A California Different Way to Do Health Care
Each and every one of us is different and, at CaliforniaChoice, we embrace those differences. We offer the freedom to choose from multiple carriers, plan designs, networks, doctors…the list goes on. But at the end of the day, employees make their own choices. Now that’s freedom.
If you’re looking for a way to help you increase your employee retention and make your employees happier – without driving up your costs – you should know about voluntary benefits. They are an easy way for your business to expand your insurance coverage options for employees. And the cost is paid entirely by those employees who participate.
For employers currently offering Medical coverage through CaliforniaChoice, it’s easy to add voluntary Dental and Vision coverage.
The SmileSaver Dental 3000 HMO is available as a voluntary option with no minimum employee participation. It includes benefits for the following, with a co-pay for some services:
- Exams and diagnostics
- Oral surgery
- Restorative care
- Prosthodontics (dentures)
Two Voluntary Vision programs are also available – from EyeMed and VSP. Both offer in- and out-of-network benefits, as shown below:
|In Network||Out of Network||In Network||Out of Network|
|Eye Examinations|| $10 co-pay|
(1 per 12 months)
|Up to $20 reimbursement|| $10 co-pay|
(1 per 12 months)
|Up to $45 reimbursement|
|Frames|| Covered in full up to $100 retail value|
(1 per 12 months)
| Up to $30 reimbursement, up to $100 retail value|
(1 per 12 months)
| Covered in full up to $180 retail value|
(1 per 12 months)
|Up to $70 reimbursement|
|Lenses|| Co-pay of $10 to $75 depending on type of lenses|
(1 per 12 months)
|Up to $40 reimbursement depending on type of lenses|| Co-pay of $10 to $55 depending on type of lenses|
(1 per 12 months)
|Up to $65 reimbursement depending on type of lenses|
|Contact Lenses||$10 co-pay; one purchase per 12 months in lieu of frames and lenses; up to $100 retail value; additional coverage for fitting is based on lens type||$50 reimbursement; one purchase per 12 months in lieu of frames and lenses; up to $100 retail value; $40 reimbursement for contact lens fitting||$10 co-pay; one purchase per 12 months in lieu of frames and lenses; up to $180 retail value; lens fitting covered in full after member cost of up to $60||Up to $150 reimbursement; one purchase per 12 months in lieu of frames and lenses; 15% discount on contact lens fitting|
Because the coverage is voluntary, you don’t have to worry about increasing your employee benefits budget. There’s no cost to you because your employees are paying the total premium.
If you would like to contribute to the costs of your employees’ additional benefits (or pay the total costs), you can expand your employee insurance options even more – giving them a choice of Dental, Vision, Chiropractic & Acupuncture, and Life Insurance. You can even “mix and match” employer-sponsored and voluntary coverage for your employees. Your broker can supply you with all of the details.
There are five employer-sponsored options for Dental coverage:
- SmileSaver Dental 1000 HMO
- Ameritas PPO 3000
- Ameritas PPO 3500
- Ameritas PPO 4000
- Ameritas PPO 5000
The SmileSaver Dental 1000 HMO includes:
- Exams and diagnostics at no charge
- Oral surgery at no charge
- Restorative care at no charge
- Endodontics with a co-pay of $40 to $95 depending on the service
- Periodontics with a co-pay of zero to $20 depending on the service
- Crowns, Orthodontics, and Prosthodontics with co-pays
The Ameritas PPO plans all include:
- An Annual Maximum and Annual Deductible – the amount varies by plan and whether services are provided in- or out-of-network
- Preventive care with the deductible waived in-network (services are covered at 100% in-network and 80% out-of-network)
- Basic services are generally covered at 80% in- or out-of-network
- Major services are subject to a Waiting Period and are covered at 50%
- Endo/Perio are covered at 50% on most plans; 80% coverage in-network for PPO 3500, 4000, and 5000 plans
- Dental Rewards® by Ameritas
Orthodontia is available on the PPO 3500, 4000, and 5000 plans with a $1,000 lifetime maximum.
CHIROPRACTIC AND ACUPUNCTURE
The employer-sponsored Landmark Healthplan Chiropractic or Chiropractic and Acupuncture plans are available for a low monthly fee and include the following benefits:
- Office visits with a low $15 co-pay per visit
- Maximum 20 visits per year (20 total Chiro and Acupuncture visits under combo plan)
- Discounts on office visits exceeding 20 per year
- No deductibles
- Free health coaching, education, and referral services
Enrolled members have access to Landmark’s fully credentialed network of chiropractors and acupuncturists across California.
Employer-sponsored Life Insurance from Assurity Life Insurance Company gives your employees access to affordable Life Insurance and Accidental Death & Dismemberment (AD&D) benefits – plus a Conversion Privilege if they leave your employment in the future.
Coverage amounts start at a minimum of $10,000 during the initial enrollment period. (Reduced amounts are available after the initial enrollment.) Your group’s Guaranteed Issue Maximum is based on your total group size, as shown below:
|Employee Participation||Guaranteed Issue Maximum at Initial Enrollment|
Through the Living Benefits Provision, an early partial payout of the Life Insurance amount is available if you’re diagnosed with a future terminal illness.
