Health care is not one size fits all, which is why CaliforniaChoice gives you the freedom to choose from eight different health plans in a single program. While everyone loves choices, understanding the options and selecting a health plan that is right for you and your family can be a confusing process.
So, we’re breaking it down and comparing key benefits of each of our eight participating health plans. Below, we compare the benefits of Kaiser Permanente and Sutter Health Plus, two popular health plans available through CaliforniaChoice.
Kaiser Permanente was founded in 1945 and was one of the nation’s first health programs to offer comprehensive health care services on a prepaid basis.
Headquartered in Oakland, California, Kaiser Permanente’s innovative spirit drives the country’s largest non-profit health care organization – guided by physicians and focused on providing high-quality care to members.
Kaiser Permanente Benefits Overview
- 11.8 million members in eight states and the District of Columbia, including 8.5 million members in California
- More than 16,000 physicians provide care at 450+ medical offices and 36 hospitals in California
- Only one of ten physician applicants is chosen to become a member of Kaiser Permanente’s care team
- Members choose their own personal physician and can change doctors for any reason
- “Excellent” ratings from the National Committee for Quality Assurance (NCQA), the leading reviewer of health plan quality
Sutter Health Plus
Not-for-profit Sutter Health Plus offers competitively priced HMO health plans in the Greater Central Valley, Sacramento, and San Francisco Bay Area. When you choose Sutter Health Plus, you gain access to a high-quality provider network that includes many of Sutter Health’s nationally respected and recognized hospitals, doctors, and other health care services – all at an affordable price.
Sutter Health Plus Benefits Overview
- Competitively priced products that give members access to a network of providers
- Convenient locations within service area for primary care, specialty care, X-ray and diagnostic imaging, lab, hospital services, etc.
- Mail-order pharmacy program and conveniently located retail pharmacies
- My Health Online (not offered by all providers) to schedule appointments, email doctors, view test results, and access your records
- Coverage for emergency and urgent care anywhere in the world
- Welcome calls to help new and returning members better understand medical benefits and coverage – and assist in facilitating initial appointments
- 24/7 nurse advice triage line
The CaliforniaChoice Advantage
With CaliforniaChoice, you and your employees have more choice – and the ability to find health insurance that meets your unique needs. One of your employees might choose a plan because of its broad PPO network. Another employee might select HMO coverage from a regional or statewide plan. With CaliforniaChoice, they both get what they need – while other employees have the option to choose from six other plans.
There are benefits for you, too – like a single monthly bill for all of your employees’ coverage and single-source administration for enrollment, eligibility, and customer care.
Check back to see additional comparisons on other CaliforniaChoice plans, including:
- Anthem Blue Cross
- Health Net
- Oscar Health
- Sharp Health Plan
- Western Health Advantage
An employee benefits agent can provide you with more information about the advantages of CaliforniaChoice and the available coverage options . If you don’t already have an agent, you can search for one here.
People are accustomed to making choices every day based on their personal preferences and individual tastes — from what they wear and drive to the restaurants they frequent. With the “individualization” of the market (think Amazon, Netflix, and DoorDash), more and more industries are serving up options to stay relevant in a world where choice isn’t just a nice to have, but the expectation.
It should come as no surprise that the health insurance industry is not immune to these expectations. In the past, employees were limited to a single health insurance option (selected by the employer) that did not necessarily address their individual needs. However, that model is quickly becoming a thing of the past and the private health exchange is leading the way.
What is a Private Health Exchange?
A private health insurance exchange gives employees access to multiple health plans through a single program. It enables you and your staff to individually shop, compare, and enroll in an array of coverage options and receive one bill for all of your employees’ insurance.
Many people became acquainted with insurance “exchanges” when the Affordable Care Act (ACA) was signed into law in 2010. The ACA created a national public health exchange and established the framework for states to take part or create their own state-run exchanges. California was among the first group of states with a state-run exchange.
However, California small businesses have been able to choose coverage through a private health exchange since 1996, when CaliforniaChoice opened its doors. The Word & Brown Companies’ co-founders John Word and Rusty Brown created the state’s first private health exchange and modeled it after large group and government employee insurance programs offering enrollees access to multiple health plans.
Choice Matters to Employees
Today’s workforce is dramatically different from the past. It’s fairly common to find a business with employees ranging in age from 20-somethings to baby boomers. Also, on the rise is workplace diversity of gender, religion, race, ethnicity, cultural background, sexual orientation, and language.
With so much to consider, it can be a challenge for employers to provide health insurance to an employee population with such variance. For example, the preferences and needs of an older, married employee are going to be vastly different than those of a younger, single person who is just starting out in the workforce.
