We work with all major health plan carriers approved in California to meet the guidelines of the Affordable Care Act.
Small Group ACA plans in California use a standardized tiering system to denote richness of benefits (Platinum, Gold, Silver, Bronze). All plans have an in-network out of pocket maximum that caps the members’ annual financial liability.
Health Maintenance Organization (HMO) Plans require members to seek services from the Primary Care Physician (PCP) or specialist associated with the medical group the member has chosen. The PCP directs patients to specialists within the HMO network. Members are typically restricted to see providers within a certain radius of their home.
Preferred Provider Organization (PPO) Plans offer benefits in or out of network, but the member benefits most from using network providers. PPO plans offer flexibility in seeing providers throughout the state, and often out of state.
HSA compatible health plans (also known as High Deductible Health Plans, HDHP) require the member to meet a high deductible before a coinsurance or copay may be charged. Enrolling in an HSA compatible plan allows the member to deposit funds into a Health Savings Account, which has tax advantages. Each year, the IRS specifies the terms of the health plans and the contributions. It is important to speak with a tax advisor prior to enrolling on this type of plan. Note that HSA funds belong to the member and roll over year to year (no “use it or lose it”).
Health Reimbursement Arrangement (HRA) plans are less common but like the HSA, offer tax incentives for the member and employer. The employer makes a contribution to the HRA, and the member must use the HRA funds or they may expire.
Covered California for Small Business (CCSB) is the public small business health plan exchange in California, in operation after ACA legislation. This exchange offers both PPO and HMO plans (including Kaiser). Certain businesses may qualify for the small business tax credit. We can help you determine if your company qualifies, or if CCSB may be right for your company.
CaliforniaChoice has been California’s small business exchange since 1996. This very popular health plan exchange gives the employer and employees access to a wide range of HMO and PPO plans, including Anthem Blue Cross, United HealthCare, Kaiser, Sutter Health Plus, Western Health Advantage with Canopy Health, and more.
The PEO Model – TriNet. Larger employer groups looking for a PEO (Professional Employer Organization) will find a solution with TriNet. Tasks such as employee benefits, payroll and workers’ compensation, recruiting and more can be outsourced to the PEO. Within a PEO, Tri-Net becomes the employer of record for tax and insurance purposes (also known as co-employment). We work with Tri-Net when the situation is right for the client, to offer a comprehensive and strategic solution.
Finding the right dental and vision plan for a group starts with understanding your needs and network, and this is always where we begin. Dental and Vision plans can be offered as employer sponsored or as voluntary, and can be offered stand-alone or within your medical plan offerings.
Dental Plans are among the most appreciated employee benefits, offering 100% covered preventive and diagnostic services which can be keys to finding health conditions such as heart disease and diabetes. Most dental plans offer in-network contracted rates for basic and major dental services, which greatly reduce the member’s out of pocket expenses. We work with all the top carriers such as Delta Dental, Guardian, MetLife, Ameritas and more.
Vision Plans provide members with annual routine exams and coverage for materials such as frames, lenses, contacts and more. Vision exams help to diagnose eye diseases such as glaucoma and cataracts, as well as early stages of other chronic illnesses including high blood pressure and high cholesterol. Members often receive discounts on sunglasses and LASIK.
Term Life Insurance provides employees with some financial security for their loved ones in the event of a critical illness or death. Employer sponsored plans are 100% employer paid and 100%
Key Person Life – Is your company prepared for a worst-case scenario? Key person insurance an important form of business insurance. It is similar to life insurance as it pays out to a beneficiary, but in this case the company or investor in the event of the loss of the key person (owner or principle). Some policies also offer coverage for illness as well as short- or long-term disability. These policies are usually owned by the business and the purpose is to protect against the loss of the key income generator.
Short Term and Long Term Disability Insurance can be critical to an employee who is unable to work due to a qualifying illness or injury, in order to maintain cash flow on a temporary or longer term period. California has a state Short Term Disability (DIS) program, but not all states are alike. Some employers are required to provide this benefit by purchasing a plan. When an employee is unable to return to work beyond the limits of the short term disability program, a Long Term policy can pay the employee for a few years, up to age 65 or even for life.
Voluntary Benefits – Most employee benefits include a contribution by the employer. If your budget doesn’t allow, there is a great alternative. Voluntary and value-added benefit can be offered to provide a one-two punch solution to build a productive, engaged workforce, and will help alleviate the stress of an emergency medical bill. We work with recognized name carriers such as Aflac, Unum, and Colonial Life to protect an employee with a cash benefit should there be a critical illness, hospitalization, emergency, or cancer. Other types of voluntary benefits can include dental and vision, life insurance, and disability insurance. These plans can be purchased by the employee through the employer as a payroll deduction, often at discounted rates.