We put together this Group Health Insurance FAQ as a helpful guide for companies looking to start offering group health insurance plans to their employees.
Here’s just a preview of what you’ll find inside:
- Common questions from businesses like yours about group health insurance and the CaliforniaChoice program
- Answers to questions about managing the cost of offering health insurance coverage
- Information on group health insurance eligibility and requirements
- Insights on the benefits of offering group health coverage
- Tips for allowing your employees to pick a health plan that works best for their needs
Download your copy today!
CaliforniaChoice Takes Your Digital Security Seriously
Cyberattacks and information security breaches are on the rise in today’s high tech and data-driven environment. The list of examples goes on at length.
In July 2017, it was discovered that an Equifax data breach exposed the names, birth dates, Social Security Numbers, and credit card information for 147.9 million consumers. In September 2018, Marriot International had data stolen on approximately 500 million customers. More worrying, the Marriot breaches started in 2014 and were not discovered for four years.
Security magazine reports 2.8 billion consumer data records were exposed in 2018, costing U.S. organizations more than $654 billion. Health care was the hardest hit sector – with 48% of all breaches. Among the most high profile health care breaches are the 2015 Anthem, Inc. hack that affected nearly 80 million people and a breach at Premera, which impacted Blue Cross and Blue Shield members in 30 states.
Data protection is serious business. Companies who want to earn and maintain the trust of customers must be willing to invest in security products to protect consumer data. CaliforniaChoice is committed to preventing breaches in security as is reflected in the recent certification from HITRUST, the most prestigious certifiable security framework for the health care industry.
The HITRUST CSF Certification is the benchmark that organizations required to safeguard Personal Health Information (PHI) are measured against regarding information protection. By taking the steps necessary to obtain HITRUST CSF Certified status, CHOICE Administrators has distinguished itself as an organization that people can count on to keep their information safe. This achievement places the companyin an elite group of organizations worldwide that have earned this certification.
You and your employees can take comfort in knowing your personal information is secure with CaliforniaChoice and CHOICE Administrators.
There has been a lot of talk about a push by some of the presidential candidates to move toward a “Medicare for All” health care plan. Many of the Democratic candidates back a version of the proposal put forth by U.S. Sen. Bernie Sanders (I-Vt.). Other are supporting less-sweeping alternatives. Let’s look at how Sen. Sanders’ proposal and others might affect employer-sponsored health insurance and health care in the United States.
As proposed, Sen. Sanders’ plan would create a government-run system to provide health insurance for all Americans. His latest proposal goes beyond a prior bill he introduced to establish a single-payer system and would cover essential health treatments with no premiums or deductibles. It would also include long-term care for people with disabilities and coverage for dental and vision. Sanders has 14 co-sponsors for his bill, including fellow senators and Democratic presidential candidates Cory Booker (MA), Kamala Harris (CA), Kirsten Gillibrand (NY), and Elizabeth Warren (MA), although Sen. Harris has recently announced her own plan as well.
Sen. Sanders’ proposal would eliminate existing public health programs – and private health insurance in the U.S. after a four-year transition period. Insurers could offer supplemental plans to cover items not included under Medicare coverage, such as cosmetic surgery. Some current programs operated under federal authority, like the Veterans Health Administration and Indian Health Services, would be maintained.
While Senator Warren and New York City Mayor Bill de Blasio have voiced full support for a single-payer system, many of the other Democratic candidates have proposed alternative plans for health care. Sen. Amy Klobuchar (D-Minn.) says she favors a “public option” that builds on the Affordable Care Act (ACA), the health measure signed into law in 2010 during President Barack Obama’s first term. Former Vice President Joe Biden also supports broadening the ACA, in contrast to moving toward a Medicare for all system. South Bend Mayor Pete Buttigieg supports a hybrid proposal, “Medicare for All who want it.”
Although not a candidate for president, Rep. Pramila Jayapal (D-Wash.) is advocating a more modest Medicare for All proposal. Her House of Representatives bill, with 112 Democratic co-sponsors, expands access to Medicare and Medicaid without actually ending private health insurance in the way the Sanders bill does.