An exchange program gives employees a way to find coverage that best fits their health care needs and budget. One employee might select a PPO because of a particular doctor or hospital in the PPO’s network. Another employee who rarely visits the doctor might choose a HMO. A third employee might select an EPO (Exclusive Provider Organization) plan because it has a slightly lower premium, but offers direct access to in-network specialists without a Primary Care Physician referral. A fourth employee might choose a Health Savings Account-compatible plan due to cost and tax considerations.
It is your employees’ choice when you offer them access to a private health exchange.
Cost Control for Your Business
In addition to offering you streamlined administration and one bill for all of your employees’ health coverage, a private exchange program also offers you the ability to control your employee benefits cost. The CaliforniaChoice exchange lets you set your own budget for benefits using Defined Contribution.
You decide what you want to contribute to your employees’ benefits. You can select between a Fixed Percentage (50% to 100%) of a specific plan and/or benefit, or a Fixed Dollar Amount for each employee. Employees then apply your contribution to whatever health plan and benefits they prefer. If employees selects a plan that costs more than your contribution, they simply pay the difference.
When you renew, you have the option to adjust your premium contribution – up or down – giving you complete control over your benefits cost for another 12 months.
Finding Coverage That’s Right for Everyone
Offering a greater level of choice to your employees — without increasing your cost as compared to a single health plan solution — sets a private health exchange apart from other health insurance options. It also gives your business a recruiting advantage and a powerful tool to retain your current employees.
If you have an employee benefits agent, ask about a private exchange quote for your business. If you’re not currently working with a benefits professional, go here to find a licensed expert in your area.
According to the federal National Health Interview Survey and the Kaiser Family Foundation (KFF), nearly 60 percent of America’s non-elderly population have health insurance through their employers. There’s no doubt, health insurance is highly sought after by employees. However, many employers are still unclear as to how group health plans provide distinct advantages to their business.
Here are 5 reasons why businesses choose Group Health Insurance for employees:
1. Employee benefits help in recruiting new employees.
A survey by the Harvard Business Review found that 88% of respondents would choose a job that offers a lower salary with better health, dental, and vision insurance over an opportunity with a higher salary but lesser benefits. Providing employee benefits sends an implicit message to job candidates that your business is competitive and financially stable – and it also shows you care about your employees, which can further set you apart in your recruitment efforts.
2. Benefits affect current employee retention.
Fifty-six percent of U.S. adults taking part in a 2018 SHRM survey said that a favorable opinion of their health coverage is a key factor in deciding whether to stay in their current job. Forty-six percent said health insurance was either the deciding factor or a positive influence in choosing their current job. Clearly, health benefits are among the most critical components of job satisfaction – second only to compensation.
3. Group Health Insurance helps reduce stress in the workforce and improve morale.
The Affordable Care Act (ACA) mandates that 10 essential health benefits be included in ACA-qualified health coverage:
- Ambulatory patient services
- Emergency services
- Pregnancy/maternity/newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Lab services
- Preventive and wellness services and chronic disease management
- Pediatric services (including oral and vision care)
Having comprehensive health care services can make a huge difference in the lives of your employees. The Annual U.S. Employee Benefit Trends Study by Metlife found that 74% of employees agree that having insurance provides peace of mind for the unexpected. It has been well-documented that happy employees are more productive and use less sick time, in addition to staying with a company longer.
4. Group Health Insurance offers tax benefits for employers.
Generally speaking, your expenses related to providing health insurance for your employees and their dependents are 100% tax deductible as an ordinary business expenses on your state and federal income taxes. Ask your employee benefits agent about the added benefits of a Premium Only Plan, which can reduce your payroll taxes and give employees the ability to pay their share of premiums with pre-tax dollars.
5. Group Health beats Blanket Health and Individual Health Insurance.
Group Health Insurance is, often, a better choice for your business and your employees than so-called Blanket Health policies because Group Health offers protection that is more comprehensive. As mentioned above, ACA-qualified plans include coverage for essential health benefits that are not part of Blanket Health plans. Typically, a Blanket Health policy offers coverage in connection with accidental injury. If it does cover broader health benefits, a Blanket Health policy may limit the amount it pays toward treatment or services – perhaps limiting coverage to $5,000, $10,000, or $50,000 for the life of the plan. The ACA prohibits health insurers from limiting coverage annually in qualified Group Health plans.
Group coverage may also beat individual insurance for two of the same reasons: no maximum benefits and continuous protection. Once you sign up, coverage will continue for one year as long as you pay the premium.
Finding What’s Right for Your Business
To learn more about the advantages of Group Health, talk with your insurance agent.
