. Employees can then pay their share of premiums for their Medical and Dental coverage with pre-tax dollars. This lets employees take home more of their paycheck dollars. In turn, your taxable payroll decreases – saving you on FICA and Workers’ Compensation expenses.

COBRA BILLING SERVICES

With CaliforniaChoice, COBRA-related activities are also included at no cost.

Based on your group size, you’ll receive Cal-COBRA services (for groups with 1-19 employees), or federal COBRA services (for groups of 20 or more employees), when an eligible enrollee loses coverage because of a qualifying event, including:

Services available include COBRA participant invoicing, premium collection and remittance, and processing eligibility changes for non-payment of premium.

PAYROLL SERVICES

Heartland Payroll Services can be combined with your health benefits. Any payroll changes you make are communicated in real time to CaliforniaChoice. This allows you to:

Available payroll services include:

HOW TO LEARN MORE

CaliforniaChoice offers affordable health insurance coverage and more. It’s available to employers in California with up to 100 employees. To get a quote for your business, talk with your health insurance or employee benefits broker. If you don’t already have a broker, we can help you find one.

When you offer the CaliforniaChoice to your employees, they get more than their choice of leading health plans. They also have access to Active&Fit Direct® through the ChooseHealthy® Program.

ChooseHealthy is available to all CaliforniaChoice members at no added cost. It offers you and your employees discounts on a variety of health and fitness brands, including Fitbit®, Garmin®, Vitamix®, PRO Compression®, and others. It also includes discounted fitness center memberships and other benefits through the Active&Fit Direct program.

Active&Fit Direct offers all CaliforniaChoice members access to:

In addition, as CaliforniaChoice members, you and your employees can also get:

Your health insurance broker can provide you with more information about all of the benefits of CaliforniaChoice – as well as a custom quote for your small business employees. If you don’t have a broker or agent, we’ll help you search for one here.

As we head into a busy fall and open enrollment season, many businesses will be shopping for and comparing health coverage. This year, employers are taking a look at employee benefits from a different perspective. That’s because the pandemic forced people to reconsider what they want from a health plan.

If you’re considering offering coverage or making changes to an existing plan, here are some things to consider.

Choice and Affordability

The CaliforniaChoice private exchange offers several advantages, including employee choice and affordability:

Employers and employees love the freedom and flexibility CaliforniaChoice offers. For example, one of your employees might choose a PPO plan because of its broad provider network. Another might select an HMO because of its cost savings. With CaliforniaChoice, they both get what they need.

Who You Cover Is Up to You

Employers subject to the ACA’s Employer Mandate are required to offer health coverage to full-time employees and their eligible dependents. However, if you are not an Applicable Large Employer (with at least 50 full-time employees, including full-time equivalents), you get to choose who you want to cover – full-time employees only or FTEs and their dependents. It’s your choice. (If you don’t know if you’re an ALE, visit the ACA Information Center on the IRS website.)

More Reasons to Consider Benefits

Beyond helping your business attract and retain top talent, health insurance and other employee benefits offer other advantages. Generally, as a business owner, you can deduct most (if not all) of the cost of your employees’ health insurance as a normal business expense.

According to the IRS, if you pay for accident and health insurance, your payments are not considered employee wages – and they are not subject to Social Security, Medicare, and Federal Unemployment Tax Act (FUTA) taxes or federal income tax withholding. Additionally, if your business is incorporated, and you are the owner of the business, your health insurance costs are also deductible.

It’s Easy to Learn More

According to MetLife’s 19th Annual U.S. Employee Benefit Trends Study 2021, because of the blending of home and work during 2020-2021, employees want (and are expecting) more flexibility. With CaliforniaChoice, it’s easy to give it to them – while also giving you the ability to control costs for your business.

To get a CaliforniaChoice quote for your employees, talk with your health insurance or employee benefits agent. It may surprise you to learn that using the services of a health insurance agent does not cost you anything. In fact, you could save money because an experienced agent has the expertise to help you find the most competitive benefits program. An agent can also ensure you and your employees have access to the doctors, specialists, and hospitals you want.