Talk With Your Broker About Your Benefits
CaliforniaChoice gives employers like you the ability to easily expand your employee benefits program, and still control your costs. CaliforniaChoice can help you attract new employees, boost employee morale, and reduce turnover – because employees are happier when they have the ability to choose insurance that best fits their specific individual or family health care needs.
Talk with your broker about adding voluntary or employer-sponsored benefits to your employee benefits program. You can add these benefits to your program at any time. You don’t have to wait until your next Medical plan open enrollment.
If you don’t already have a broker, we can help you find a CaliforniaChoice broker to speak with about a quote for coverage for your employees.
Health care is complicated – and it seems like it’s becoming more complicated every day. As you consider health insurance coverage options for your business (and yourself), it might be useful to have a glossary of frequently used insurance- and medical-related terms.
What follows is not a full list of the terms you and your employees might encounter; rather, it’s a list of frequently used words and phrases you may encounter in your health plan literature or your health insurance policy. Keep in mind, these are general definitions; your health plan or insurer may define something in a slightly different way. When in doubt, always check your policy or ask your health plan for information.
Affordable Care Act; also referred to as the Patient Protection and Affordable Care Act (PPACA); the federal health care reform law enacted by Congress in 2010 to establish creation of an American Health Benefits Exchange (AHBE) and Small Business Health Options Program (SHOP) Exchange. See related entries below.
Annual Enrollment Period; that time of the year when an annual enrollment takes place – for example, for 2017, the AEP for the ACA was November 1, 2016, through January 31, 2017. The expected open enrollment period for the ACA for 2018 is November 1, 2017, through December 15, 2017, based on an announcement from the Centers for Medicare & Medicaid Services in May 2017.
American Health Benefits Exchange; refers to the health care exchange established under the Affordable Care Act (ACA) enacted by Congress in 2010 (see related entry above), under which lower-income individuals earning between 133% and 400% of the Federal Poverty Level can access sliding-scale tax credits and cost-sharing subsidies toward the purchase of health insurance coverage.
Administrative services only. A relationship between an insurance company or other management entity and a self-funded insurance plan or group of providers in which the insurance company or management entity performs administrative services, such as billing, premium collection and submission, etc., and does not assume any of the risk with the insurance operation (the plan bears the financial risk for all claims).
This refers to the practice when a health care provider (like a doctor, hospital, or outpatient facility) bills a health plan member for the balance of the amount due on services provided. This amount is the difference between the actual amount billed and the amount allowed by the health plan. For example, if the provider charge is $200 and the amount allowed by the member’s health plan is $120, the provider may “balance bill” for the remaining $80. This often happens when a member visits an out-of-network (or non-preferred) provider.
This is a request for payment made in connection with a health care expense reimbursement. It can be made to the health plan/health insurer by a health plan member or a health care provider for services or items that are (or are expected to be) covered under the plan.
Refers to the Centers for Medicare & Medicaid Services, a federal agency responsible for Medicare, Medicaid, and children’s health, survey, certification, and quality improvement as well as implementation of the ACA; CMS is an agency within the U.S. Department of Health & Human Services (HHS), under the leadership of the Secretary of HHS, who serves as one of 15 members of the President’s Cabinet.
Consolidated Omnibus Budget Reconciliation Act; refers to the federal act that established a continuation of coverage option for employees (and their dependents) when group health insurance plan coverage ends (due to voluntary or involuntary termination); applies to employers with 20 or more employees; coverage for employees can be extended for up to 18 months, while coverage for dependents can be extended for up to 36 months; COBRA premiums are the sole responsibility of the insured person(s).
A Consumer Operated and Oriented Plan; a new type of private, nonprofit, consumer-governed health insurer offering access to qualified health plans through health insurance exchanges; established under the guidelines of ACA; CO-OP profits must be used to lower premiums, while improving health outcomes through quality of care and expanded coverage for members.
This refers to an insured member’s percentage share of the costs of health care services (ranging from 10% to 40%, depending on the metal tier of plan you select). Under the ACA, there are four tiers of coverage – Platinum, which pays 90% of the costs of covered health care services, while the member pays 10%; Gold, which pays 80% of the costs of covered services, while the member pays 20%; Silver, which pays 70% of covered services, while the member pays 30%; and Bronze, which pays 60% of covered services, while the member pays 40%.) You generally pay your coinsurance percentage plus any deductible. After your deductible is satisfied annually, you continue to pay your coinsurance amount for covered services throughout the plan year, up to your total out-of-pocket maximum.
A fixed amount (for example, $25) that you must pay when receiving covered health services. The amount can vary based on the type of covered services provided.
Your share of the costs for health care services; also referred to as your out-of-pocket costs, which includes your coinsurance amounts, annual deductible, and copayments.
This is the amount you must pay before your health plan begins to pay. An overall deductible applies to all – or almost all – covered services and items. Separate deductibles may also apply to some services. (As an example, if you have a $500 deductible, your health plan will not pay for any covered services until you have first paid your deductible.)
To learn more about the ABCs of health insurance, and what you need to know when considering health insurance for your business and employees, talk with your employee benefits broker. If you don’t already have a broker, we can help you find a CaliforniaChoice broker to speak with about the plans and choices available in your area.