The Right Choice for Small Businesses

CaliforniaChoice has been helping small businesses offer customized group health insurance solutions for more than 20 years. Check out this video to find out how CaliforniaChoice helps businesses choose the right group health insurance plan. With our program companies can control health care costs, while offering their employees access to eight health insurance carriers.

If you have a small business and you want to offer health insurance to your employee, there are three important things to know.

1. You Decide Who to Cover

If you’re a small business with fewer than 50 full-time and full-time equivalent (FTE) employees, the Affordable Care Act (ACA) does not require you to offer health insurance to employees. However, many smaller businesses offer employee benefits as part of their employee recruitment and retention strategy.

Small businesses do not have to offer coverage to employees’ dependents either, although many do – again, to help attract and retain top talent.

You also do not have to offer benefits to part-time workers (those averaging less than 30 hours per week) or seasonal workers.

2. You Set Your Budget

Controlling the cost of benefits is important for every business, but it’s even more important for a small business. The good news is you get to choose how much you want to contribute to your employees’ insurance premiums. Depending on the health plan or health insurance exchange you select, you may have a choice of a fixed percentage amount (50% to 100%) or a fixed dollar amount for each employee. If an employee selects a plan that costs more than you are contributing, he or she simply pays the difference. And, at renewal, you have the option to change your contribution – giving you control over your costs for another year.

You could qualify for a Small Business Health Care Tax Credit. To take advantage of this tax credit program, all of the following must apply:

• You have no more than 25 FTE employees
• Your average employee salary is about $50,000 or less
• You pay at least 50% of the annual premium for employees’ health insurance
• You offer all full-time employees coverage through a Small Business Health Options Program (SHOP) marketplace (like Covered California)

Link here to find out if your company qualifies for SHOP coverage.

3. You Choose Your ACA Metal Tier

The ACA divides health plans into four “metal” tiers: Bronze, Silver, Gold, and Platinum. The tiers offer different levels of cost sharing between your employees and their selected health insurance plan, as shown below:

Here’s a summary of the features of each tier:

Bronze

• Lowest monthly premium
• Highest out-of-pocket costs when seeking care
• A low-cost way to protect yourself from worst-case medical scenarios, like serious sickness or injury. However, while the monthly premium will be low, employees will have to pay for most routine care on their own.

Silver

• Moderate monthly premium
• Moderate costs when seeking care
• Employees pay a lower deductible than with a Bronze plan before the Silver plan begins to pay. This is a good choice for employees willing to pay a slightly higher premium (than Bronze) to have more of their routine care covered.

Gold

• Higher monthly premium
• Lower costs when seeking care
• Works well for employees willing to pay more each month to have more costs covered when being treated. If an employee needs frequent care, a Gold plan can be a good value.

Platinum

• Highest monthly premium
• Lowest costs when seeking care
• Deductibles are often lower, which means the plan starts paying earlier than other plan categories. This is often a great choice for employees needing a lot of care who are willing to pay a higher monthly premium, knowing that more of their costs are covered.

You can offer your employees access to a single ACA metal tier or multiple tiers, depending on which insurance carrier(s) or health insurance exchange you select for your group’s coverage.

Help Is Available

Offering health insurance to your employees is easier than you might expect. A health insurance or employee benefits agent can assist you in shopping for coverage and determining your benefits budget. Working with an agent is free, too. If you don’t have an agent, we can help you find one.

At CaliforniaChoice, we are all about offering you and your employees health care choices. That’s why we have expanded our Affordable Care Act (ACA) metal tier options for coverage effective in 2019.

You can now choose from three metal tier options for your CaliforniaChoice coverage:

1. SINGLE TIER: Access to a single ACA metal tier (Bronze or Silver or Gold or Platinum).
2. TIERED CHOICE: Access to plans and benefits in two adjoining metal tiers (Bronze/Silver, Silver/Gold, or Gold/Platinum).
3. TRIPLE TIER: Access to plans and benefits in three metals tiers: Silver, Gold, and Platinum.

Best of all, the Triple Tier option 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 each employee chooses.

How ACA Metal Tiers Work

Each metal tier offers a different level of cost sharing between the health plan/insurer and the insured employee (or dependent).

For employees who want to minimize their monthly premium, and may not need a lot of medical care, a Bronze metal tier HMO plan makes sense. For an employee who may want access to a broader network of doctors and specialists, a Gold tier PPO may be the way to go. For employees who can afford higher premiums, and want the lowest out-of-pocket costs when seeking care, a Platinum plan is appealing.

