Group Health Insurance in California

Group Health Insurance in California

Affordable Group Health plans in California. Specialty insurance programs for Agricultural and CPA firms. Voluntary Benefits and Group Retiree Programs. Self Funded programs from 2-99 lives in California.

Regardless of your stance on Health Care Reform (PPACA), costs are going to continue to rise because of many underlying factors and complexities of our system. Many of the driving costs affecting the cost of care were never addressed and included in HC Reform. In 2014 groups will be dealt a severe blow under some major changes that insurers must comply with. California is moving forward with a “full speed ahead” attitude whether PPACA gets repealed or not.

Rules that will affect groups based on their demographics in 2014

  • Age Band Compression – Rates will be changed to 3 age brackets. Currently we have 6-7 brackets in California. Groups with a majority of older workers could see a reduction in premiums. Groups with a majority of younger workers will see a higher than normal increase in premiums.
  • Risk Adjustment Factor – Small group carriers are allowed to offer better rates to healthier groups. The standard rate is 1.10 and the best rate is a .90. All groups will be a standard rate so healthy groups with a .90 will see a 20% increase on top of the rate increase at renewal.

“Michael thoroughly evaluated the needs of our company and came back with a recommendation that not only improved our plan of benefits, but also saved a lot of money.  He has provided superlative customer service, and has gone beyond what we requested several times in providing that service.”  Owner, Kast and Company Communications

California AB 1672

California AB 1672 was passed in 1992 as an improvement to the federal government’s HIPPA, Health Insurance Portability and Accountability Act. As California so often does, they led the way in providing more protections in a group health plan with 2-50 members.

What this Law Does

  1. Allows individuals with pre-existing medical conditions to change over to a newer group health plan without an exclusionary period;
  2. Ensures small businesses, professional organizations, and associations have access to health plans as long as they have between 2 and 50 full time employees;
  3. Protects the insured from an increase in insurance rates after filing an insurance claim;
  4. Allows employees with health problems to change jobs and/or health plans without fear of being penalized for pre-existing conditions.


Self Funded Plans for groups from 2-99 Lives

Self funding has always had a place with larger groups of 50 lives or more, but do you realize small groups in California with 4-50 employee’s have the opportunity to have a similar plan? Many people have ideas about alternative funded plans such as:

Do I need 2 ID cards? Do I have to fax in my own claims? Is this partially funded?
The answer is “No”

With self-funding, you finance your company’s healthcare plan, and you pay one fixed premium for 12 months. Your premium is made up of 1. Stop loss insurance 2. Administrative Costs 3. Claims Funding.
Your claims payable is predetermined to a specific amount and if you exceed the amount the stop loss insurance kicks in and pays claims above that amount.

If the actual expenses are less – you keep the savings. Another benefit to self funding is composite rates. This means for groups with a majority of older workers or groups with many dependents covered through an employee of the company; Rates are much better than a fully insured plan.

To learn more about Self Funding click Here

Creating a Group Health Plan with 1 Person

Are you aware that two California carriers will allow a group of one to get guaranteed insurance? In one case I had a husband and wife that had a 50% ownership each in their corporation and no employees on payroll. Since the husband was 61 and his wife was 47 I moved them from a carrier that did not allow it to one that did and he was placed under his wife. He naturally waived the coverage since he had access to it through his spouse and we had a group of one with a much lower premium and we decreased the deductible.

Specialty Plan Using Kaiser Permanente

California Choice is a Specialty Program in California for Employers with 2-50 Employees. It’s the only program in California offering 5 different health plans and multiple HMO, PPO and HSA plan designs. Each employee adds their employers contribution to the plan that they choose. California Choice also includes basic dental and vision discounts. Enrollment can be done online

  • 3 Networks to Choose From
  • PPO, HMO, and HSA Plans
  • Optional Vision, Dental, Hearing, Chiropractic and Acupuncture
  • Discounted Payroll Service
  • Free HR Support
  • Entertainment Discounts for Group

If you would like to learn more about this plan please call us (855) 592-3200

Specialty Plans for Agricultural Companies and CPA’s

We have several large carriers in California that for the most part meet the need of small business owners offering benefit packages. For some industries, however, their needs go unmet. One particular company provides a flexible benefit program to agricultural companies that make up 67,000 small businesses in California. From farming, dairies, and trucking, many companies can build a benefit package for the office staff and workers in the field. Drug Plans vary in coverage and can be included as well as dental, vision, and life insurance. Larger companies can self-fund if a potential savings exists.
CPA firms and certain bookkeepers have access to a group health product offered for CPA’s and by CPA’s. This plan operates on the Blue Cross network, allows employees working 20 hours a week to be eligible, and has the only “Right of Survivorship” offered to members of deceased participants.

