In 2014, California Choice will change their plans and requirements in the 1-50 employee market

Below are the updates from the Northern CA California Choice Broker Meeting. These updates were provided by the President & CEO, Ron Goldstein and National Vice President, Kevin Timone: California Choice has been around for 17 years. California Choice will be the most competitive small group (1-50 employees) private medical exchange in California next year. Aetna HMO is being added as a carrier for January 1, 2014. Health Net and Anthem will offer PPO coverage as well. California Choice will offer broad network access; limited and full networks side by side.  This is a huge advantage over Covered CA since the CA state exchange is offering a limited network with Blue Shield. Covered CA will not have as many options as California Choice. Kaiser will have same network and same premium with CA Choice and Covered CA’s SHOP in every plan. Therefore, Kaiser direct groups will now be able to offer Aetna, Anthem Blue Cross, Health Net, Western Advantage and Sharp in 2014 at no additional cost. Minimum employer contributions will remain the same. The employer will pick a metal tier at a minimum contribution of 50% or fixed $100 or may offer a higher contribution. Kaiser HSA plans will be available. Risk Adjustment Factors (RAF’s) will be removed. Underwriting enhancements: if case is clean and received by 20th of the month then all employees will receive ID cards by the 1st of the following month. California Choice is partnered with Ovation payroll. When a new hire is added or employee terminated an email is sent to broker to contact the business to set up or terminate benefits. Some additional benefits...
What is your worse case or out-of-pocket maximum next year? It could be double…

What is your worse case or out-of-pocket maximum next year? It could be double…

The Affordable Care Act’s (ACA) out-of-pocket maximum provision goes into effect starting in plan year 2014. The limits of the allowed out-of-pocket maximum through Covered CA and the private medical insurance market are $6,350 for an individual and $12,700 for a family. The grace period that the government has announced applies only to Covered CA and private health plans that use more than one entity to provide benefits and where each policy carries its own out-of-pocket maximum. The most common example is when there is a separate medical plan and prescription plan. In these instances, the major medical plan will be subject to the out-of-pocket maximum limit and the other benefit plan (such as the prescription care plan) will be subject to its own out-of-pocket maximum of $6,350 for individuals and $12,700 for families. Essentially, for these specific cases and for one year only (until plan year 2015), the government is allowing double out-of-pocket maximums. The reason for this delay in fully implementing the out-of-pocket maximum is that these different health benefit providers have not yet been able to coordinate how to establish separate plans with one out-of-pocket maximum. As with many aspects of the Affordable Care Act, there likely will be more changes. The good news is Bedrosian & Associates will be here to provide you with the most up-to-date information as it becomes...