If you don’t already have an agent, we can help you find one.

When comparing health plans, it’s important to know if you’ll have access to the doctors, specialists, and hospitals you prefer. If you have a current patient relationship with a provider, you may want to avoid interruptions to your ongoing care.

The CaliforniaChoice Online Provider Search provides insight into these details. It helps you can find out if a doctor or hospital is part of a plan’s provider network. You have many health plans from which to choose: Anthem Blue Cross, Cigna + Oscar, Health Net, Kaiser Permanente, Oscar, Sharp Health Plan, Sutter Health Plus, UnitedHealthcare, and Western Health Advantage.

You can look up other care providers, too. That includes dentists, vision care providers, chiropractors, and acupuncturists.

Here’s how it works for a Medical search:

You can narrow or widen a Medical search by adding:

For Dental, Vision, and Chiropractic & Acupuncture searches:

Our Online Rx Search allows you to look up prescription drugs by brand, generic name, or health condition. You can see if each is included in the health plans you’re considering.

These online search tools are just two of the valuable resources available from CaliforniaChoice, the multi-carrier, employee-choice, small business private exchange.

To find out how CaliforniaChoice can help you expand your options for employees while still controlling costs, contact your employee benefits agent. If you do not already have an agent, we can help you find one.

When the Affordable Care Act (ACA) was signed into law in 2010, it was heralded as a way to make affordable health insurance available to more people. Supporters also touted it as a vehicle to implement reform for the country’s private health insurance marketplace (especially for individuals and small group purchasers). That included coverage for individuals with pre-existing health conditions, which were not always covered under the patchwork of health plans marketed prior to the ACA.

While the ACA has been challenged in court several times since it went into effect, it is the law of the land, and it’s been able to deliver on its promise to expand coverage to more Americans. Before the ACA was implemented, California’s uninsured rate was 17.2% in 2013. In 2020, it was 7.1%. According to the California Health Care Foundation (CHCF), the ranks of the uninsured have decreased by 3.7 million since the ACA took affect.

The CHCF says 1.5 million Californians get coverage through the state’s public exchange, Covered California. Another 12.5 million are covered through Medi-Cal, the state’s Medicaid program. The CHCF says that number includes 3.7 million residents who have health insurance resulting from the coverage expansion of the ACA.

Nearly half (48%) of Californians with health insurance get their coverage through their employer, according to the Kaiser Family Foundation (KFF). KFF is an American non-profit organization focused on health care issues and the nation’s role in global health policy; it is not affiliated with the Kaiser Permanente health plan.

Public and Private Exchanges Expand Choices

The ACA introduced public exchanges to much of the country more than a decade ago. California’s public exchange, Covered California, offers individual and family coverage as well as coverage for small business. Employers (and their employees) can choose from HMO and PPO plans from Blue Shield of California, Health Net, Kaiser Permanente, Oscar, and Sharp Health Plan.

California’s longest operating private health exchange, CaliforniaChoice, has been serving small businesses in the Golden State for 25 years. The CaliforniaChoice exchange opened its doors in 1996 – expanding options for employers looking to give employees a greater role in selecting health coverage that best meets their individual or family health care needs.

Today, CaliforniaChoice offers everything you and your employees want in a benefits program:

Essential Health Benefits

One of the added benefits of the ACA is that it standardizes what must be included in individual and small group plans marketed as ACA compliant. This makes it easier for you to compare plans, knowing that compliant plans must include these Essential Health Benefits:

Because insurers are required to include coverage for these essential benefits, when you shop you know plans in the same ACA metal tier offer comparable features and coverage. The four ACA metal tiers are Bronze, Silver, Gold, and Platinum. Each tier offers a different level of support for covered services, ranging from 60% of health care costs for Bronze plans, 70% for Silver plans, 80% for Gold plans, and 90% of costs for covered services under a Platinum plan.

