Author Archive

Keeping Employees Covered: Latest Carrier Actions

Carriers are taking substantive action to help employers maintain health coverage for their employees. Get the latest carrier information on maintaining coverage in the event of a:

• Furlough
• Reduction in Hours and Salary
• Relaxation of “Active at Work” (AAW) Requirements
• Return to Work and Relaxation of Waiting Period Requirements
• And More

Visit our COVID-19 Broker Resources for details on carrier actions to keep employees covered.

Questions?
Contact the small group experts at 800.696.4543 or info@claremontcompanies.com.

Families First Coronavirus Response Act (FFCRA)

The paid leave provisions of the Families First Coronavirus Response Act (FFCRA) became effective April 1, 2020. With many California small businesses subject to the new law, business owners are turning to their advisors for support in assessing and implementing it.

The information below will provide you with a high-level understanding of the new law’s provisions, the concerns of small business owners, and the resources available.

Summary

The Families First Coronavirus Response Act (FFCRA) requires certain employers to provide their employees with paid sick leave and expanded family and medical leave for specified reasons related to COVID-19. These provisions apply from April 1, 2020, through December 31, 2020.

The paid leave provisions apply to, among others, private employers with fewer than 500 employees.

Generally, covered employers must provide to employees who are unable to work due to qualified COVID-19 reasons:

1. Emergency Paid Sick Leave: up to two weeks (or a part-time employee’s two-week equivalent) of paid sick leave, paid at rates of pay based on the reason for the leave (illness, quarantine or school closures).
2. Emergency Paid Family and Medical Leave (EFMLA): up to twelve weeks of paid expanded family and medical leave to employees that are unable to work due to school closures.

The FFCRA provides employers refundable tax credits that reimburse them, dollar-for-dollar, for the cost of providing this leave.

Small Business Exemption: small businesses with fewer than 50 employees may qualify for an exemption to provide leave for the school closure reason if the leave requirements would jeopardize the viability of the business. The rules governing this exemption are quite specific.

Small Business Owner Concerns

While small business owners are trying to best accommodate the health and leave needs of their employees, many are concerned about the burden that the law’s provisions – especially the 12 weeks paid expanded family and medical leave – will place on the viability of their business. And for this reason, many owners of businesses with fewer than 50 employees are also showing strong interest in the “fewer than 50 employees” exemption.

Below are some resources that will help you help your small business clients navigate the FFCRA.

Resources

US Department of Labor (DOL) has published a COVID-19 resource page to provide employers with information on, among other issues, the paid sick leave and expanded family and medical leave provisions of the FFCRA, including:

• Fact sheets on FFCRA employee paid leave rights and FFCRA employer paid leave requirements.
• A comprehensive series of more than 50 FAQs to help businesses and their advisors. The FAQs address questions including:
  • How to determine if a business is subject to the law.
  • How to calculate the number of hours of leave, and the rate of pay, when calculating the paid leave.
  • How to take advantage of the “small business” (under 50 employees) exemption.
• Links to FFCRA posters that covered employers are required to conspicuously post in the workplace: either on the premises, on the employee website, or emailed or direct mailed to employees.

This helpful FFCRA flow chart (courtesy of Filice Insurance Agency) provides a visual step-by-step guide to assessing if an employer and employee are subject to the FFCRA provisions

Visit our COVID-19 Legislation & Regulations FAQs for answers to frequently asked FFCRA questions from brokers and their small business clients.

Claremont’s HR Partners Mammoth HR and HR Service, Inc. both provide resources to help small businesses with the FFCRA.

Questions?
Contact the small group experts at 800.696.4543 or info@claremontcompanies.com.

Member Options for Accessing Care

As the Coronavirus continues to advance, many employees are left feeling nervous and anxious. To help quell growing fears and cope with uncertainty about the Coronavirus, employers should educate employees on prevention and symptoms, and make them aware of the many options for accessing care through their health plan.

Both Blue Shield and UnitedHealthcare provide helpful resources that outline the options for accessing care.

Blue Shield members can access care through urgent care centers, Heal, Teladoc, virtual visits, NurseHelp, CVS MinuteClinic, and more.