Learn More by Talking to an Agent

Call or email your employee benefits agent to learn more about the expanded metal tier options available from CaliforniaChoice. He or she can also share information on the many other ways CaliforniaChoice can help you offer affordable health insurance to your employees. If you do not have an agent, we can help you find one.

If you own or manage a small business and you’re considering offering health insurance to your employees, it’s important to be informed before making a decision. We’ve answered seven of the most common questions concerning health insurance for employees of small businesses.

1. Is health insurance required?

Currently, the “employer mandate” of the Affordable Care Act (ACA) is still in place. If your business employed, on average, a combination of 50 or more full-time and “full-time equivalent” (FTE) employees during six months or more of last year (or, this year, if you’re a start-up), you are considered an Applicable Large Employer. As an ALE, you must provide employees and their eligible dependents with affordable, minimum essential health insurance coverage. If you do not offer such coverage, your business is subject to ACA penalties if at least one full-time employee receives a premium tax credit for enrolling in health insurance through a state exchange (like Covered California).

If you have fewer than 50 employees, you are not required to offer health insurance coverage (nor are you subject to a penalty for not offering it). However, many small business owners do elect to extend such benefits to their employees. That’s because, in today’s highly competitive talent marketplace, health insurance and other perks can help level the playing field when it comes to attracting new employees and retaining your existing staff.

2. How is “affordable” coverage determined?

Affordability is determined by whether the employee’s share of the premium for personal coverage costs no more than 9.56% of his or her household income in 2018. The figure for 2019 is 9.86% of household income. If an employer’s coverage is not considered affordable, the business is subject to a penalty: the lesser of $3,480 for each full-time employee receiving a premium tax credit subsidy or $2,320 for each full-time employee (minus the first 30 employees).

3. What’s the maximum Waiting Period?

If you offer health insurance to your employees, you must offer it to all eligible employees within 90 days of the date they start their employment. Coverage must begin no later than 91 days after employment begins.

You can choose a shorter waiting period, such as 30 or 60 days, but you cannot offer a longer waiting period. Many employers choose to make coverage effective the first of the month following 30 days of employment. So, for example, if an employee started on May 15, coverage would be available beginning on July 1. (Link here to download a PDF of IRS guidance on the 90-day waiting period limitation.)

4. What are the rules on SBCs?

Businesses that offer health insurance to employees are required to provide a standard “Summary of Benefits and Coverage” (SBC) that explains what’s covered by each plan and the related costs. The SBC is designed to help employees better understand their health insurance options when comparing plans. Failing to comply with the ACA’s requirement concerning SBCs could subject your business to a fine. Your insurance company, health insurance exchange, or third party administrator will be able to provide you with an SBC in advance of your group’s enrollment.

5. What are the ACA reporting requirements?

The ACA requires Applicable Large Employers (see above) to report to the IRS annually on health insurance coverage offered – or not offered – to eligible employees and dependents.

It further requires reporting by all employers of any size who sponsor self-insured health insurance coverage or a QSEHRA (Qualified Small Employer Health Reimbursement Arrangement).

6. Is there a minimum employer contribution?

Employers with fewer than 50 full-time equivalent employees are not subject to the ACA’s employer mandate, so they are not required to make a certain percentage contribution to employees’ costs.

Small businesses looking to qualify for a Small Business Health Care Tax Credit must:

• Have no more than 25 full-time equivalent employees
• Pay employees average wages of no more than $52,000
• Pay at least 50% of the annual premium for employees’ health insurance, and
• Purchase coverage through a Small Business Health Options Program (SHOP) marketplace

Some health insurance carriers and administrators do require at least 50% of the premium be paid by the employer. Ask your employee benefits agent for information about the plans you’re considering.

7. Where can I get help?

Using a health insurance or employee benefits agent can help you save time and money. And, working with an agent is free.

Your agent can provide you with valuable assistance, including answers to any questions you may have – about health insurance, offering voluntary or employer-sponsored coverage (or a combination), and benefits budgeting. If you do not already have an employee benefits agent, we can help you find one.

In 1996, CaliforniaChoice challenged the health care status quo. We created the first multi-carrier, employee-choice private health insurance exchange designed to meet the needs of small businesses in California. Today, CaliforniaChoice serves more than 18,000 employers and 300,000 members, and our membership continues to grow.