The ABCs of HMOs, PPOs, and EPOs

Whether you get your employee coverage directly through an insurer, through a public or private exchange, or with the assistance of a broker, you will likely have a range of plan types available. Among the most popular options are Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. Both have been around for decades. The Kaiser Family Foundation’s 2020 Employer Health Benefits Survey reports a 47% penetration rate for all firms for PPOs, while the penetration rate ranged from eight percent to 31% for other plans (HMO, Point of Service, and High Deductible Health Plans with a savings option). Those numbers have shifted somewhat from 2015, when PPO enrollment was five percent higher and most other enrollment was lower.

Exclusive Provider Organization (EPO) coverage is somewhat new, and it is a sort of hybrid between an HMO and PPO. An EPO offers a local network of doctors and hospitals from which members can choose; however, it often limits benefits outside the network. EPOs do allow members to self-refer to specialists who are part of the EPO network. Outside the network, there may be no or limited coverage. In California, Anthem Blue Cross and Oscar, as well as the Cigna + Oscar joint venture include EPO options in their portfolios.

Shopping for Your Business and Employees

The best way to learn about affordable local coverage available to you and your employees because of the Affordable Care Act is to talk with an employee benefits broker. Using a broker does not cost you more – and it can often help you save on your employees’ health coverage. That’s because your local broker will be familiar with providers that are part of each of the health plans available in your community. If you don’t have a broker, we can help you find one here.

Effective June 15, 2021, California Governor Gavin Newsom terminated emergency orders that put the state under restrictions as part of its response to COVID-19. Mandates concerning physical distancing, capacity limits on businesses, and the county tier (color-coding) system have ended. The California Department of Public Health has issued new guidance concerning the use of face coverings, requirements for “mega events” (with 5,000 or more attendees), and requirements for public schools.

Employers statewide are implementing different approaches to reopening. Some have fully reopened; some have announced plans to maintain remote-work arrangements with some or all of their workforce; others are implementing a hybrid approach, with employees returning to work for a portion of the week, while continuing to work remotely on some days.

We recently interviewed Flor Real, the Human Resources Director at The Word & Brown Companies, to learn more about what her organization is doing as workers return to the office (after a majority of staff has worked remotely for 15 months). Flor has been the organization’s HR Director since October 2019. She has more than 20 years of HR management experience in various industries, including health and human services, education, and manufacturing. Flor’s passion is health and safety in the workplace. She attends annual OSHA trainings to stay up to date on changes in safety regulations for workplace compliance. She is a proud member of the Society for Human Resource Management (SHRM). Below is a summary of our recent interview.

How did COVID-19 impact your company, both from an operations and culture standpoint?

At the beginning of the pandemic, like many businesses, our Executive Leadership team at The Word & Brown Companies was faced with the challenge of making quick business decisions that would have an impact on our operations and culture to ensure the safety of our employees and business continuity.

It was decided to deploy our business continuity plan and allow more than 95% of our staff to work 100% remotely. The entire company pulled together to ensure we made this operational change happen without an interruption of the business. We did this very successfully. 

With respect to our culture, like many family-owned businesses, we are proud of the fun and family- oriented culture that we have built since 1985. During the pandemic, we wanted to make sure we maintained our culture despite the challenges we faced while physically distant. The Human Resources department planned many, almost monthly, virtual activities for our staff to keep us connected and engaged. 

The staff sent a Health & Wellness communication every Friday to remind staff we are in this pandemic together, and that no one is alone. Additionally, individual departments planned virtual team building events, virtual staff meetings, and attended virtual conferences to remain connected with each other and with our industry. 

Describe the policies you put in place to address any challenges that arose.

