California Group Health Insurance & Employee Benefit Plans

California group health insurance plans

California Group Health Insurance & Employee Benefit Plans

A quality group health insurance plan and employee benefits package is one of the key markers that differentiates companies that attract the best and those that don’t. Thanks to recent changes in the way that group health insurance and health savings account are administrated, the onus of providing a good health care option that will attract the best employees falls on employers.

For more information about small business health insurance plans, see this resource from the National Association of Health Underwriters.

Many California employers may be hesitant to offer a high-quality, comprehensive group health insurance option, largely because so much of that cost now falls on the business itself. In California, where it’s not easy or cheap to start and operate a business to being with, this is an especially relevant concern.

At Taylor Benefits, we specialize in tackling this exact problem in a way that will appeal to businesses and employees alike. We offer a host of affordable group benefit provider networks and health small group insurance options with plenty of flexibility, all while being tailored to the precise needs of your business and its workers. Whether you have a small business with just a few employees, or a large company with more than 100, we will craft a workable and affordable cost savings plan that fits your needs.

California Large Group Health Insurance Plans

Large companies are typically seeking ways to reduce the cost of their health insurance without sacrificing quality. One increasingly popular way for large businesses to accomplish that goal is self-insurance. With a self-funded insurance plan, the employer pays directly for health care services used by the workers. However, employers almost always use an insurer or a third-party administrator. Some large companies attest to savings obtained from the approach, combined with the ability to offer a customized coverage package. Consult your Taylor Benefits Insurance representative for details.

Another tool employers use to reduce their healthcare insurance expenses is cost-sharing with their employees. Many companies pay a portion of the premium charged for individuals and family dependents, with the employee responsible for the balance. In addition to the premium, workers typically have a deductible and often a co-payment or coinsurance to pay when they use their coverage. Deductibles have been increasing for all types of plans, with notable increases in enrollment in “high deductible” options. In most cases, the subscriber must satisfy the entire deductible amount before services are covered, except for preventative care. If the subscriber has a co-payment, that is typically a specific dollar amount. In contrast, a coinsurance payment is likely a percentage of the price charged.

California Small Business Health Insurance Plans

When smaller employers implement self-funded insurance, as they are increasingly doing, they often employ a stop-loss component to limit their risk. This tactic is sometimes called level funding rather than self-funding since the company shares the risk with an insurer. The Kaiser Family Foundation survey reported a significant increase in level-funded insurance programs among small companies during 2021 compared to previous years.

However, the Kaiser survey uses a generous definition for small companies. Smaller businesses that don’t have to provide health care coverage may prefer to use the resources available to them from the Small Business Health Options Program (SHOP), which provides some coverage plans and tax credits for the small employers that offer health insurance.

California Employee Benefit Plans and Employee Benefit Packages

In California, employees have access to paid family leave benefits. However, the temporary disability program does not fully replace a worker’s income. Companies must also provide at least three days (24 hours) of paid sick leave per year, with accrual limited to 48 hours. In addition, the state requires other unpaid leaves for employees who need them.

California employers do not have to provide paid holidays or vacation time. However, if a company does offer paid vacation days and the employee does not use them, they must receive pay for earned but unused days when they leave that job. While some famous technology companies have made over-the-top benefits like yoga classes, free haircuts, onsite catering, and other perks a goal for many, these remain unusual. However, some companies in major metropolitan areas offer commuter assistance, such as subsidies for employee vanpools or public transportation. Many counties in California will assist with these arrangements in an effort to reduce traffic.

Dial 800-903-6066 and get free consultation on California Group Health Insurance & Employee Benefit Plans

Group Benefits & Health Coverage Options | California

A good group health benefit will provide value not just to employees, but to business owners as well. For employees, a quality health plan generally provides preventive care and wellness programs, both of which are designed to incentivize workers to take a more active role in their own health and prevent undetected long-term health issues.

Good news for business owners and employees is that there are tax breaks to be had through the manner in which the plan is administrated. In most cases, the employers cost of providing health care is tax-deductible and there are options which extend this same benefit to workers. To get a full understanding of our most popular plan options and services in California, see the following list:

Are you looking for a California Group Health Insurance & Employee Benefit Plans? Click the quote button to get an instant quote.

