Choice Stories

June 16, 2022

Group Health Insurance 101: An Introduction for Employers

Today’s workforce is vastly different from environments of the past. It's more diverse than ever before, which means broader perspectives, increasingly varied opinions, and more inclusion of previously underrepresented groups.

Bringing a diverse group of people together has a wealth of benefits, but it can pose challenges for business owners trying to meet a variety of employee needs, especially when it comes to health care.

The Expectations of Today's Employee

The challenge for employers is offering an employee benefits program that can address the needs of a varied group. The 20th Annual MetLife Employee Benefits Trends Study released this year finds workers today expect their employers to recognize the importance of their lives – on the job and away from work.

As MetLife notes, “Forward-thinking HR leaders are looking at benefits and beyond to adopt a more holistic view of employee needs.” That’s because it is what’s needed to serve today’s broad employee population.

Changing “Must-Haves”

The pandemic of the past two years has prompted employees to rethink their priorities, and reconsider their “must have” benefits when it comes to making a job change. Here’s a comparison of views pre-pandemic (in 2020) and today (in 2022).

The priorities of employees when it comes to benefits stayed the same from 2021 to 2022, but are a bit different from 2019. The top insurance-related “must have” or “nice to have” benefits during this period are as follows, according to MetLife’s studies in the three-year period:

2019

  • Health Insurance
  • Prescription Drug
  • Dental Insurance
  • Vision Insurance or Discount Program
  • Life Insurance
  • Disability Insurance
  • Accident Insurance
  • AD&D Insurance
  • Critical Illness

2021 and 2022

  • Health Insurance
  • Dental Insurance
  • Vision Insurance or Discount Program
  • Life Insurance
  • Disability Insurance
  • Critical Illness
  • Accident Insurance
  • Hospital Indemnity
  • Cancer Insurance

An enduring trend – year after year -- is that Health Insurance is among the most desired employee benefits. And, thanks to the Affordable Care Act (ACA), Health Insurance coverage offered through ACA-compliant plans offers a comprehensive range of care.

What Is Group Health Insurance?

Group Health Insurance most often refers to an employer-sponsored, Affordable Care Act (ACA) compliant health insurance plan that provides benefits for employees' and dependents' care. To qualify as ACA compliant, plans have to include 10 Essential Health Benefits (EHBs), including:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (like surgery and overnight stays)
  • Pregnancy, maternity, and newborn care (both before and after birth)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

Plans must also include birth control coverage and breastfeeding coverage.

More information is available at the healthinsurance.org website, and at the HealthCare.gov website.

Frequently Asked Questions

Often employers have questions about Group Health Insurance, and we’ve answered some of the most frequently asked questions below.

  • How can I be sure I am getting the best deal on health insurance for my business and my employees?
    • One of the best ways to ensure you’re getting the most for your employee benefits dollars is to engage an employee benefits broker to help you shop and compare the marketplace. Your broker will be able to provide you with quotes for multiple plan types from different insurers and/or available exchange programs.
  • How can I be sure the plan or plans I am considering include the doctors and hospitals my employees and I want?
    • If CaliforniaChoice is among the options you’re considering, there’s a valuable Plan Comparison Tool online. You can easily compare plans based on monthly premium, health plan, metal tier, plan type, or preferred doctors. 
  • Once coverage begins, is it easy for employees to make changes? If, for example, they move, get married or divorced, adopt a child, or have a baby.
    • Absolutely. Many “life event” changes can be made at calchoice.com or by submitting paperwork through the website.
  • If an employee has a pre-existing health condition, is he/she/they still able to apply for and get Health Insurance coverage?
    • Under the ACA, health insurers can no longer refuse coverage or charge an applicant more because of a pre-existing health condition. If you’re buying an ACA-compliant Group Health plan for your small business, all of your employees should be able to get coverage.
  • If I have a new hire or an employee termination, is it easy for me to make changes?
    • It’s very easy to make changes online whenever your staff changes. Just login at calchoice.com, select Manage My Account and request a new hire quote or employee coverage termination. You can also get help through Customer Service.
  • If an employee is enrolled in an HMO, can he/she/they change doctors?
    • If you or your employees are enrolled in an HMO (or an EPO [Exclusive Provider Organization]) plan, you are usually required to select a Primary Care Physician (PCP) to help guide your care. Most plans allow you to change your PCP whenever you wish, although there may be frequency limits. For example, you may be able to change only one per month.
  • If I am enrolled in an HMO, can I switch to a PPO?
    • Unless you move out of your health plan’s coverage area, or you experience a qualifying life event, you are usually locked-in to your health plan until your next enrollment period. At that time, you can change plans or move from an HMO to another plan type.