We implemented new COVID-19 Office Safety Guidelines with respect to handling possible exposures in the workplace, and new office safety guidelines regarding sick time and requirements around social distancing, face coverings, room capacities, facility cleaning, sanitization schedules, etc. We also put a policy in place where employees and management had one point of contact (the HR Director) to report possible exposures, and/or if they had any questions with respect to COVID-19 Office safety procedures. 

Have employees expressed hesitation/concern over returning to work?

After surveying our staff, more than 70% stated they preferred working remotely rather than returning to the office. 

What are common employee concerns and how are you addressing them?

The staff did not list any specific concerns, but, rather, expressed a preference in working from home, which has provided for them a better work/life balance. Our Executive Leadership team addressed this concern by implementing a “Work from Home Policy.” Our employees could choose to come in to the office or continue to work from home, and in some cases based on business needs, the manager could request the employee come in to the office up to two days per week. This new policy will allow us to optimize productivity, while offering employees the flexibility of a healthier work/life balance. We expect to welcome more employees back to work on-site in mid-July.

Does your company have a “Safe Return to Work” plan?

Yes, in fact we called ours the “Safe Return to the Office” plan.

Please describe your process for formulating the plan.

I worked with the Executive Vice President of Human Resources and Executive Vice President of Marketing to create the Safe Return to the Office plan referencing Governor Newsom’s State of California Road to Recovery Plan, as well the CDC guidelines. Once we developed the draft plan, we sent it to a select group of management staff to provide input for clarity of understanding and operational effectiveness. 

What advice do you have for other employers working to safely transition employees back to the office?

The advice I would offer other employers as they are safely transitioning their employees back to the office is to consider employees’ desires about returning to the office. It is important to balance those desires with your business needs and strategy. In other words, optimize business productivity with the flexibility of healthier work/life balance by allowing employees to work a hybrid office and remote schedule. 

Also, be ready for your employees to return safely to the office by developing a “Safe Return to the Office” plan that is communicated clearly to all employees. Your employees must know that the company is concerned with their ongoing safety, and is prepared for their safe return. The only way to do this is staying on top of all the COVID-19 safety guidelines delineated by Cal/OSHA and Centers for Disease Control and Prevention, whichever is more stringent to ensure the health and safety of all employees.    

Additional tools and information: The State of California offers guidance and a variety of resources through its COVID19.CA.GOV website, including information on:

The California Department of Industrial Relations also offers Cal/OSHA COVID-19 guidance and resources on its website.

Employee benefit surveys commonly show health insurance among the most appreciated employee benefits. In the MetLife 2021 Employee Benefits Trends Study, health insurance ranked atop employees’ prioritized benefits list. An overwhelming majority – 85% – said it is a “must have.” Ten percent said it is nice to have. A mere four percent said it was unneeded.

With so much employee enthusiasm for health insurance, the challenge for you is finding coverage that can address all employees’ needs. That’s especially true with today’s workforce so diverse (often multi-generational and multi-ethnic). CaliforniaChoice Total Choice is the answer.

More Tiers, More Choices

Since CaliforniaChoice began in 1996, it has offered employers a better way to control employee benefits costs. And it does so, while offering increased choices to employees.

Today, CaliforniaChoice offers four options to you and your employees.

Total Choice: Access to health plans and benefits in all four ACA plan tiers:

Triple Choice: Access to health plans and benefits in three plan tiers:

Double Choice: Access to health plans and benefits in two plan tiers:

Single Choice: Access to health plans and benefits in any single plan tier:

Total Choice has been the leading employer option since its 2020 launch.

Total Choice satisfies everyone:

Coverage from Top Carriers

CaliforniaChoice gives you and your employees access to nine health plans – and dozens of coverage options – across California.

With CaliforniaChoice, your employees can choose from HMO, EPO, and PPO plans based on their unique needs. It’s their choice.

Offering this level of choice also gives you a recruiting advantage and a powerful tool to help you retain current employees. And it does so without increasing your costs, as compared to a single health plan solution.