If your organization has fewer than 50 employees, CaliforniaChoice can help you deliver valuable health insurance options to your employees. Here are five reasons to choose CaliforniaChoice:

1. Employee Choice

The modern workplace has evolved. Offering a single health plan option to your multigenerational workforce is no longer sufficient. Today’s employees have different health care needs. To compete for the most talented workers, you must be able to give your employees a choice.

CaliforniaChoice offers you access to eight different health plans statewide – and the greatest access to doctors, specialists, and hospitals in California – through a single program. You and your employees can choose from dozens of Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO), Health Care Service Plan (HSP), and Health Savings Account (HSA) compatible options.

For example, one employee might select a PPO from Anthem Blue Cross because of a specific doctor or hospital in its network. A second employee might choose an HSP from Health Net. Another employee who wants a lower copay plan might select an HMO from Kaiser Permanente or UnitedHealthcare. A fourth employee might want access to a regional option like Oscar, Sharp Health Plan, Sutter Health Plus, or Western Health Advantage. With us, the choice is yours.

2. Employer Cost Control

Controlling benefits costs is an important consideration for employers, and CaliforniaChoice makes it easy. Using what we call Defined Contribution, you choose how much you want to contribute to your employees’ health insurance premiums. You can choose a Fixed Percentage Amount (50% to 100%) toward a specific benefit, or a Fixed Dollar Amount, for each employee. (Your contribution must be the same for all employees.)

Each employee then uses your generous contribution toward the cost of the plan he she prefers. (Think of it as a sort of health care voucher.) If employees pick plans that costs more than your contribution, they simply pays the difference.

The amount you choose is locked in for a full year – and you can change it at your group’s renewal.

3. Optional Benefits

CaliforniaChoice offers great medical benefits for your employees, and the opportunity to offer additional benefits like Dental, Vision, Chiropractic & Acupuncture, and Life and AD&D. Employees can tailor their coverage to their specific individual or family needs.

CaliforniaChoice gives you the ability to meet nearly all of your employees’ health needs without the hassle of dealing with multiple insurance agents.

4. Free Value-Added Extras

When you make CaliforniaChoice coverage available to your employees, you also get no-cost extras.

CaliforniaChoice offers Smart Decision Technology to streamline the enrollment process, provide more information about each available plan, and simplify the process of finding the right doctor.

You can choose online or paper enrollment, or a combination, depending on the method that best suits your employees. In addition, throughout the year, your agent or our Customer Service team will help you when you hire a new employee, add coverage for a dependent, or make other changes.

Talk to an Agent to Learn More

If you’re ready to find out how CaliforniaChoice can help you offer health insurance to your employees, contact your employee benefits agent. If you don’t have an agent, we can help you find one.

When you are shopping for health insurance for your employees, using a health insurance or employee benefits agent can help you save time and money. Best of all, working with an agent is free.

An agent can provide you with valuable assistance, including:

• Answering your health insurance and related questions
• Finding a plan that fits your budget and your employees needs
• Providing you with a personalized quote for coverage
• Enrolling your employees (and dependents, if you choose)
• Serving your needs throughout the year when you have changes (like terminating coverage for an employee, adding a new employee or dependent, address updates, billing resolution, etc.)
• Returning at renewal to help you re-enroll or shop for new coverage

Things to Consider

When you are talking with potential agents, you should consider:

• Experience: While you may already know your property and casualty agent (because he or she handles your auto insurance or liability coverage for your business), employee benefits is a specialty. When it comes to health and other insurance for your employees, your best bet is to choose an agent with experience in this field. Your agent’s expertise could save you money when you’re shopping for coverage.
• Niche: If yours is specialty business, like an accounting or architecture firm, you may want to look for an agent with similar clients, because he or she may have expertise that could benefit you and your employees in finding the right plan for your specific needs.
• Location: Finding a “local” agent who knows your area, the carriers serving the market, and the plans offering access to the health care providers you and your employees want can save you time as well as money.
• Carrier Roster: One size does not fit all. Your employees have differing needs. An employee benefits agent who represents multiple carrier options is like a shopping mall, because he or she can offer you and your staff a broader array of choices to address your diverse needs.
• Customer Focus: Another consideration – some would say the most important of all – is that your future agent be committed to customer service. Pay attention to your interactions – and ask yourself whether your potential agent seems to care about you, your business, and your employees. Don’t be afraid to walk away if you think there’s not a match in your expectations and his or her attention to detail and follow-through. Other agents may be a better fit for your needs.

