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Group Health Insurance

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 California is moving forward with a “full speed ahead” attitude whether PPACA gets repealed or not.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