Last week, the U.S. Congress passed and President Trump signed a Paycheck Protection Program (PPP) reform bill.
The Paycheck Protection Program Flexibility Act gives business owners more time to use emergency funding received under the PPP set up to assist businesses affected by COVID-19. It extends the period in which employers must use the money to qualify for loan forgiveness from eight weeks to 24 weeks.
It also gives small businesses increased flexibility by changing the rule requiring employers to use 75% of the money for payroll, while limiting other costs to no more than 25% to qualify for loan forgiveness. The amended ratio is at least 60% of funds going toward payroll and no more than 40% going toward other costs.
Equally important, the new legislation pushes back a June 30 deadline to rehire workers in order for salaries to count toward loan forgiveness. Businesses now have until December 31, 2020, to rehire workers.
The SBA is expected to provide formal notice of the changes to funded businesses in the near future. More information will soon be posted on the SBA website.This information is provided on an “as is” basis and you acknowledge and agree that CHOICE Administrators, Inc. and its affiliated entities (collectively “Choice”) makes no representations or warranties, express or implied, concerning the accuracy, reliability, timeliness, completeness, or suitability of any content provided. The information provided is not a substitute for professional advice, whether legal, tax, financial, or otherwise and therefore, you should consult an appropriate professional prior to acting on any such information. You acknowledge and agree that in no event will Choice be liable for any general, special, indirect, incidental, or consequential damages, related to the information provided, even if advised of the possibility. All rights to information are expressly reserved by Choice and/or the respective legal owners of such information, including, without limitation, copyright, trademark, and service mark rights. You may not reproduce, publish, or distribute such information without the express written consent of Choice or the respective content owners.
As you consider health insurance options for yourself — and for your employees — you may be wondering what makes one health plan choice the right one for you. This article spotlights PPOs, and offers information about new choices coming in Summer 2020 from Anthem Blue Cross.
What is a PPO?
A preferred provider organization (PPO), also sometimes called a participating provider organization or preferred provider option, is a health care plan with a network of health care professionals who have an agreement with an insurer or a third-party administrator to provide health care at pre-negotiated, reduced rates. The doctors, specialists, and hospitals are considered preferred providers for the health plan with whom they are contracted.
PPOs account for more than one-third of the enrollees in small group health plans in California, and more than a quarter of all commercial plan enrollment (individual, small group, and large group). A PPO is attractive to many people because it offers participants greater freedom to seek care from any in- or out-of-network health care provider. Typically, the premiums for PPO coverage are greater than for an EPO or HMO, but for some individuals and families, the added cost is worth it.
There are no required referrals for seeing a specialist when you have PPO coverage. You can book an appointment directly with a doctor. If he or she is in-network, you’ll pay a preferred rate for your office visit or other care. If the specialist is out-of-network, you will pay more. Likewise, if you or your employees need to go to a hospital for care, you can make the appointment yourself; no referral is necessary. If you use a lot of specialists or specialized services, or if you require hospitalization, some people find a PPO is a better choice because it offers greater flexibility.
Networks: In general, PPO networks tend to be broader, which gives you and your employees access to more doctors and hospitals. The Anthem Blue Cross PPO options offered through CaliforniaChoice give you access to three Affordable Care Act (ACA) metal tiers and multiple provider networks, as shown below.
|Anthem Blue Cross PPO Networks||Bronze||Silver||Gold|
Anthem’s Prudent Buyer network is one of the largest health care provider networks in California and nationwide.
New 7/1 Options from Anthem
For groups looking for coverage effective on or after July 1, 2020, CaliforniaChoice is expanding its PPO options available through Anthem Blue Cross. Four new plans are being added – three with access to the Anthem Prudent Buyer network and a fourth offering access to Anthem’s Select PPO network. The new plans are available in the Gold, Silver, and Bronze metal tiers, including one with a Health Savings Account (HSA).
If that isn’t enough, also beginning with coverage effective in July, CaliforniaChoice is offering you and your employees two Triple Tier options. That means you can offer them access to three metal tiers: Bronze, Silver, and Gold plans or Silver, Gold, and Platinum. That gives them even more choices when it comes to in-network doctors, specialists, and facilities plus out-of-network providers, too.