The Right Choice Is Crucial

Your agent is your primary liaison to the health insurance company you and your employees choose for your coverage. He or she is there to help you – from start to finish – throughout the plan year. Selecting a good agent is crucial, and it could mean the difference between a positive and negative experience for you and your employees.

It could also mean the difference between paying an affordable premium and overpaying. An agent will work with you to find a balance between what your budget allows for employee benefits and a plan that addresses your employees’ health care needs. He or she will also help you stay in compliance, as your advisor on employee benefits and insurance matters. That means you can stay focused on what is really important: running your business.

We Make It Easy to Find an Agent

If you don’t already have an employee benefits agent, we can help you find one who will meet with you and discuss your employee benefits budget – and how you can find a plan that works for your business as well as your employees. If you have an agent, be sure to ask whether a multi-carrier exchange might be a good choice for your business. You may also want to read our post, What Defines an Employee Benefits Package?, to learn more about how you can tailor your employee benefits using an exchange.

One of the many valuable resources CaliforniaChoice offers small business owners is our suite of Smart Decision Technology tools.

Each of the four tools is designed to simplify the process of selecting a health plan for you and your employees.

1. Online Enrollment

Go paperless with online enrollment. It eliminates incomplete applications, reduces the number of pending items, and decreases your overall processing time. You can even track enrollments to see who still needs to complete an application.

A traditional paper-based enrollment is still available. If your group has employees in multiple locations, you can choose a combination of online and paper enrollment.

2. Automated Choice Profiler

This online assistant give your employees the ability to review premiums, deductibles, and other out-of-pocket costs (like copays and co-insurance) to get a total estimated cost of annual health insurance coverage. Employees can look at plans side-by-side based on costs, risk, and quality. The Automated Choice Profiler helps your employees find the right coverage to meet their ongoing, potential, or planned health care needs.

3. Online Provider Search

Take the guesswork out of finding the right doctor by offering employees an online search tool. It’s the easiest way to know whether a preferred doctor is part of any of the eight health plans offered through CaliforniaChoice.

Here’s how it works:

• Enter a city or ZIP Code
• Specify the doctor’s gender
• Select a health plan
• Review the results

You can narrow or widen a search by adding:

• Hospital affiliation
• Language(s) spoken
• Preferred doctor’s last name
• Distance from your targeted ZIP Code or city

4. Online Rx Search

Help your employees find the right health plan to match their prescription drug needs. Our online search tools allows you to look up medications based on these criteria:

• Alphabetical search
• Brand or generic drug name
• Therapeutic class: prescriptions for pain, infection, or treatment of the heart
• Various health conditions, such as acid reflux, cancer, or diabetes

Talk With Your Agent

If you’re interested in learning more about CaliforniaChoice and the valuable tools that help you and your employees find the right coverage, contact your employee benefits agent. If you do not already have an agent, we can help you find one.

If you’re an employer based in Northern California – or you have employees in the Bay Area, Sacramento, or other parts of the region – Sutter Health Plus is an employee benefits option you may want to consider. Sutter Health Plus expanded its service into a 15^th county in early 2018 and now offers members access to more than 30 hospitals and campuses. The Sutter Health Plus network also includes dozens of health care centers, urgent care centers, and other medical facilities as well as more than 7,000 health care professionals.

When you offer Sutter Health Plus through the CaliforniaChoice multi-carrier, employee-choice exchange, your employees also have access to five additional health plan options in Northern California. (There are a total of eight options across the state.) CaliforniaChoice makes it easy for everyone in your group to find a plan that fits his or her individual or family health care needs.

A Long Health Care History

While the Sutter Health Plus health plan was launched in 2014, the history of Sutter Health dates back more than a century. The organization started out as a loosely knit community of independent medical providers, but today it is a Sacramento-based health care leader committed to serving the needs of nearly 80,000 members.

Bay Area and Valley Providers

The Sutter Health Plus provider network includes Bay Area and Valley Area physician organizations as well as a broad hospital network that encompasses both Bay Area and Valley Area hospitals and other related services.