The Potential Costs
A 2018 study by RAND Corporation, an American nonprofit global policy think tank, estimated Medicare for All would dramatically increase federal spending on health care – bumping it up from $1.09 trillion annually to $3.5 trillion under a single-payer plan. Insurance and health care industry groups have joined forces to form an umbrella group, the Partnership for America’s Health Care Future, to oppose Medicare for All. The group says that since private insurers typically pay more than Medicare does, a move to reduced provider payments under a single-payer system could negatively affect care and reduce the number of available doctors and specialists.
Loss of Employer Coverage
Employer-sponsored health insurance could go away if Medicare for All or another proposal is adopted in the future. Of course, it all depends on who wins the races for the White House, Senate, and U.S. House of Representatives. Since some candidates favor a mix of public and private insurance, it is a waiting game at this point.
Private insurance potentially could shift to supplemental-only coverage, something that works in several countries with universal health coverage. For example, in the United Kingdom, the number of people buying private medical insurance has risen significantly in the past decade. Canadians can also buy private insurance to pay costs not covered by the country’s public health plan.
Even if a Medicare for All proposal did pass the Congress and was signed into law by a newly elected president, a transition period would likely need to be negotiated, since about 155 million people in America receive their health coverage through their employer. Right now, the majority of those with coverage through their jobs say they are satisfied with their plans. They could be unhappy if they’re required to give it up to move to a government-sponsored health program.
Health care is an important issue – for employers and employees. We will continue to follow what’s happening in the health insurance industry and on the political front, and will share updates. You can also talk with your employee benefits agent about proposals to change the way Americans get their health care. If you don’t already have a health insurance agent, you can search for one here.
Unless you’re an insurance industry veteran or a health insurance agent, you might be wondering, What exactly is a defined contribution employee benefit plan?! More than just a mouthful to say, a defined contribution employee benefit plan allows companies to offer employees a full spectrum of insurance coverage that includes health , dental, vision, life, chiropractic and in some cases even more benefit options.
The defined contribution aspect of the plan gives business owners and managers the ability to choose how much they contribute toward the costs of their employees’ coverage. Groups typically like defined contribution because they can choose a fixed dollar amount or a fixed percentage (like 50%) of the cost for the lowest-priced plan. Plus, the amount they contribute is tax deductible for their business.
In order to help groups select the right defined contribution plan we created a guide ( available for download below) that includes some helpful tips to consider when searching for an employee benefit plan. The guide highlights some key factors to consider when plan shopping, including:
- How to determine your contribution budget
- Tips for health plan shopping
- Choosing your coverage start date
- Deciding who gets coverage (Employees only or Employees + dependents )
- Which coverage types you should include
- Tips on finding and working with a health insurance agent
- And much more!
Download your copy today!
If you find small business employee benefits and health insurance difficult to understand, you’re not alone. Choosing the right employee benefits program for your small business can have a huge impact on your bottom line. We can help!
We’re hosting a Small Business Employee Benefits Seminar on Thursday, August 1st, at 11:00 a.m., at Andrei’s Restaurant in Irvine.
You’ll get answers to frequently asked small business employee benefits questions:
- Are you required to offer employee health insurance?
- What’s ahead in California? Are requirements changing for small businesses?
- What will employee health insurance cost your business?
- Should you choose employee-only coverage – or coverage for employees and dependents?
- What are your options? One carrier? Multiple carriers?
- What about Dental, Vision, and other coverage?
CaliforniaChoice Small Business Employee Benefits Seminar + Lunch
2607 Main Street | Irvine, CA 92614
Thursday, August 1
11:00 a.m. to 1:00 p.m.
At CaliforniaChoice, we’re committed to helping you and your employees make educated decisions about your health benefits. We’ve created several tools to help you gain a better understanding of health insurance and get acquainted with the CaliforniaChoice program.