So Many Options for Care
A guide on how to access the many different care options and the cost implications for PPO and HMO members.

Heal On-Demand Physicians
A service that lets you see a doctor at a time and place that’s best for you. Schedule visits from 8 am – 8 pm, 365 days a year. A medical assistant travels with the physician on these visits.

• Primary, preventive, or urgent care services are available.
• Heal physicians are all contracted in the Blue Shield PPO network.
• The Heal co-pay matches a traditional office visit.
• Phone, online, and Heal app access for appointment scheduling.
• Available to Blue Shield PPO members with coverage through Covered California as well as direct.
• Remote house calls for COVID-19 by phone or video.

Teladoc
Embedded in all small group plans, Teledoc provides convenient physician visits via phone or video conference. The changes below are effective January 1, 2020:

• Copay change to $0 on all Tandem PPO and Trio HMO Plans On/Off Exchange.
• The standard copay for all other PPO/HMO, non-PSP plans, On/Off Exchange will remain at $5.
• The copay for all PSP plans will increase from $40 to $45 until the deductible is met; after the deductible is met, the copay is $5.
• How-to Video on how to use the mobile app to talk to a doctor.

Member Coronavirus Resources
The latest COVID-19 updates, help with COVID-19 coverage, telehealth options, emotional health, and more.

Heal
Provides on-demand doctor house calls from 8 am to 8 pm, 7 days a week. Book a house call with a licensed, vetted doctor. In-network with CA PPO Select Plus and Core members. Only available in select cities, visit heal.com for more details.

Telehealth Options

• Telehealth visits through UnitedHealthcare’s preferred telehealth partners including Teledoc®, Doctor On Demand™, and AmWell®.
• Telehealth visits through the member’s local providers.
• UnitedHealthcare is waiving cost-sharing for:
  – COVID-19 telehealth test-related visits and treatment.
  – Until June 18, 2020 – 24/7 Virtual Visits with preferred telehealth providers Teladoc®, Doctor On Demand™, and AmWell®.
  – Until June 18, 2020 – in-network, non-COVID-19 telehealth visits.

Emotional Health Support

UnitedHealthcare’s free 24/7 emotional support line is available to anyone, not just members, to call any time at 866-342-6892. This Optum Help Line is staffed by professionally trained mental health experts. It is free of charge and open to anyone.

Sanvello, a free on-demand emotional support mobile app, is available to help members cope with stress, anxiety, and depression during the COVID-19 pandemic.

Questions?
Contact the small group experts at 800.696.4543 or info@claremontcompanies.com.

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Help Your Clients Fund Their Benefits with The New Federal Paycheck Protection Program

No-Cost, Forgivable Government Loans

Good news. Your small business clients can continue to pay employees and fund their benefits through new no-cost, forgivable government loans.

The new loans are available through the Small Business Paycheck Protection Program, part of the CARES Act that became law on March 26, 2020. These loans are for employers with fewer than 500 employees. Depending on the employer’s use of the loan, up to 100% of the loan may be forgiven.

Depending on your business structure your business may too be eligible for Paycheck Protection Program loans.

Gain a high-level understanding of the new Paycheck Protection Program, ensure your small business clients are aware of the program and be positioned to provide resources. Claremont is here to help you with the information you need now.

Summary: Small Business Paycheck Protection Program

At its core, the Paycheck Protection Program provides federally-backed loans to small businesses that are forgiven as long as payroll costs are maintained equal to what they were before the Coronavirus impacted the business. Many financial experts are explaining that in essence, the loans become grants if the business maintains its payroll costs.