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!
Decoding the Affordable Care Act (ACA) employer mandate can be difficult for the average small business owner. For some businesses, offering health insurance coverage is required. For others, it’s a choice. We’re breaking it down and shedding light on what you need to know to ensure your business is ACA compliant.
Do employers have to offer benefits to full time employees?
Applicable Large Employers with 50 Employees or More
The Tax Cuts and Jobs Act of 2017, signed by President Trump on December 22, 2017, eliminated the ACA individual mandate penalty (for not having health insurance). However, it did not affect the employer mandate, which applies to Applicable Large Employers (ALEs) with 50 or more full-time employees and/or full-time equivalent (FTE) employees. The ACA employer mandate remains in force. If your business employs 50 or more full time employees, offering health insurance is required.
Depending on how you staff your organization, calculating the number of full-time employees (including FTEs) can be complex. If you’re unsure of your group size, visit the Healthcare.gov website to use a group size calculator. When considering your group size, employees working 30 or more hours per week are considered full-time.
Employers that qualify as ALEs are subject to the ACA’s shared responsibility provisions and the reporting requirements concerning minimum essential coverage. ALEs must offer health insurance that is “affordable” and provides “minimum value” to 95% of full-time employees and their eligible children up to age 26. If you are an ALE and do not offer ACA-compliant coverage, you are subject to penalties. For 2019 employer penalty information, consider reading this article by the Society for Human Resource Management.
If your business had, on average last year, fewer than 50 full-time employees (including FTEs), you are not an ALE for the current calendar year. Still, it’s important that you evaluate your potential ALE status annually.
While non-ALEs are not required to offer health coverage to employees, you can voluntarily do so. In fact, many employers not subject to the employer mandate offer health insurance and other employee benefits because it helps them compete in an increasingly competitive talent market.
Qualifying for Group Health Insurance
If you offer full-time employees health coverage, you must make it available to all employees, regardless of any pre-existing medical conditions. Health insurers will write groups with as few as two insured persons (the business owner and an employee). However, many carriers will not write a policy for a husband and wife group if both are owners of the business, or if it is a sole proprietorship. LLC, S-Corp, C-Corp, and Partnerships where a spouse is a W-2 employee are acceptable to most insurers. Ask your employee benefits agent for more information on qualifying for group health insurance.
Cost of Coverage
If you choose to purchase health insurance for your employees, the next step is determining how much you want to contribute toward the premium. With Defined Contribution, available from the CaliforniaChoice multi-carrier private exchange, you can choose a Fixed Percentage Amount (from 50% to 100% of the cost of a selected coverage level) or a Fixed Dollar Amount. Whatever amount you choose applies to each employee, and your cost is locked-in for a full year. At renewal, you can adjust your contribution up or down and lock it in for another 12 months.
Finding a Plan
You can choose to purchase coverage directly from an insurance company, or you can use an independent agent to help you shop multiple plans. A multi-carrier exchange like CaliforniaChoice or the state’s ACA exchange, Covered California, can expand your employees’ options without increasing your costs.
CaliforniaChoice also allows you to choose one or more ACA metal tiers for your employees. This gives you and your staff greater access to doctors, hospitals, and other providers offered by the eight health plans available across the state from CaliforniaChoice. The networks for CaliforniaChoice include 84,355 individual health care providers and 389 hospitals (as of August 2019).
To learn more about the health plan options available for your group, contact your employee benefits agent. If you don’t already have one, we can help you find an agent.
Health Care Benefits Don’t Have to Be One Size Fits All
Each of your employees is different, and those differences extend to their health care needs. Traditional “one size fits all” health plans can prove limiting. As an employer, you may have wondered whether you can offer different health care benefits to your employees. You can, with CaliforniaChoice. Our multi-carrier private health insurance exchange includes eight different health plans across California.
Coverage Choice Wherever You Are
With CaliforniaChoice, you and your employees have access to Anthem Blue Cross, Health Net, Kaiser Permanente, and UnitedHealthcare statewide. If you are located in Northern California, you also can choose coverage from Sutter Health Plus and Western Health Advantage. Southern California businesses have added health plan options from Oscar Health in Los Angeles and Orange counties and Sharp Health Plan in the San Diego area. Combined, there are nearly 90 options available, so you and each of your employees can easily find coverage that’s right for their individual or family health care needs.
The provider network for CaliforniaChoice is unparalleled. Each health plan offers a diverse roster of physicians, medical groups, and hospitals. In total, there are 84,355 unique individual health care providers and 389 unique hospitals across the state.