With CaliforniaChoice, one employee might select a Gold tier PPO because of a particular doctor or hospital in the PPO’s network. A second employee might select a Silver tier EPO (Exclusive Provider Organization) plan because it offers a slightly lower premium, but offers direct access to in-network specialists without a Primary Care Physician referral. Another employee who rarely visits the doctor might prefer a Bronze tier HMO. A fourth employee might want a plan with an HSA.
It is your employees’ choice when you offer them access to a private health insurance exchange like the CaliforniaChoice multi-carrier program, which has been helping California small businesses since 1996.
Cost Control for You
The CaliforniaChoice exchange lets you determine how much you want to spend on employee benefits. It’s what is called Defined Contribution.
You decide what you want to contribute toward the cost of your employees’ benefits – a Fixed Percentage (50% to 100%) of a specific plan and/or benefit, or a Fixed Dollar Amount for each employee. Each of your employees then applies your contribution to the health plan he or she prefers. If an employee chooses coverage under a plan that costs more than your contribution, he or she simply pays the difference.
At renewal, you have the option to adjust your premium contribution – up or down – giving you control over your employee benefits cost for another 12 months.
Talk to a Broker to Learn More
If you want to learn more about the PPO, EPO, HMO, and other health plan options available through CaliforniaChoice, talk with your employee benefits agent. If you don’t have one, we make it easy to find a licensed insurance professional. Go here to find one in your area.
Advance Health Care Directive Links Included
At CHOICE Administrators, we are committed to providing small businesses and employees with support and information as we all deal with the impact of the COVID-19 pandemic.
We’ve developed a single COVID-19 Resources document that includes a range of information to help you and your employees navigate through this difficult time. It includes:
- COVID-19 Overview Information
- Situation Updates
- Information for Businesses
- Information for Families and Households
- Information for Community Events and Gatherings
- Social Media Resources
In addition, members of our CaliforniaChoice small group, multi-carrier private health insurance exchange and our ChoiceBuilder multi-carrier ancillary exchange have additional COVID-19 resources available through our partner, Mammoth HR.
Additional information from Mammoth is available behind login through www.calchoice.com and www.choicebuilder.com. You’ll find sample communications to employees, telecommuting resources, and links to various federal resources including the Centers for Disease Control and Prevention (CDC) and Occupational Safety and Health Administration (OSHA), as well as state and local resources, where available.
Tools and information are also available from the U.S. Department of the Treasury, Internal Revenue Service (IRS), U.S. Chamber of Commerce, and U.S. Department of Labor (DOL):
- Coronavirus Emergency Loans – Small Business Guide and Checklist (Chamber of Commerce)
- PPP Information Sheet for Borrowers (Treasury)
- FFCRA Poster, FAQs (DOL)
- FFCRA Fact Sheet for Employers: Employee Paid Leave Rights (DOL)
- FFCRA Fact Sheet for Employers: Employer Paid Leave Requirements (DOL)
- FFCRA Poster, Employee Rights (DOL)
- FFCRA Temporary Non-Enforcement Bulletin (DOL)
- Navigating Paid Sick and Family Leave Tax Credits FAQs (IRS)
- CARES Act Assistance for Small Employers (Treasury)
Advance Health Care Directive Form
The spread of COVID-19 has prompted many across California, and the nation, to consider their planning for major health care decisions. Even if you and your employees are not dealing with COVID-19 or any other major health concern at this time, it’s important to plan for the future. What if you were sick and in need of emergency medical treatment? What if you could not speak for yourself about your health care preferences? How would your medical professionals and family member know what course to pursue?
An Advance Health Care Directive (also known as a living will or personal directive) can provide loved ones with the information needed to make decisions that are in line with your or your employees’ wishes. Having preferences documented can relieve some of the burden for friends and family.
A legal document, the Advance Health Directive form goes into effect only if you become incapacitated and unable to speak for yourself. It can be replaced as often as needed in the event of health changes, or if you change how you want things to be taken care of if you are unable to direct them on your own.
There are numerous sources of an Advance Directive. You can ask your company counsel or personal attorney for a form, which you can share with interested employees, or you can visit or direct others to one of several websites, including those listed below:
- Office of the California Attorney General
- California Courts: The Judicial Branch of California
- California Hospital Association
Information from Your Insurer
If your employees are currently covered by a group health insurance plan, your insurer, administrator, or health plan may offer additional tools and resources. Contact your broker for information. If you don’t have broker, we make it easy to search for one here.