Defined Contribution Cost Control

One of the biggest advantages offered by CaliforniaChoice is Defined Contribution. It lets you decide how much you want to contribute toward your employees’ benefits costs, without limiting your employees’ benefit choices.

You can choose a Fixed Percentage (50% to 100%) of a specific plan and/or benefit, or you choose to contribute a Fixed Dollar Amount for each employee.

Your employees then apply your generous contribution toward whatever health plan they each like best. If the plan an employee prefers costs more than you’re contributing, the employee simply pays the difference.

Options for Other Coverage

In addition to great Medical coverage, CaliforniaChoice includes options for Dental, Vision, Chiropractic, and Life, too.

There are value-added extras as well – for you and your employees. The Business Solutions Suite offers HR Support, a Flexible Spending Account (FSA), COBRA or Cal-COBRA billing services, and a Premium Only Plan (initial set-up at no cost). The Member Value Suite includes outstanding savings on entertainment, a range of fitness and wellness products, and discount services for Dental, Vision, and prescription drugs, as well as a free hearing service plan.

Whether you have one employee or 100, you’ll receive a single, consolidated monthly bill that lists all of your employees, their selected coverage, your contribution, and employee deductions. It’s also easy to pay your CaliforniaChoice bill and manage your employee benefits online.

Talk with a Broker to Learn More

If you’re considering employee benefits for the first time, or you want to review your program to make sure you’re getting the most value for your dollar, a great place to start is by talking with an employee benefits broker.

A broker can help you review available health plans and networks, talk about your tier options, including Total Choice, and deliver a quote based on your employees’ specific needs.

If you’re not already working with a broker, we can help you search for one here. The services of a broker will not cost you anything – and using one could actually save you and your company time and money.

On June 3, the California Division of Occupational Safety and Health (Cal/OSHA) said whether an employee has to wear a mask depends on the vaccination status of others. Now, Cal/OSHA will propose something different. At its June 17 meeting, it will consider allowing fully vaccinated individuals to stop wearing a mask on the job.

The new rule could go into effect by June 28, aligning it with rules issued by the California Department of Public Health that take effect on June 15.

Earlier, Cal/OSHA said workers would be able to go without a mask only if everyone in a work area is vaccinated fully against COVID-19. For workers without full vaccination, masks stay on except when drinking or eating.

What Californians can do outside of their workplace versus at home poses a challenge – for employers and employees.

Regulations issued by Cal/OSHA apply in virtually all California workplaces. The exception is for a single employee who does not have contact with others. Or, where employees are working from home.

As of June 11, statewide, 58.5% of Californians have had at least one shot. More than 45 percent are vaccinated fully, according to Bloomberg. The Golden State has the highest daily rate of vaccine doses. Unfortunately, those numbers are down from five weeks ago.

The highest distribution counties are Los Angeles (10 million), San Diego (3.61 million), and Orange (3.27 million). Marin County has the highest rate of vaccination at 67.3%, with 10 other California counties above 50%.

CaliforniaChoice is committed to helping its members get the support needed to deal with COVID-19. As California moves toward a full reopening, it’s a good time to remind our customers and prospective customers of the COVID-19 resources offered through our partner, Mineral (formerly known as Mammoth HR/ThinkHR).

Through Mineral’s dedicated, public website, www.thinkhr.com/covid19, we offer access to trusted and timely information, including:

We also offer other free resources through our HR Support Center powered by Mineral:

Discounts through Cal Perks

Another benefit available to CaliforniaChoice members is the Cal Perks program, which offer savings on entertainment, health and wellness, and much more.

Cal Perks is free to you and your employees enrolled in CaliforniaChoice, offering steep discounts on a range of tickets, products, and services:

Flexible Insurance – and So Much More

If you’re not already offering health insurance from CaliforniaChoice to your employees, there are many reasons to consider it. CaliforniaChoice offers everything you and your employees want:

To learn more, contact your employee benefits broker. If you don’t already have a health insurance agent, we make it easy to find one in your area.