This flyer describes the key components of the CaliforniaChoice multi-carrier, private health insurance exchange for small business. It features a quick overview of “Why CaliforniaChoice?,” calling out special benefits such as:
- Eight health plans in one program
- Cost control
- Optional benefits
- Single source administration
- Smart Decision Technology tools
- Value-adds through the Business Solutions Suite and the Member Value Suite
- Payroll solutions
We’ve created a variety of short videos to help you better understand the benefits of CaliforniaChoice. Each video addresses different components of our program, including:
An Introduction to CaliforniaChoice
With access to eight of California’s leading health insurance carriers and plans – plus optional benefits like Dental, Vision, and Chiro – CaliforniaChoice combines everything you need into one program. It also gives employers like you more time to spend on your business and less time worrying about employee benefits.
Multiple Options, One Program
Get an overview of how CaliforniaChoice offers employees HMO, PPO, EPO, HSA, and other options to find the coverage that works best for their individual or family needs.
Defined Contribution makes it easy to control your costs because you choose what amount you want to contribute to employee benefits.
Health Insurance Plans
Employees choose the CaliforniaChoice coverage that best meets their needs and budget. One employee might choose a PPO, while another selects an HMO, EPO, Health Care Service Plan (HSP), or Health Savings Account (HSA) qualified coverage. It’s their choice.
Ease of Administration
Similar to the way you may bundle your phone, cable, and Internet at work or home, CaliforniaChoice bundles dozens of HMO, PPO, EPO, HSP, and HSA options for your employees. We then send you one consolidated bill for all employees’ coverage at the end of the month.
Additional Plans and Perks
CaliforniaChoice offers more than Medical benefits. Our program includes Dental, Vision, Chiropractic, and Life Insurance plus valuable savings on other products and services through our Member Value Suite and Business Solutions Suite.
When you work with a broker, you get an industry expert dedicated to helping you make the right health insurance decisions for your business. Even better, there is no cost to you.
This informative guide provides additional details on CaliforniaChoice, including information on:
- Access to care through eight leading health plans
- Controlling business costs through Defined Contribution
- Optional benefits: Dental, Vision, Chiropractic and Acupuncture, and Life and AD&D
- Streamlined enrollment and renewal
- Smart Decision Technology: Online Provider Search, Online Rx Search, Online Enrollment, and our Automated Choice Profiler with side-by-side plan comparisons and cost estimators
- No-cost extras available through our Member Value Suite and Business Solutions Suite
Learn More About CaliforniaChoice
To learn more about the CaliforniaChoice program and the benefits available to you and your employees, contact your broker.
No matter the size of your business, you should consider making team-building part of your company culture. The time spent away from the office is shown to improve communication, boost morale, and promote creativity and collaboration.
- Better communication: Team building requires employees to communicate successfully and work together to achieve a common goal.
- Improved employee morale: When employees’ feel their thoughts and ideas are being considered, it helps build a better connection across all levels of the organization and increases morale. It also breaks down barriers between leadership and employees.
- Promotes creativity and collaborative problem solving: If your employees can work together and think outside the box when dealing with a challenge, they will build connections that can benefit your organization in the future.
- Fun for all (with the right activity): Team building can be fun, as long as the selected activity does not put any employees at a disadvantage or makes them feel embarrassed in any way. Read this Forbes article to make sure you understand the potential downsides of team building.
Here are five easy and inexpensive team-building ideas for your business.
1. Scavenger Hunt
This is a great option for multiple small groups. Depending on your work environment, you can have the hunt onsite or at a nearby location like a shopping center. Tasks can include taking a selfie with a stranger (possibly dressed in specific attire – like a hat) or photographing an object in the office or neighborhood. Make a list, set a deadline for task completion, and whatever team completes the most items on the list first wins.
2. Possibilities Game
The idea behind this game is for team members to talk and come up with potential new uses for common office items like a stapler or letter opener. Then, a member of the team must present the new use to the larger group without speaking, while others guess what’s being presented.
3. Truth or Lie?
Each person secretly writes down two truths and one lie about himself/herself. The objective is for the lie to be believable rather than over the top. Then you go around the group and share your tales, trying to determine which is real and which is not for each employee. It’s the perfect opportunity for your team members to learn more about one another.
Another variation on this game is “Who Is It?, where employees write down a fact about themselves, put it in a box and then draw out the facts and attempt to figure out to whom it applies in the group. The team with the most accurate guesses wins. You can also deduct points for wrong guesses.