• Funding amount. Payroll costs for up to 8 weeks plus an additional 25%, capped at $10 million.
• Funds can be used for:
  • Payroll.
  • Employer health insurance premium contributions and other benefits costs.
  • Rent, mortgages, and utilities.
• Fully Forgiven. Funds are provided in the form of loans that will be fully forgiven when used for payroll costs, interest on mortgages, rent, and utilities, provided the employer maintains their payroll at a level equal to what it was before the Coronavirus impacted the business.
• Loan Payments/Interest. If the loan must be repaid, payments will be deferred for six months. The loan has a 0.50% fixed interest rate.
• Collateral/Fees. No collateral or personal guarantees are required. Neither the government nor lenders will charge small businesses any fees.
• All Small Business Eligible. Small businesses with 500 or fewer employees—including nonprofits, veterans organizations, tribal concerns, self-employed individuals, sole proprietorships, and independent contractors. Businesses with more than 500 employees are eligible in certain industries.

You can find more details in the Resources section below.

Next Steps

1. Start the conversation with your small business clients about how they can best continue providing benefits to employees.
2. Advise your clients that benefits can be funded through the Paycheck Protection Program. Provide them with the resources below.
3. Recommend to your clients that they talk through the available assistance with their financial and banking advisors.
4. Let us know if there is any way we can assist. While we are not licensed to provide financial or tax advice, we may be able to help in other ways, including if you or your clients have questions about how to maintain employee benefits. Contact us at covid@claremontcompanies.com.

Resources

The US Chamber of Commerce Paycheck Protection Program guide helps small businesses understand the Paycheck Protection Program and file for a loan.

The US Department of the Treasury  Paycheck Protection Program web page includes several helpful resources, including a Paycheck Protection Program Factsheet for Borrowers that provides even more details.

The US Small Business Administration (SBA) Paycheck Protection Program web page provides information on the program, who can apply, how to apply, loan details and forgiveness, and more.

Claremont Insurance Services and its affiliates do not provide tax, legal, or accounting advice. This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, tax, legal, or accounting advice. You should consult your own tax, legal, and accounting advisors before engaging in any transaction.

Questions?
Contact the small group experts at 800.696.4543 or info@claremontcompanies.com.

Zero Cost-Sharing Coronavirus Screening and Testing

Late last week California regulators issued guidance requiring all commercial health plans to provide coverage for medically necessary Covid-19 screening and testing at zero cost-sharing.

All major California carriers have since announced their zero cost-sharing coronavirus policy. Get the details.

Get The Details

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

Heal: Physician Home Visits Through Blue Shield and UnitedHealthcare

The Coronavirus health concern is resulting in more employees and their dependents staying home, either for work or as a health precaution. Now is a good time for employers with a qualifying Blue Shield or UnitedHealthcare plan to remind employees of the availability of physician home visits through Heal.

Heal lets members see a doctor at a time and place that’s suitable for them. Using the Heal app, members can schedule a licensed pediatrician, internal medicine doctor, family practitioner or general practitioner to come to them on their schedule.

Heal is available to members enrolled in qualifying plans in certain geographical areas. To learn more, download the Blue Shield and UnitedHealthcare product brochures.

Questions?
Contact the small group experts at 800.696.4543 or info@claremontcompanies.com.

Reliance Standard Voluntary Benefits Insights

Designing benefits plans to help workers manage and maintain their health and finances — and thus remain engaged and productive at work — is a top priority for companies around the globe.

Employers understand that their benefits can be instrumental in shaping the type of organization they are and the way their employees — and their peers — perceive them.

The challenge of providing benefits that satisfy everyone is leading employers to reassess their benefits packages to provide greater benefits choice and flexibility to meet a growing and broader range of needs. The good news – technology advances are reducing some of the roadblocks associated with providing greater choice with the emergence of flexible and streamlined administration platforms that enable a more efficient and customized benefits delivery approach.

Challenges

According to the Willis Towers Watson 2019/2020 Benefit Trends survey, the key challenges facing employers are:

• The rising cost of employee benefits is cited as a key concern by 79% of employers in North America. As health insurance premiums see more price hikes, traditional health coverage no longer provides a financial shield against a health crisis.
• The differing wants and needs of a multi-generational workforce is the second key challenge, with over half of employers citing this as a critical problem.
• Communication with employees around benefit choices is an issue for 52% of employers.
• Lack of employee engagement with benefit programs is a core challenge for 45% of employers.

Opportunities

Employers plan to add more voluntary benefits. 