To learn more about Specialty Plans click Here

Many small groups with under 20 employees do not realize they have a better option for their age 65 plus population. Seniors Choice is a premier Retiree program that allows a group to move their older population to a separate plan that:
  • Lowers the overall age of the group
  • Lowers the premium cost for the employee
  • Lowers the premium cost for the employer
  • Provides favorable renewals for the group as a whole
  • Provides complete savings for the employer

How Does it Work?

An employer completes a master application and has the employee fill out a short application and include a copy of the Medicare card. If the group has a $500 deductible, the employer can offer a Medigap like plan that has a $500 deductible. For an enrollee that is turning age 65, the monthly rate for medical is $108.06. There is also a Part D drug plan that can be offered alongside the medical plan or as a stand alone plan. The rate is $61 monthly for the base plan. * I recently had an employer mistakenly forget to pay his part d premiums and his drug plan was cancelled. We immediately set-up a Seniors Choice stand-alone drug plan and he had co-pays again!  

Typical Savings

A 65 yr old employee on a Blue Shield 500 Value plan is $492 monthly In this example the employer would Save $3,875.28 a year

The Seniors Choice plan is much stronger than the 500 Value plan because it has Medicare behind it sharing the costs. The drug plan has no deductible and has immediate co-pays from day 1.

To learn about Individual Medicare Plans Click Here

Most small businesses use a bookkeeper or their accountant to manage their payroll services. There are also those that use ADP and Paychex. If you would like a free analysis of your payroll fees I highly recommend you contact Molly Castro at Ovation Payroll. They typically can save a California business up to 40% of what they currently pay. They don’t have the typical junk fees that I come across with ADP and Paychex. If you are a bookkeeper Ovation can manage multiple accounts for you and pay a commission to you. For a free quote that will get routed to Ovation Payroll fill in the request form below.

Self Funding in California for groups from 5-99 Employee’s

Starmark Healthy Incentives is a cutting edge carrier in California that offers what feels like a traditional health plan but can reward an employer by returning a portion of their premium dollars based on how the group runs. The plan includes stop loss protection so the group can have a fixed monthly premium regardless of anticipated claims. All administration and claims payments are done internally by Starmark and their networks include Aetna and Cigna. The carrier has included a Lab Card benefit into their plans for Labs and Diagnostic testing at Quest diagnostics to be no charge to employees.

How Self Funded Plans Work

  • A set amount is taken from the monthly premium and put into a separate account that is used to pay expected claims
  • Covered medical claims are paid from this account for you by Starmark
  • If covered claims are MORE than the specific and/or aggregate deductible, stop-loss insurance covers the balance
  • If cover claims are LESS than what you funded, you keep the surplus!

Agricultural Carrier for Ag Companies in California

There are over 67,000 agricultural companies in California from Farming, Dairies, Produce, and Wineries to Trucking, Veterinarians, Cheese Production, and Nurseries. If their insurance agents have done a good job they have shared with them the advantages of having a benefits package from United Agribusiness Benefit Trust. If you would like to find out if your business qualifies click Here on the acceptable SIC codes. The United Agribusiness League has been in business since 1980 and is headquartered in Irvine, California with district locations offices in Corona, Fresno, Imperial, Los Angeles, Oxnard, Salinas, and Santa Maria. They offer health benefit packages through the United Agricultural Benefit Trust that include multiple plan offerings, Drug Plans, Dental, Vision, Life insurance, and Partial Funding. Some additional benefits of being a member include: scholarships to students of members, a Credit Union, Legal assistance, Entertainment Discounts, Networking, and a Mexican Panel providing lower co-pays and drugs across the border. UABT’s flexibility is unmatched by the common carriers and they will continue to provide benefit packages for specific industries. REQUEST A QUOTE

CPA Protect Plus for CPAs

Since 1959 the Group Insurance Trust has been providing high-quality programs to California CPAs. The program is contracted with Blue Cross and operates on their network of providers and hospitals. They are the ONLY insurance plan in California allowing a “Right of Survivorship” which means an eligible dependent of a deceased plan participant can stay on the plan. Their prescription plan is an open formulary which means there is no drug list. Groups can also be eligible for an 18 month rate guarantee. Group Dental, Vision, Life and Disability plans are also available. REQUEST A QUOTE