Learn more about California employee benefit packages offered by Taylor Benefits.

California Group Health Insurance & Employee Benefits Information Center

Key Points for California Group Health Insurance:

  • Premium amount of small business health insurance can’t be changed on basis of size or health of group.
  • To be eligible for group health insurance plans, it is necessary to enroll 75% of group size and pay 50% of premium.
  • Except owner or spouse, minimum one person should be on payroll for half of previous calendar year.

Some carriers have special offers for participation requirements.

  • Employers can choose whether they want to provide insurance to part time employees working below 30 hours weekly. They can also open a health reimbursement account for part time employees.
  • Group health plans offer extensive range of PPO’s, HSA’s, HMO’s and HRA’s which makes them expensive.
  • Employer’s can choose the small group insurance amount payment through plan’s percentage or dollar amount.
  • The California small business health insurance market share is grabbed by few like Blue Shield of California, Aetna, Anthem Blue Cross, PacifiCare, Covered California, and Health Net.
  • We offer the best standardized price and comprehensive benefits.
  • Any medical plans modification can be done within 30 days.
  • Monthly contract is offered keeping it short and simple for small business owners.

ACA Health Law Changes on Group Market

  • Standardized plans with Bronze, Silver, Gold, and Platinum levels are available.
  • Group size up to 100 employees.
  • Group Tax Credits available and you can check the availability on our website.
  • There are penalties if health insurance is denied on behalf of size of company.
  • Penalties are imposed for individual/family plans if you are paying on behalf of your employees.

Tax Credit Options in California

A tax credit can be paid if you have minimum 25 full-time employees with an average salary of $50,000 or less yearly. The Patient Protection and Affordable Care Act (PPACA)offers tax credit to small organizations for covering cost of group health insurance.

50% of the premiums is reimbursed for small businesses under vision and dental insurance. Tax-exempt organizations can avail credit up to 35% of their premium expenses.

*Some states offer tax credit only to Qualifying Health Plans (QHPs).

Small businesses paying average wages of $25,000 or less and a minimum of 10 full-time employees can avail full credit. The credit amount keeps on getting reduced for small business employers that have employees with higher wages. Conditions to qualify are based on full-time employees excluding part time workers. Part-timers can qualify for tax credit for greater than 25 individuals also.

Looking to purchase group health insurance in California?

California health insurance companies for individuals, families and small businesses are listed below.

  • Oscar
  • Blue Shield of California
  • Cigna + Oscar
  • Kaiser Permanente
  • Anthem BlueCross
  • UnitedHealthcare
  • Covered California

You can also check out Covered California, which provides a marketplace for health plan options in California under PPACA regulation. Individual employees as well as small business employers can buy insurance at subsidized premiums under Obama care. Get a quick overview of all small group plans at no additional cost.

Important Points Regarding ACA (Affordable Care Act) and Small Business Health Insurance

Change of Rates for Small Group Medical Insurance after ACA

Prior to 2014, insurance plan rates were decided as per the employee’s age range. Thus, a fixed rate was selected for all age groups to cover the health care expenses. Similarly, age of spouse, number of dependents and children didn’t matter for selecting insurance rate. The group plan rate was same for every other dependent.

Now, its no longer the same after the Obama Care and Covered California plans. The health care plans premium rate is now calculated differently as per the age of individual, their spouse and children. Get the best health plan as per your household size.

Also, ACA removed the clause for checking pre existing medical conditions to decide the group health plan premium amount. Thus, the health benefits premium are now in a broad range of +-10%with respect to the standard premium rate in California. This has eliminated “Risk Adjustment Factor”. Now, same rate is offered irrespective of health conditions and the insurance plan pays for all medical expenses.

Metallic Level Plans and Standardized Benefits for Comparing Group Plan Benefits

To make health insurance less complicated and easy to understand, an AI-based computation system is used for comparing the coverage options. It tells you about the health benefits of the plan and percentage of money paid for expensive doctors visit and hospitalizations. Employees access the HMO plan and understand the other benefits before opting for the plan.