• 42% of employers offer voluntary income protection benefits, such as accident and critical illness.*
• 69% of employers plan to offer more voluntary benefits over the next three to five years.*

For brokers, this means there’s a great opportunity to win more sales. These benefits can be essential to employee recruitment and retention plans, especially with today’s record-low unemployment numbers.

Employees are seeking better choices.

• 79% of employers are broadening or enhancing their benefits portfolio.*
• Employee choice is driven by voluntary benefits, choice in benefit levels and flexible benefits.
• Tools that support benefit choices and help make informed decisions are being used to drive employee engagement and support benefits decisions for 60% of employers.*

To mitigate the bad news of rising healthcare costs during enrollment and offer the financial protection employees desire, offer them the choice of voluntary benefits.

More interest expected from younger workers.
As millennials and generation Z employees try to protect their assets, there’s an increased interest in voluntary benefits. When explaining the value of voluntary benefits to these savvy consumers, show them how they can offer a financial shield and cite examples that are relevant to their lifestyles.

Solutions for multi-generational workplaces.
Today’s workplaces can include up to five generations. From the silent generation (born in 1945 or earlier) to Generation Z (born in 1995 and after). Addressing the diverse wants and needs of today’s multi-generational workforce is a top challenge worldwide. Voluntary benefits can be the solution that addresses the needs of all generations, protecting wealth at any stage of life.

If benefits packages are to meet the individual needs of today’s multi-generational workforce, employers need to protect core benefits while offering flexibility and choice. Today’s employment deal will need to evolve to encompass a broader range of employee benefits, including voluntary as well as workplace perks. Download the flyer for details.

To learn more about Reliance Standard’s integrated and flexible group voluntary benefits and services, check out their microsite. For articles on topics such as “Growth Opportunities in The Voluntary Insurance Market” and “Why Small Businesses Should Offer Voluntary Benefits,” visit the Reliance Standard Knowledge Center.

To meet your business goals, contact us for a customized Reliance Standard quote today!

Questions?
Contact the small group experts at 800.696.4543 or info@claremontcompanies.com.

*Willis Towers Watson’s 2019/2020 Benefit Trends survey.

Beam – A Unique Approach to Dental Benefits

Valued by both employers and employees, Beam Dental offers:

• All members a complimentary smart toothbrush, toothpaste, dental floss, and the Beam app through Beam Perks.
• Easy dental benefits management for employers through the Beam Lighthouse technology platform.
• Employer savings of up to 15% at renewal, with member dental hygiene, through SmartPremiums.
• A Member Portal to view plan information, print insurance cards, view claims data, and more.
• The Beam App for members to view their insurance card, find a dentist, control brush settings, etc.
• Quality vision coverage through VSP, with frame allowance options up to $250.

Plan Options

Beam offers a range of plan options designed to fit the needs of every employer, including:

• Smart: 100/80/50 plan: Endo-perio-oral is surgery covered under Major.
• Plus: 100/80/50. Endo-perio-oral surgery is covered under Basic. Adult/child ortho options come with a $1,500 lifetime max.
• Select: 100/90/60/50. Up to $2000 annual maximum. Adult/child ortho options are available with a $2,000 lifetime maximum.
• Ultra: 100/100/80/50. Up to a $5,000 annual maximum. Adult/child ortho is available with a $2,000 lifetime maximum. (Available to groups with 10+ enrolled eligible employees.)

Plan Highlights

• 90th UCR Out-of-Network (OON) standard, upgradeable to 95th UCR.
• Dental and vision bundles with VSP.
• Large Max and Unlimited Ultra plans available.
• No downgrades on composites.
• Available for 2+ enrolled eligible employees.
• Rate cap or 2-year guarantee available on request.
• Child Ortho at 5+ with 5 enrolling (standard plans) or 10+ for custom plans.

Standard Provisions

• Annual open enrollment.
• No waiting periods unless requested.
• No missing tooth clause.
• Implants are covered.
• Occlusal (night) guards.
• 90th, 95th, MAC options for OON.
• Composites on posterior teeth covered on all dental plans, porcelain material covered on posterior teeth with no downgrades.
• Standard 12- month rate lock.