In mid-April, the Kaiser Family Foundation (KFF) released a Data Note on 2020 Medical Loss Ratio (MLR) rebates, which are due to groups and individuals later this year. Under the Affordable Care Act (ACA), an insurer is required to use a specified percentage of each premium dollar received to pay for medical claims and activities that improve quality of care.
For small business and individual health insurance policies, the MLR is 80%, which leaves 20% of premium revenue to go toward administration, marketing, and profit. The MLR is higher for large group insurance plans, which must spend 85% of premium dollars on claims and quality improvements.
Insurers that fail to meet the required MLR must pay rebates to customers. MLR rebates are based on a three-year average, which means that 2020 rebates will be paid based on insurers’ financial data for 2017, 2018, and 2019. Rebates can be given to customers via a premium credit or a check. For those insureds with employer-based coverage, the rebate can be sent to the employer – with checks distributed in the fall.
According to a U.S. Department of Labor bulletin and the Society for Human Resource Management (SHRM), employers’ responsibility for rebate distribution depends on who paid for the coverage. For example, if the employer paid the entire cost, no part of the rebate is due to participants. If participants/employees paid the entire cost, they are due the full rebate. If the cost is shared, employers and employees are due a proportional share of any rebate. Employers can either distribute rebates to employees or apply them toward future premiums, taking into consideration potential tax reporting (for rebates paid directly to employees) as well as the cost effectiveness and administrative feasibility of distributing funds received.
KFF reported that preliminary insurer data compiled by Mark Farrah Associates projects companies will issue a total of nearly $2.7 billion in rebates this year – nearly double the record $1.4 billion distributed last year. In 2020, about two billion dollars will go to individual market insureds, while small groups will receive $348 million and large groups will be rebated $341 million. Healthcare Dive says individual rebates will average $420 and enrollees in large groups will average $110. Small groups will be rebated the most – an average of $1,850 each. Final rebate data is expected this summer, as insurers must finalize their numbers by the end of the July with payouts due in September.
CaliforniaChoice just expanded the health care choices available to you and your employees. Our new Triple Tier includes Bronze, Silver, and Gold. Here’s how it works:
Triple Tier is the most popular option for CaliforniaChoice groups because it delivers something for everyone.
- Provides employees with the most plan choices and price points to satisfy their needs.
- Employees can buy up or down, allowing an employer to keep costs low without limiting choice to employees.
- Encourages increased participation by employees by offering a lower-cost option for employees wanting to enroll their dependents.
- Offers more at renewal! Triple Tier is a great way to offer new options to employees without disrupting current plan availability for your group.
- There’s no cost to offer Triple Tier, and there’s no participation requirement for any Tier.
- Offers more PPO and EPO options if you have employees residing out-of-state.
Best of all, offering Triple Tier does not cost you more. That’s because you decide what you want to spend on employees’ health care with Defined Contribution. Your contribution is the same for each employee regardless of how many ACA metal tiers are offered, or what tier and plan each employee chooses.
How ACA Metal Tiers Work
Under the Affordable Care Act, there are four metal tiers. Each offers a different level of cost sharing between the health plan/insurer and the covered employee (or dependents).
|ACA Metal Tier||Health Plan/Insurance Pays||Insured Pays|
For employees who want to minimize their monthly premium, or those who may not need a lot of medical care, a Bronze or Silver metal tier Health Maintenance Organization (HMO) plan may make sense. CaliforniaChoice offers HMO plans through four statewide and four regional health plans: Anthem Blue Cross, Health Net, Kaiser Permanente, Oscar Health, Sharp Health Plan, Sutter Health Plus, UnitedHealthcare, and Western Health Advantage.
For an employee who wants access to a broader network of doctors and specialists, an Exclusive Provider Organization (EPO) plan may offer a good balance between affordability and provider access. CaliforniaChoice offers EPO plans in all four ACA tiers: one in the Bronze tier and two in the Silver tier from Anthem Blue Cross as well as 11 plans in all four metal tiers from Oscar Health. Currently, Oscar is available regionally in California.