4. Best Moments
Ask your team members to think about the best moments from their lives. This can be something achieved on their own (like running a marathon), an event or accomplishment they’ve shared with others (like a personal or professional achievement or event), or an exciting life adventure (like hang-gliding, getting married or taking part in a friend’s or relative’s wedding in an exotic locale, whatever).
After a couple of minutes, ask everyone to consider what 30 seconds in life they would want to relive if given the opportunity. This allows individuals to look back on their lives and share some moments with co-workers who may not know them well. Your facilitator can ask everyone why they chose that particular event and moment.
5. Escape Room
You can take your team off-site to a venue designed just for this purpose, or you can hire a firm to come in and create an escape room, murder mystery, or other themed event at your worksite. The concept presents your team members with puzzles they must solve in order to “find the key” or otherwise escape the venue. If they reach the time limit for the game, they are set free whether they have found the key or not. Escape rooms are popular for team building because they require workers to collaborate to find the exit or solve the mystery.
These are just a few ideas to help get you started. Whatever activities you choose, team building can help you foster a highly motivated, positive corporate environment that pays off big in the end.
The National Research Business Institute says that more than three-quarters of large employers (79%) have an employee wellness program of some type. Across the broader workplace, the percentage of employers offering a wellness program is close to half, according to the 2018 Aflac WorkForces Report, as reported by Small Business Trends in January 2019.
So, what steps should you consider if you want to implement a wellness program for your organization? Here are our five suggestions.
- Ask Your Employees
Employee feedback is critical to establishing a successful wellness program. Survey your employees to get their perspective. You’ll discover what they consider most valuable. As a starting point, wellness programs could include onsite classes, discounted gym memberships, and discounts on fitness gear such as Fitbits®.
- Start Slow
While you may have big ideas about what you want your program to do, it is best to start small. You want a program that is inviting for all employees and easy to understand. Make sure you consider everyone in your workforce when developing your program. That may include specific features designed to appeal to different segments of your employee population: women, men, younger and older workers, etc.
- Education is Important
Providing useful wellness information to your employees can help them take charge of their health. Talk with your health insurance agent to find out what information might be available from your health plan(s) that you can post onsite or include in regular staff communications. Consider a lunch-and-learn or health fair to share information or introduce employees to stress reduction techniques, health screening resources, fitness classes, or other opportunities available in your area.
- Healthier Food Choices
If you have onsite restaurants, cafés, or food trucks, talk with the operators about adding a “healthy choice” to their daily menus. If you have vending machines managed by an outside firm, talk with the vendor about replacing some of the sugary drinks and empty-calorie foods with healthier options.
- Consider Walk-and-Talk Meetings or a Rewards Program
There are several out-of-the-box ideas you can implement in your workplace. “Standing desks” are increasingly popular. Having walking meetings can work for some managers and employees. You might also consider a rewards program or a prize drawing for employees who take part in charity walks or weight-loss clinics.
Health Plan Wellness Options
Supporting healthier employees can reduce workplace illness and absences, boost morale, and increase productivity. Many health plans offer wellness activities, education, and resources to help employees get and stay healthy. Talk to your employee benefits agent to find out what’s available to you. If you are not currently working with an agent, you can search for one here.
The Affordable Care Act (ACA) took effect in March 2010. Still, many employers – particularly small businesses – remain unclear of its requirements. We’re untangling critical details about ACA coverage and the associated penalties.
If you employ 50 or more full-time or full-time equivalent (FTE) employees, you are an Applicable Large Employer (ALE) under the ACA and, therefore, subject to the ACA employer mandate. Under the mandate and the ACA employer share-responsibility provision, ALEs must offer minimum essential coverage that is “affordable” and provides “minimum value” to full-time employees and dependents.
All ACA-compliant plans for individuals and small groups must include these Essential Health Benefits:
- Ambulatory patient services
- Emergency services
- Pregnancy, maternity, and newborn care (before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services (including chronic disease management)
- Pediatric services, including oral and vision care for children (adult dental and vision services are not essential health benefits)
The ACA divides health plans into four metal tiers: Bronze, Silver, Gold, and Platinum. Each tier offers a different level of support for covered services, with Bronze plans covering about 60% of health care costs. Silver plans cover 70%, Gold plans cover 80%, and Platinum plans cover 90% of costs for covered services.