Network

• A nationwide industry-leading network with 325,000+ access points, comparable to most major dental carriers.
• Participates in the top nationwide networks such as First Dental Health, DenteMax, Stratose, and Plusnetwork.
• Provider reports are available upon request.
• 90th percentile UCR OON standard. 95th percentile UCR OON available as an option.
• Learn more about the network.

Quality Vision Coverage Available Through VSP Vision Care

• VSP Choice Network and plans.
• $150, $175, $200, $250 frame allowance options.
• Available for 2+ eligible enrolled employees if bundled with dental.
• Beam handles enrollment, billing, and ongoing account management. VSP handles claims and support.
• 24-month rate lock.

Beam Perks

Every Beam member receives complimentary Beam Perks. The member welcome kit contains a sonic-powered, smart, electronic toothbrush, custom formulated toothpaste, dental floss, and access to the Beam App and Member Portal.

• Delivered every 6 months, enrolled members in every plan receive a Beam Perks kit that includes replacement heads and batteries, toothpaste, and dental floss.
• Beam’s smart toothbrushes sync with the Beam Dental App scoring dental hygiene to help lower the group’s pricing at renewal.

SmartPremiums

Beam’s SmartPremiums help groups save up to 15% at renewal. When members use the Beam Brush, the group earns a Beam score. The better the group’s Beam score, the lower the group’s premium at renewal.

Premium reduction occurs at renewal (plan year or calendar year) and is based on the group’s aggregate Beam score, prior year claims data analysis, and changes in dentist reimbursement contracts.

Start quoting Beam today and take advantage of the features, benefits, and savings!

Questions?
Contact our small group experts at 800.696.4543 or info@claremontcompanies.com.

Are You Capitalizing on The Health Care Tax Credit?

Cost concerns continue to be one of the top health care challenges for small businesses.

Address employers’ cost concerns with the Health Care Tax Credit, which provides employer savings of up to 50% on health care premiums for up to two years. Maximize your clients’ savings by moving to them into a Covered California for Small Business plan this year.

Start by estimating the amount of tax credit your clients can realize. Then use our simple turnkey Health Care Tax Credit Solution to ensure your clients get the most for their health care dollars.

Results We’ve Seen So Far:

• 75% qualified for the tax credit.
• Nearly 25% of those purchased coverage after reviewing the tax credit report.
• $5,800 was the average credit received.

Bring the Tax Credit value to your clients.

Partner with Claremont for:

• Help understanding employers’ needs to deliver the right benefits solutions.
• Assistance with small group sales, enrollments, and renewals.
• Actionable solutions and practical tips, such as:
  – Advantages for Agents and Employers
  – Agent Resources
  – Health Care Tax Credit Solution
  – Top 20 Lowest Cost Medical Plans
• Expertise and support behind the scenes — all at no cost to you.

Claremont has been a trusted CCSB partner since its 2014 launch, and we are the top producing general agency in our sales territory. From agent certification and quoting to assessing new group eligibility and resolving post-enrollment issues, our CCSB experts will provide guidance and support every step of the way.

Questions?
Contact the CCSB small group experts at 800.696.4543 or info@claremontcompanies.com.

Broker Commission Schedules by Carrier

Click on the carriers below to view their commission schedule for 2017:

• Blue Shield of California
• Chinese Community Health Plan
• Covered California for Small Business
• UnitedHealthcare

Blue Shield Specialty Products: 10%
Download the Blue Shield Commission Schedule.

*When annualized premium for a single group reaches $500,001 or more in a contract year, the commission is reduced to 1.0% for amounts over $500,001 for that group.

The sole factor to determine the applicable commission schedule for all groups is the number of enrolled employees in the employer group at the time the employer group enrolls in coverage through Covered California for Small Business.

For Specialty Benefits Commissions download the Schedule.

Please Note:
• The enrolled employee count is re-evaluated at each renewal.
• Existing cases that have effective dates before January 1, 2016, will remain on the commission schedule that is in effect as of their original effective date.

Questions?
Contact the small group experts at 800.696.4543 or info@claremontcompanies.com.