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We have compiled a list of frequently asked questions to help you navigate the world of small business health insurance and better understand the CaliforniaChoice private exchange.
Federal and California state laws require an employer to have at least one but not more than 100 employees to qualify as a small business for group health insurance. Under the Affordable Care Act (ACA), groups with 101+ employees are considered Large Groups for purposes of health insurance.
Quotes are customized for each group, based on the individual ages of planned enrollees (employees and participating dependents, if insured) as well as the coverage selected.
With CaliforniaChoice, the amount an employer pays depends on the Defined Contribution selected. CaliforniaChoice allows employers to choose a Fixed Percentage (50% to 100%) of a specific plan and/or benefits. Or you can select a Fixed Dollar Amount for each employee. (Each employee receives the same amount.)
Employees then apply your generous contribution to the health plan and benefits they like best. If a plan an employee prefers costs more than the employer’s contribution, the employee pays the difference. It’s that simple.
With CaliforniaChoice, employees can choose from 130+ benefit choices from eight different health plans doing business in California.
One employee might select an HMO from Health Net, Kaiser Permanente, UnitedHealthcare, or a regional plan like Sharp Health Plan, Sutter Health Plus, or Western Health Advantage. Another might choose a PPO from Anthem. A third employee might select an EPO plan from Cigna + Oscar. With CaliforniaChoice, it is the employee’s choice.
CaliforniaChoice offers coverage to businesses with 1 to 100 employees. Other administrators and health plans have their own guidelines, which can vary. If you’re seeking ACA-qualified coverage for a group, 1 to 100 employee groups are standard.
Most insurers require a minimum employer contribution of 50% toward employees’ premiums. An employer can choose more. According to a 2022 employer health benefits survey conducted by the non-partisan Kaiser Family Foundation, most covered workers contribute toward the cost of the premium for their coverage. For all firms and plans, on average, covered workers contribute 17% of the premium for single coverage, while employers contribute 83%. For family coverage, workers contribute 28% of the premium, while employers contribute 72% toward family coverage. These amounts were similar to 2021 percentages.
You can choose to get your coverage directly through an insurer, through a public health exchange, or with the assistance of a broker. The choice is yours.
Contrary to what you might think, using a health insurance broker does not cost you more. In fact, using a broker could save you money. That’s because a broker will know the most popular plans in your area, and who is part of each health plan network. That is important because you and/or your employees may already be seeing a doctor or undergoing current medical treatment. If you have current coverage and you change plans, your access to a preferred doctor, specialist, or hospital could change.
A broker works for you, not the insurance company. His/her/their focus is on helping you find a plan that best serves you and the needs of your employees – and one that fits your budget.
If you are interested in coverage through a private health exchange, you should know that CaliforniaChoice only accepts coverage written through a broker. That is because CaliforniaChoice believes businesses and employees are better served when shopping for health insurance and using a broker.
Depending on your budget, a broker can help you determine how much to contribute toward employee benefits plan. Here’s how it works:
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