CaliforniaChoice gives your employees the freedom to choose the health plan that’s right for them. One of your employees might select a PPO from Anthem Blue Cross because it includes a favorite doctor or hospital in its network. A second employee might choose coverage from Health Net. Another employee who is looking for a lower copay might select an HMO from Kaiser Permanente or UnitedHealthcare. A fourth employee might prefer a regional plan like Sutter Health Plus, Western Health Advantage, Oscar, or Sharp Health Plan. With CaliforniaChoice, it’s their choice. As an added perk for you, the coverage selected by all of your employees is included in a single bill each month.
Tools to Find the Right Plan
CaliforniaChoice offers several tools to help match your needs to the health plans available through our multi-carrier exchange.
- Automated Choice Profiler: Thisonline assistant give users the ability to review premiums, deductibles, and other out-of-pocket costs (like copays and co-insurance) to get a total estimated cost of coverage. Employees can view side-by-side plan comparisons based on costs, risk, and quality.
- Online Provider Search: This tool takes the guesswork out of finding the right doctor by helping employees find out in advance whether a preferred doctor is part of any of the health plans offered through CaliforniaChoice. It’s easy to search by city or ZIP Code, doctor’s name or gender, health plan, hospital affiliation, language(s) spoken, and distance from a targeted city or ZIP Code (like home or office).
- Online Rx Search: You and your employees can use this tool to match your prescription drug needs to available plans. It’s easy to look up medications alphabetically, by brand or generic drug name, therapeutic class (prescriptions for pain, infection, or treatment of the heart), or health condition.
Employer Cost Control
Beyond giving your employees more options from which to choose, CaliforniaChoice helps you control your employee benefits expenses, too. With Defined Contribution, you choose how much you want to contribute to your employees’ health insurance premium. It’s up to you if you want to choose a Fixed Dollar Amount or a Fixed Percentage Amount (50% to 100%) toward a specific benefit. The contribution for each employee does need to be the same.
Your employees then use your contribution toward the cost of coverage for the plans they like best. It’s like a health care voucher. If employees choose coverage that costs more than you’re contributing, the employees simply pay the difference. The amount you choose is locked-in for the plan year, and you can change it at renewal if you choose.
Get Help from an Agent
A health insurance agent can help you set your contribution amount and discuss available options. Best of all, there’s no cost for an agent’s service. If you do not already have an agent, you can search for one here. You can find additional information on this subject in our prior post, 6 Things to Consider When Choosing an Insurance Agent for Your Business.
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’re a small business owner, spending time building your company brand may not be at the top of your priority list. In reality, though, businesses of every size need to think about how they can brand themselves to gain an edge in today’s competitive market.
Brand Building Tips1. Determine Your Voice
The first step in creating your brand is selecting your voice. Think about who you are as a company and what you are known for. If you were meeting someone for the first time, how would you describe what your organization does?
If you already have a mission statement and core values, you’re off to a good start. If not, it may take a little more thought, but it’s well worth the effort. Your approach – and how you “sound” – play an important role in your branding.
You want to be able to develop a tone and message that will help create a connection with your prospects and customers, while also helping differentiate you in your local market and business space.2. Add Some Visual Flair
If you are just starting your business, and you don’t already have a name and logo, you may want to engage help in selecting one or both. You can talk with friends or other small business owners about their recommendations or look online for a naming or logo design resource.
A good name and visual identity are important to creating a strong brand. Think about the logos of the organizations you know, locally, regionally, and nationally. Some organizations, like McDonalds or Nike, can be identified by a logo alone.3. Go Your Own Way
You may be tempted to borrow from what you think is working for a competitor, or a large, regional or national brand. Don’t do it. Think about what makes your organization different, and why a prospect should choose your company over another. Your independence may be a differentiator that helps you attract and retain customers.4. Consistency Is Key
Some businesses – large and small – make a mistake in branding and use a different approach depending on who they are communicating with and what vehicle they’re using (say, for example, an ad versus social media). That can undermine your efforts, because your prospects and customers can be confused by your mixed messages. It’s more effective to be consistent in your approach. Familiarity is important, and it can help you build trust.5. Deliver on Your Promise
You can create long-term relationships with your prospects – and turn more of them into customers – by delivering on your promises. Be clear about what you do, and what your customers can expect from you. Then make sure you work to follow through. You can earn their trust and generate positive word of mouth. Customer service is vital.
It can be helpful to learn from others’ brand-building missteps. Click here to read Five Branding Mistakes That Could Put Your Small Business Out of Business, published by Crowdspring, or check out this article, You May Be a Small Business, But You Can Still Focus on Building a Big Brand Image!, from Espresso.