Coverage and Eligibility

The employer mandate in the ACA requires Applicable Large Employers (ALEs) to offer Minimum Essential Coverage (MEC) to full-time employees and eligible dependents. An ALE is a business with at least 50 full-time employees, including full-time equivalent employees, on average during the prior calendar year.

If your business is an ALE, and you fail to offer your eligible employees “affordable” coverage that provides minimum value to 95% of your full-time employees and their children (up to the end of eligibility when they turn age 26), you are subject to ACA penalties.

If you are not subject to the employer mandate, you can choose to cover full-time employees only, full-time employees and eligible dependents, or full-time and part-time employees (with or without dependents). Depending on your selected carrier and plan, there may be eligibility guidelines for participants. Ask your broker for details.

Selecting Your Contribution Amount

If you select coverage from the CaliforniaChoice multi-carrier, private exchange, you decide what you want to contribute to your employees’ health insurance costs. It’s called Defined Contribution. You can select a Fixed Percentage (50% to 100%) of a specific plan and/or benefit. Or, you can choose a Fixed Dollar Amount for each employee. (The amount has to be the same for all employees.)

Your employees then apply your generous contribution to whichever health plan and benefits they prefer. If an employee selects a plan that costs more than your contribution, he or she simply pays the difference.

When you renew your CaliforniaChoice coverage, you have the option to adjust your contribution – up or down – giving you complete control over what you spend on employee benefits.

Finding the Right Coverage

If you’re shopping for Group Health Insurance for your employees, what can you do to offer more to your employees? How can you give them the ability to personalize their benefits? Depending on the options available from your broker, you might be able to package together a program involving multiple insurers and benefits administrators. Or, you might consider the multi-carrier CaliforniaChoice exchange.

Your employees can choose from eight different health plans: Anthem Blue Cross, Cigna + Oscar, Kaiser Permanente, Health Net, Sharp Health Plan, Sutter Health Plus, UnitedHealthcare, and Western Health Advantage.

There are plans available at different price points, too. Health Maintenance Organization (HMO) plans are generally the least expensive, followed by Exclusive Provider Organization (EPO) plans and Preferred Provider Organization (PPO) plans. There are multiple Health Savings Account (HSA) qualified plans among the offerings.

CaliforniaChoice also offers added benefits like Dental, Vision, Chiropractic (with or without Acupuncture), and Life Insurance. Plus, you and your employees have access to fitness and wellness products and services, discounts through the Cal Perks program, and more.

Greater Access to Doctors

One of the reasons so many small businesses in California prefer CaliforniaChoice is that it offers a choice of full and limited provider networks. That gives you and your employees access to more doctors, specialists, and hospitals than any single health plan in California.

You can offer plans in a single Affordable Care Act (ACA) metal tier, multiple tiers, or all four ACA tiers (Bronze, Silver, Gold, or Platinum). Each tier offers a different percentage of shared health costs for employees. They range from 10% to 40% (with the health plan paying the other 90% to 60%). This can significantly increase the number of plans, doctors, and specialists available to your employees.

Talk With a Broker

To get more information – or a custom quote for your group – talk with an employee benefits broker. Your broker can share details about the plans in your area, as well as options to help you address the diverse needs of your employees. If you don’t already have an employee benefits broker, you can search for one here.

Your Beginner's Guide to Choosing a Small Business Employee Benefits Program

Do you need help choosing the right health benefits for your employees?
This guide can help!