Across all tiers, carriers, and health plans, CaliforniaChoice offers 10 PPO, 14 EPO, and nearly 70 HMO options statewide. With CaliforniaChoice, employees can choose what they want – and you still control your annual costs.
Talk to a Broker to Learn More
Contact your employee benefits broker to learn more about the expanded Triple Tier options from CaliforniaChoice – and all of your insurance choices. If you do not have a broker, search for one here.
You may have read that funding ran out last week on the Paycheck Protection Program (PPP) established to aid employers affected by the COVID-19 pandemic.
Congress has now approved an added $484 billion to fund COVID-19 assistance programs. That includes $370 billion in additional funding for small business: $310 billion for the PPP and $60 billion for the Economic Injury Disaster Loan program. An added $100 billion will go toward hospitals ($75 billion) and testing ($25 billion).
If you want more information about the Small Business Administration (SBA) programs, you will find it here.
Remember to speak with a tax professional to be sure you understand the implications of taking an SBA EIDL or PPP loan for your small business.
Be well and stay safe.
This information is provided on an “as is” basis and you acknowledge and agree that CHOICE Administrators, Inc. and its affiliated entities (collectively “Choice”) make no representations or warranties, express or implied, concerning the accuracy, reliability, timeliness, completeness, or suitability of any content provided. The information provided is not a substitute for professional advice, whether legal, tax, financial, or otherwise and therefore, you should consult an appropriate professional prior to acting on any such information. You acknowledge and agree that in no event will Choice be liable for any general, special, indirect, incidental, or consequential damages, related to the information provided, even if advised of the possibility. All rights to information are expressly reserved by Choice and/or the respective legal owners of such information, including, without limitation, copyright, trademark, and service mark rights. You may not reproduce, publish, or distribute such information without the express written consent of Choice or the respective content owners.
In these challenging times, we have some good news.
Congress approved, and President Trump has signed, a $2 trillion Coronavirus stimulus bill to help small businesses and others coping with the COVID-19 pandemic.
The new legislation includes the “Keeping American Workers Paid and Employed Act,” which provides $350 billion in Small Business Administration (SBA) loans to assist employers who keep employees on payroll and pay rent and insurance premiums.
For more information, or to apply for a loan, please visit the SBA website.
If you decide to pursue an SBA loan, we encourage you to speak with a tax professional to better understand the implications for your business. Be well and stay safe.
The U.S. Senate passed a $2 trillion Coronavirus stimulus bill last night designed to provide economic relief to all Americans.
The bill is with the U.S. House of Representatives and will route to President Trump for his signature; the bill is expected to get approved tomorrow.
Included in the bill is the “Keeping American Workers Paid and Employed Act,” which provides $350 billion in loans for small businesses to cover salary, wages, and benefits worth 250% of an employer’s monthly payroll, with a maximum loan of $10 million.
Businesses with fewer than 500 employees will be able to work with the Small Business Administration to get more information and apply for a loan. Loans will be forgiven for qualifying groups who use their loan to keep employees on payroll, pay rent and insurance premiums, and other guidelines in the law. Please consult your tax professional with questions.
For a copy of the details before the House of Representatives, click here. We encourage you to review the information on the Small Business Administration website and we will share more information as it becomes available.
As concern grows regarding the Coronavirus (COVID-19), please know the team at CHOICE Administrators is committed to providing a safe environment for our employees and visitors to our office, and ensuring business continues as usual.
However, in the event of a serious disruption to the market, we have a Business Continuity Plan in place. Our business operations supporting CaliforniaChoice and ChoiceBuilder will continue and your employees will have access to the health care they need.
For details on what our health plan partners are sharing with members, please see below:
- Anthem Blue Cross
- Health Net
- Kaiser Permanente
- Oscar Health
- Sharp Health Plan
- Sutter Health Plus
- Western Health Advantage
Stay safe – steps to protect you and your employees
Keeping your business healthy is key. In alignment with the Centers for Disease Control and Prevention, be sure to remind your employees to:
- Wash their hands
- Avoid touching their eyes, nose, and mouth
- Avoid close contact
- Stay home if they are sick
We wish you good health and thank you for placing your business with us.
- Review the details of your account
- Make a payment
- Add an employee to coverage
- And more
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.