You get the “actuarial value” (AV) from the insurance company. Next the plans are sorted into different categories, They are:

  • Platinum Plan
  • Gold Plan
  • Silver Plan
  • Bronze Plan

The Platinum plans has the highest pay rate ( up to 90%) whereas the bronze plans cover at least 60% of the cost. The ACA doesn’t consider plans covering anything less than 60% of hospitalization expenses or excludes expensive doctors.

Affordable Doctor Visits and In-Network Hospitals for Reducing the Health Insurance Plans Cost

Health care costs vary from hospital to hospital. A few doctors who are highly speciated and having more than 30 years of experience charge more, whereas a primary care physician will charge less. Employees can save their out of pocket costs by selecting a group health plan policy which excludes doctors and medical care facilities which charge a lot. Don’t go for small group health insurance plan with higher deductibles even if the premium is for little contribution only.

So, always choose a “narrow” or “medium” provider for your health plan and try to spend less for the “full” network. United Health Care and Aetna are the insurance companies that offers small, medium or large health plans simultaneously to employees. Also, Blue Shield and Kaiser provide only single network. Insurance company like Health Net provides either full networks or narrow networks.

Choose only those health insurance companies whose insurance plan pays maximum medical expenses and patient pays the least. Check out Covered California for such plans.

Small Business Owners offering Variety of Health Plan Options

Health insurance needs vary from person to person. Thus, small employers can choose a health plan to meet employees needs and budget. Most employers provide medical insurance plan such as PPO or HMO; it can be from 4 different metal tiers like Platinum, Gold, Silver, and Bronze. Some employees need catastrophic coverage while others want cost effective coverage .

Many employers provide single HMO and PPO plans while others may offer 2-5 different group health plans and employee can choose the best one. But, insurance companies also offer greater than 20 medical insurance plans but the high cost is controlled by the small business employer.

Frequently Asked Questions About Health Insurance And Employee Benefit Plans in California

Here are brief answers to some frequently asked questions about California health insurance.

What Are the Benefits of Large Group Health Insurance Plans in California?

For organizations with more than 50 employees, large group health insurance is an excellent option. As you use this health insurance plan, you may find that it offers you coverage at an affordable price with a significant discount. Large group health insurance plans come with the following benefits:

  • Pre-existing conditions
  • Deductibles
  • Coinsurance
  • Employer-sponsored (funded) Medicare/Medicaid enrollment
  • Employee dental programs and coverage
  • Health Savings Accounts (HSAs)
  • Employee vision insurance and care
  • Employees’ drug coverage
  • Comprehensive healthcare strategy
  • Employees’ major medical expenses
  • Out-of-pocket expenses
  • Employee wellness initiatives

How Do Small Business Group Health Insurance Plans Work in California?

Health plans for small businesses in California operate in five different ways.

First, we have a conventional group health insurance plan for small and medium businesses. In return for providing health benefits to their employees and, in certain cases, their employees’ families, employers pay a specified healthcare insurance premium, a portion of which may be paid by employees.

Another type of health insurance plan is the Qualified Small Employer Health Reimbursement Arrangement (QSEHRA). Each month, employers can offer employees a specific amount of money in benefits (at their discretion).

You can also choose a Group Coverage Health Reimbursement plan. The employer provides group health insurance as well as a monthly allowance to cover deductibles, copays, and other costs. 

The risky nature of self-funded insurance plans is one of the reasons many individuals avoid them. The employer pays the employee according to the cost of prescriptions or medical bills rather than paying monthly premiums.

Finally, Associate Health Plans (AHPs) are an investment option that is slightly risky for small businesses. There is only one way to get AHP coverage: a collection of smaller companies from the same industry or region band together to buy large health insurance coverage from an insurance provider.

What Benefits Can Employers Offer in California?

In California, most employers provide health insurance that covers a range of medical treatments, including prescription medications, doctor’s appointments, and surgeries.

The cost of plastic surgery, for example, is not covered because it is deemed unnecessary. Furthermore, since most health insurance policies do not cover dental and vision care, these two aspects of health must be purchased separately.

How Much Do Employers Pay for Health Insurance?

Group health insurance plans allow employees to make contributions, regardless of their income. The average employee pays around $3240 per year, roughly three times less than the average cost of healthcare for Americans.

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