Penalties for Non-Compliance
If you’re an ALE and do not offer health coverage, when an employee receives a federal subsidy to help pay for coverage through the Covered California exchange, that triggers a non-compliance penalty. The penalty is assessed monthly and is equal to the number of FTE employees (minus the first 30), multiplied by one-twelfth of $2,500 (the 2019 penalty amount). There is no penalty for not offering health insurance to part-time employees.
A greater penalty of $3,750 applies if you offer employee coverage that is not affordable or does not provide minimum value. Affordable means the cost does not exceed 9.86% of an employee’s household income for the lowest-cost, self-only coverage option. A health plan meets the ACA minimum value test if it includes substantial coverage of physician and inpatient hospital services and pays at least 60% of the total cost of medical services covered by a plan.
If you have seasonal or part-time workers and you are unsure if your business is an ALE, visit the IRS website to help determine your status.
Employer Cost Control
Cost is a huge consideration for employers when it comes to providing health benefits for employees, whether you’re required to provide coverage or not. However, the ACA does not require ALEs or non-ALEs to pay 100% of the costs of employee coverage. Businesses can share the costs with workers.
If you are not an ALE, what you contribute to employee coverage is entirely up to you. However, most employers who offer coverage, regardless of their workforce size, do pay at least half the cost. The Kaiser Family Foundation says in its 2018 Health Benefits Survey report that on average, covered workers make an 18-30% contribution to the cost of health insurance, depending on their plan type.
If you choose employee benefits through CaliforniaChoice, with Defined Contribution, you contribute a Fixed Percentage (50% to 100%) of a specific plan type, OR you can choose to contribute a Fixed Dollar Amount. If employees select a plan that costs more than your contribution, they simply pay the difference. At renewal, you can adjust your company’s Defined Contribution – up or down – to help you manage your costs for another year.
There are several non-Major Medical plans that are not regulated by the ACA, and therefore, non-compliant. Among them are short-term health insurance plans (already limited in California), accident-only plans, limited-benefit policies (such as Long Term Care plans and indemnity coverage), and plans offering medical discounts that are not actually insurance programs. None of these meet the ACA employer shared responsibility requirements.
How to Learn More
The best way to learn more about required ACA benefits and the potential costs for your business is to talk with a licensed health insurance agent. If you are not working with an agent, click here to find one in your area.
CaliforniaChoice has always placed the highest priority on giving its members more choices when it comes to something as important as health care.
Now, as part of our continuing commitment to deliver more, we’re excited to introduce the Member Value Suite. It gives your employees and their loved ones access to outstanding savings on a range of products, services, and activities. Plus, it’s available to your employees at no added cost to you or your business.
Here’s a snapshot of all of the available discounts through the Member Value Suite:
Your employees’ free Cal Perks® program membership offers savings on movies, theme parks, water parks, sporting events, travel, tax prep, retailers, and more.
The ChooseHealthyTM program offers discounts of up to 57% on Garmin®, Vitamix®, and Fitbit® products, fitness memberships for $25/month, and 25% savings on specialty health care practitioners in acupuncture, chiropractic, and therapeutic massage.
Employees enjoy reduced fees on hundreds of procedures at participating Dentegra® dentists across California and nationwide. Dentegra offers instant savings to your employees with no Dental claim forms or waiting periods.
The EyeMed® Vision One Eyecare program offers discounts on frames, lenses, and exams at participating JCPenney, LensCrafters, Pearl Vision, Sears, and Target locations in California and nationwide.
Your employees can save up to 50% on brand-name hearing aids, and take advantage of additional discounts on testing, batteries, and other devices through the EPIC® Hearing Service Plan.
The California Rx Card saves your employees up to 75% on brand name and generic prescription drugs – often reducing their cost to less than their Rx co-pay with insurance.
Talk with an Agent to Learn More
If you are interested in finding out more about the CaliforniaChoice Member Value Suite – and all of the benefits offered to your business and your employees through CaliforniaChoice – talk with your employee benefits agent.