Bay Area Physician Organizations

• Affinity Medical Group
• Alta Bates Medical Group
• Brown & Toland Medical Group
• Mills-Peninsula Physician Network
• Palo Alto Medical Foundation
• Sutter East Bay Medical Foundation
• Sutter Pacific Medical Foundation

Valley Area Physician Organizations

• Sutter Gould Medical Foundation
• Sutter Independent Physicians
• Sutter Medical Group

Bay Area Hospitals

• Alta Bates Summit Medical Center (Berkeley and Oakland)
• California Pacific Medical Center (San Francisco)
• Children’s Hospital Oakland
• Eden Medical Center (Castro Valley)
• El Camino Hospital (Los Gatos and Mountain View)
• Lucile Packard Children’s Hospital (Palo Alto)
• Menlo Park Surgical Hospital
• Mills-Peninsula Medical Center (Burlingame)
• Novato Community Hospital*
• San Ramon Regional Medical Center
• Sequoia Hospital (Redwood City)
• Stanford Health Care – ValleyCare Medical Center (Pleasanton)
• Sutter Delta Medical Center (Antioch)
• Sutter Maternity & Surgery Center (Santa Cruz)
• Sutter Santa Rosa Regional Hospital
• Watsonville Community Hospital (Santa Cruz)

Valley Area Hospitals

• Dameron Hospital
• Memorial Medical Center, Modesto
• Joseph’s Medical Center
• Sutter Auburn Faith Hospital
• Sutter Davis Hospital
• Sutter Medical Center, Sacramento
• Sutter Roseville Medical Center
• Sutter Solano Medical Center
• Sutter Tracy Hospital

Other Services

• Sutter Walk-In Care
• Sutter Urgent Care
• Home Health and Hospice Services
• Sutter Center for Psychiatry

*Novato Community Hospital in Marin County serves southern Sonoma County

Plans to Fit You

Through CaliforniaChoice, you and your employees can choose from eight Sutter Health Plus plans; that includes two plans in each of the Affordable Care Act’s four Metal Tiers: Bronze, Silver, Gold, and Platinum. Plan options include traditional, deductible, and Health Savings Account-compatible, high deductible plans.

Talk to Your Agent

If you want to get a quote for Sutter Health Plus for your employees – or you’re interested in offering Sutter Health Plus alongside other options from CaliforniaChoice – call or email your employee benefits agent. If you do not already have an agent, we can help you find one who will meet with you and discuss available options. CaliforniaChoice is a great way to offer your employees the coverage they want, while still giving you control over your employee benefits budget.

As an employer, you probably want to offer health insurance benefits to your employees. However, you may be concerned about how much it might cost. After all, you have just so much money in your budget that you can allocate to employee benefits. So, what is the answer? Defined Contribution.

What Is Defined Contribution?

With Defined Contribution, you have the ability to determine (or define) the amount of money you want to pay toward each of your employees’ health insurance benefits. (The amount you choose has to be the same for all of your employees.)

With the CaliforniaChoice small business, multi-carrier private exchange, you can choose a fixed dollar amount or a fixed percentage of the cost for a specific health plan – for example, 50% of the lowest-cost plan available in your area. Then your employees can use the generous contribution you make toward their coverage to pay for their preferred health plan.

When you offer CaliforniaChoice, your employees have access to dozens of plans from seven different health insurers, including popular regional providers like Sutter Health Plus and Western Health Advantage in Northern and Central California and Sharp Health Plan in San Diego. Statewide, employees can choose coverage from Anthem Blue Cross, Kaiser Permanente, Health Net, and UnitedHealthcare.

If your employees choose a plan with a premium that exceeds your Defined Contribution, the employee pays the difference. It’s that simple.
The amount you select is locked-in for one year – and you have the flexibility at renewal to adjust your premium contribution, up or down. The choice is yours.

Why Offer Employee Benefits?

One of the most important reasons to consider employee benefits is they can help your employees. They can also help you stand out as an employer in an increasingly competitive talent marketplace. They are highly desired by employees, so they can aid you in attracting new employees and keeping your current employees happy, too. According to the Society for Human Resource Management (SHRM), the vast majority of employees rank health care benefits as the most important.

Getting Started Is Easy

If you want to learn more about Defined Contribution – and how it can help you expand your employee benefits, while still controlling your cost – ask your broker. If you don’t have a current broker, we’ll help you find one who represents CaliforniaChoice, and who can meet with you to discuss a custom quote for your employees.

Related: 7 Reasons to Use a Broker and a Private Exchange