Covered California for Small Business is one of the state Marketplaces established as part of the federal Affordable Care Act signed into law in 2010. CaliforniaChoice is a private, multi-carrier exchange established in 1996 to help small businesses shop for health insurance for their employees. CaliforniaChoice allows employers to offer multiple health plans from different insurance companies through a single platform.

Rates offered by insurers participating in Covered California and CaliforniaChoice are similar. However, a significant advantage offered by CaliforniaChoice is the broader range of plans and value-added benefits for which there is no additional premium. Covered California offers coverage from three health plans: Blue Shield of California, Kaiser Permanente, and Sharp Health Plan. CaliforniaChoice offers twice as many health plans – and 100+ coverage choices across all four Affordable Care Act metal tiers (Platinum, Gold, Silver, and Bronze). CaliforniaChoice health plans include Anthem Blue Cross, Health Net, Kaiser Permanente, Sharp Health Plan, Sutter Health Plan, UnitedHealthcare, and Western Health Advantage. Plan availability varies based on the metal tier(s) chosen by the employer and where employees live. Premiums for both Covered California and CaliforniaChoice are based on the employer’s location, each applicant’s age, each employee’s selected coverage, and family size. Health history and pre-existing conditions do not influence the rates for coverage.

Absolutely. CaliforniaChoice includes a variety of optional benefits as part of our program. You can give employees access to multiple Dental options, including a MetLife Dental Health Maintenance Organization (DHMO) plan, SmileSaver DHMO plan, and Ameritas Dental PPO.

Voluntary Vision plans are offered by EyeMed and VSP.

During the plan year, employees may be able to make changes to their coverage if they experience a “qualifying life event.” These include marriage, divorce, birth or adoption of a child, loss of other coverage, a move outside their health plan’s service area, etc. Ask your broker for details.

GLP-1 medications may be available when medically necessary. Different health plans have different criteria for what is and is not covered by their prescription drug formularies.

Your broker can develop different Defined Contribution scenarios for your employee benefits program. If you want to pay 50% to 100% of premiums for employees, that’s your choice. Defined Contribution puts you in charge.

With CaliforniaChoice, whether you have one employee or 100, you will get a single, consolidated, and itemized monthly bill. It does not matter how many plans are selected by employees. Your bill will list all employees’ plans, your contribution, and each employee’s contribution. You can pay your monthly bill online or set-up auto-pay. You can also easily manage employee benefits online at calchoice.com.

You can add or terminate coverage for an employee at any time. For new hires, benefit eligibility is based on the completion of your company’s waiting period. If an employee is a rehire, the waiting period may not apply; ask your broker for details. Complete a New Hire Enrollment Quote Request or an Employee Medical / Dental / Life / Vision Enrollment Application and submit it via email or fax to CaliforniaChoice. Effective dates are always on the first of the month.

To terminate coverage, submit an Employee Termination Notification Form, Census Enrollment Change Request Form, or a Change Request Form (if it’s a voluntary termination by the employee). Termination effective dates are always at the end of a month.

Cal-COBRA or COBRA may be available to employees who want to retain coverage after leaving their employment. Refer to the Employer Administrative Guide for additional information.

Under current CaliforniaChoice underwriting guidelines, 1099 independent contractors are ineligible to participate in the small business private health exchange. Participants must be permanent, W-2 employees working a minimum of 30 hours per week. Seasonal staff, per diem employees, 1099 workers, and commissioned workers cannot enroll.

Absolutely. There are Medical and Ancillary plans participating in CaliforniaChoice that offer coverage in California and out of state. Ask your broker about what plans may be available to your enrolling employees.

During the plan year, employees may be able to make changes to their coverage if they experience a “qualifying life event.” These include marriage, divorce, birth or adoption of a child, loss of other coverage, a move outside their health plan’s service area, etc. Ask your broker for details.

As long as you have at least one employee who resides in California, you can maintain your CaliforniaChoice coverage. Your group participation level could change, though. For groups of 3-100, 70% of eligible employees must enroll in CaliforniaChoice. For groups of 1-2 employees, 100% of employees must enroll. Group participation is reviewed annually at your group’s anniversary.

The CaliforniaChoice provider directory offers a robust search engine to find providers that are part of each participating health plan. You can search by city/ZIP Code, physician gender, name, health plan/carrier affiliation, specialty, spoken language, Affordable Care Act (ACA) metal tier, plan type (HMO, PPO), medical group/IPA, and hospital.

All family members must enroll in the same health plan. Your range of plans is based on where you live. CaliforniaChoice includes 100+ coverage options from seven health plans: four statewide and three regionally.

Members receive a welcome letter from CaliforniaChoice and a health plan ID Card for their selected coverage from the insurer.

CaliforniaChoice is highly rated for its flexibility and health plan options. However, it is not a traditional health insurance provider. It is a third-party administrator operating a private, multi-carrier, employee-choice exchange. Members can choose from 100+ coverage options offered by Anthem Blue Cross, Health Net, Kaiser Permanente, Sharp Health Plan, Sutter Health Plan, UnitedHealthcare, and Western Health Advantage.

If you visit your doctor’s office and do not have an ID Card for your selected plan, your doctor’s office can contact CaliforniaChoice Customer Service for assistance: 800.558.8003.

You may be able to continue your coverage under Federal COBRA or Cal-COBRA guidelines. Ask your employer for details.

Your first step should be to identify why the claim may have been denied. Review your Explanation of Benefits (EOB) to understand the basis for the rejection. If the EOB is not readily available, a copy may be available through the insurance company customer service team.

Was there a possible coding error, missing information, or a determination that the care was not “medically necessary”? Call the phone number on your health plan ID Card and ask about what is needed to appeal and overturn the denial.

If you are enrolled in an HSA-eligible High-Deductible Health Plan (HDHP), you can easily open an online account through a financial institution of your choice or through your employer. Contact your employer’s Human Resources staff for details. You can also find several HSA banking partners in the HSA Resource Center.

If you are enrolled in a Preferred Provider Organization (PPO), you likely have access to providers throughout California and across the country. Look for providers using the online search engine or link to out-of-state providers through the BlueCross BlueShield national doctor and hospital finder.

CaliforniaChoice offers members access to the benefits of ChooseHealthy as part of the Member Value Suite. With ChooseHealthy, you can take advantage of a variety of discounts. These include savings on popular health and fitness brands like Fitbit®, Garmin®, Vitamix®, and more. The Active&Fit Direct^TM program offers savings on gym memberships for $28 per month. And you can save on dental care, vision care, prescription drugs, and hearing services, too. Login at calchoice.com for details.

All CaliforniaChoice members have access to a range of services and discounts through the Member Value Suite. These include discounts on entertainment, vision care, pet insurance, wellness, hearing services, and a free California Rx Card, which offers prescription drug savings. Members can get detailed information by creating an online account at calchoice.com. Once online, select Member Value Suite from the “Resources” drop-down.