Choice Stories

March 24, 2022

How to Understand Your Group Health Insurance Quote

The world of group health insurance can be difficult to navigate for small business owners – beginning with the quote itself. Whether you're looking for coverage for the first time or considering changing your plan, here are some insights that will help you understand your CaliforniaChoice health insurance quote.

Here’s a snapshot of the sections you’ll find in your quote for health insurance:

1. Introduction

The first section provides an overview of how the CaliforniaChoice program works:

  • Choice: You set your own budget, have a diverse selection of coverage options, and have no minimum participation across the eight plans offered through CaliforniaChoice.
  • Access: We offer the most doctors and hospitals in a single program. You can also choose from multiple provider networks. With so much choice, you and your employees may be able to keep your current doctor, medical group, specialist, hospital, and prescriptions.
  • Solution: As your needs change, you can stay in the CaliforniaChoice program and only change your selected health plan. It’s that simple.
  • Optional Benefits: You can add Dental, Vision, Chiropractic & Acupuncture, Life Insurance and Accidental Death & Dismemberment for your employees, too.
  • Online Enrollment: CaliforniaChoice online enrollment helps you by speeding up your group’s enrollment, increasing efficiency, and offering you better control.
  • Value-Added Extras: The Business Solutions Suite and Member Value Suite give you and your employees valuable benefits at no added cost. Through the Business Solutions Suite, depending on your group size, you may be eligible for a Flexible Spending Account (FSA), COBRA billing services, a Premium Only Plan (POP), and HR support from Mineral. Our Member Value Suite offers CaliforniaChoice members access to discounts on entertainment, dental and vision care, wellness, hearing services, and prescription drugs. Ask your broker for details.

2. Census

Your proposal includes a copy of the census provided to us for your group. All of the information in your quote is based on this census, including any coverage for dependents. If you need to update your group census, talk with your broker.

3. Setting Your Health Care Budget

There are two ways to contribute to your employees’ benefits from CaliforniaChoice. You can select a Fixed Dollar Amount or a Percentage of Premium.

Regardless of your choice, the amount must equal or exceed 50% of the lowest plan premium. For example, if the lowest premium is $2,000 per month per employee, your fixed-dollar premium for each employee must be at least $1,000.

Your quote includes a summary for multiple Affordable Care Act (ACA) tiers – Bronze, Silver, Gold, and Platinum – as well as Total Choice, which includes plans in all four tiers. Different columns on your summary in this section include:

  • The lowest-cost health plans available by tier or tier combination.
  • The total premium for employees in the lowest-cost health plan.
  • The total premium for employees’ dependents in the lowest-cost plan available.
  • The total group premium for the lowest-cost available health plan.
  • Your net cost if you contribute 50% to employees’ premiums and 0% to dependents’ premium.
  • Your net cost if you contribute 75% to employees’ premiums and 0% to dependents’ premium.

You can work with your broker to calculate different percentage contributions to premiums. With CaliforniaChoice, the choice is yours.

4. Ancillary Rate Summary

If you and your broker discussed Ancillary coverage – for Dental, Vision, Chiropractic & Acupuncture, and Life and AD&D coverage, the premiums (for employees and dependents) are shown in this section.

5. Employee Worksheet

Here you’ll find a sample Worksheet showing the plan options available to your employees. The Worksheet shows the monthly premium prior to your contribution and the cost per pay period to the employee.

It breaks down HMO, PPO, EPO, and other options from which employees can choose.

Information about CaliforniaChoice’s Smart Decision Technology is also summarized in this section.

6. Administration

Your quote summarizes the consolidated administration available to you and your employees through CaliforniaChoice, including:

  • Enrollment services: Choose a paper or online enrollment for your group. Working with your broker, we offer onsite meetings or virtual enrollment meetings, where we walk your employees through our program.
  • Coverage updates: Employees can make online updates when they have a qualifying Life Event such as marriage, birth of a child, or other eligible changes.
  • Customer service: We take service seriously. When you call, you’re likely talking with someone who not only works for CaliforniaChoice, but is also an active member who understands the program inside and out.
  • Account changes: Managing your account and your employees’ benefits is simple at calchoice.com. With an online account, you can update your profile and billing information, generate a New Hire Quote, review and approve pending changes, order ID Cards, and more. You can also download forms and documents (including your Administrative Handbook, Group Service Agreement, and more). If you still have questions, you can schedule a meeting with your account representative directly from our website.
  • Billing: We’ll send one monthly bill for all of your employees’ coverage. What could be easier? Set up Auto Pay and never miss a bill again. It’s simple and secure.

A sample invoice is also included in this section of your proposal, along with Employee and Dependent Rates, Medical Benefit Summaries, and Ancillary Benefit Summaries.

Talk With a Broker

Getting a custom quote for CaliforniaChoice starts with your broker. If you don’t have a broker, we can help you find one.

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