ACA “Family Glitch” Updated Rules Announced by IRS

On October 11, 2022, the Internal Revenue Service (IRS) announced updated rules designed to fix the Affordable Care Act (ACA) “Family Glitch.” The change impacts family health coverage options for hundreds of thousands of lower-income Californians currently enrolled in group family coverage. The updated rules come into effect for 2023 coverage.

As you conduct open enrollment meetings with your clients, you will likely get questions from employees, so you’ll want to familiarize yourself with the updated rules.

Learn more or contact us for help navigating these changes with your clients.

Q1-2023 Plan and Rate Updates

LocalPlus® Network Updates

• National Network Enhancements:
  • Effective 7.1.22 for new and existing business
    (effective 4.1.22 with CalChoice).
  • LocalPlus can now be offered to out-of-area members as long as they reside in a LocalPlus service area.
  • Lower cost options for OOO members.
  • More competitive option for renewals.
• Expanding PPO Products with LocalPlus - Effective 1.1.23:
  • LocalPlus and Open Access Plus networks will be available as a PPO product within Cigna + Oscar direct. Includes full access to Open Access Plus network, OON benefits, and no PCP referrals.
  • CalChoice offers LocalPlus and Open Access Plus networks as EPO product only.

Underwriting

• 51% eligible in CA. 1 enrolled living in CA service area.
• No DE9C down to 3 enrolled.
• 4 plans allowed. Any 4 plans, any tier, and any network combination.
• Most flexible for startups/virgin groups.
• Can be paired alongside any other carrier and any other plan type.
• 60% overall participation, only 3+ needed to enroll.

Rates

• 3.6% average increase from Q4 to Q1.
• Average 10-12% premium savings when offering LocalPlus vs Open Access Plus.

2023 Small Group Plans

• 2 new Bronze plans: Bronze $3,000 and Bronze $7,250.
• All plans offer employees the choice between LocalPlus and Open Access Plus networks.
• 20 plans across all metal tiers, including 2 HSA plans.
• Industry-leading mobile app and member portal.
• Member ID card enhancements.
• Cost savings tools: virtual urgent care, prescriptions, care routing and provider search tool, and Step Rewards Program.
• Dedicated Care Team and HIPPA.

Prior Carrier Deductible and Maximum Out-of-Pocket Credits

2023 Bonus Program
This Q4, earn a bonus for writing multiple groups with 12.1.22, 12.15.22, and 1.1.23 effective dates.

• Tier 1: Earn $250 when you sell 1 group with 4+ enrolled.
• Tier 2: Earn $500 when you sell 3 groups with 4+ enrolled.
• Tier 3: Earn $1,000 when you sell 5 groups with 4+ enrolled.
• Maximum payout: $1,750 for hitting all three tiers.

Get the details and contact us today for a Cigna + Oscar quote!

Cigna + Oscar Broker Webinar

Join the Cigna + Oscar (C+O) California sales team for an overview of important updates for the first quarter. Learn about their pricing, 2023 portfolio, network updates, and more!

Webinar: Thursday, October 20, 2022, 9:00 am – 10:00 am PT

Space is limited. Register now!

With rates comparable to Kaiser, and networks that include Dignity Health, UCSF, Stanford, and Sutter, Cigna + Oscar brings together the power of Cigna’s nationwide and local provider networks, and Oscar’s member-focused tech-driven experience, to deliver small group health insurance that meets the unique needs of California small businesses and their employees.

Q1-2023 Plan and Rate Updates

Summary

• Cigna + Oscar (C+O) is available out-of-state.
• 2 new Anthem Priority Select plans.
• 6 new UnitedHealthcare plans with benefit parity across multiple networks in Platinum/Gold.
• UnitedHealthcare Harmony Network expands into Northern California.
• New Health Net Gold plan.
• New Kaiser Permanente Gold plan.

2023 Plan Updates

• 20 new medical plans: new networks from Anthem Blue Cross, C+O, Health Net, and UnitedHealthcare in all 4 metal tiers.
• 2 new networks: Open Access Plus is a new full network from C+O and SmartCare is a new network from Health Net.
• More choice: your clients can choose from more networks and plans for January 1, 2023.

Employer-Friendly Budgeting – Defined Contribution

The Member Marketplace (Coming Soon)
Additional products and services from MetLife, such as accident, hospital indemnity, and critical illness coverage, and legal plans.

Special Enrollment Period (SEP)
For coverage effective January 1, 2023, your clients must enroll between November 15th and December 15th. And they must still meet the small group employer qualifications.

Learn more, see the recorded webinar, and get a CalChoice quote today!

Q1-2023 Plan and Rate Updates

Below are the updates announced by Blue Shield of California. Make sure to take advantage of the Small Business Incentive Program and the Renewal Rewards Program.

Q1-2023 Rates

• Rates are now available for quoting through PRISM, our free and easy online quoting system.
• The Q1-2023 rate action is a statewide average of 2.1%.

Medical Plan Updates

• On and off-exchange plans have minimal cost share changes which will impact the plan names for 2023.
• The Bronze HMO 7000/70 for 2022 is only available on the Trio network. For 2023, the plan will be expanded and available on the Access+, Local Access+, and Trio network.
• Effective January 1, 2023, the Trio ACO HMO network will expand to include additional parts of Monterey.

Plan Comparison Tool and Network Comparison Tool
To help support your open enrollment meetings, learn about Blue Shield's broker-friendly digital tools.

Specialty Plan Updates
8 new dental PPO plans will be added.

Teladoc
Blue Shield members have access to Teladoc’s national network of doctors 24/7/365 by phone or video.

Relaxed Participation Program - extended through December 31, 2023.

2023 Broker Roadshow Recording, Slides, and Q&A
If you missed the recent Blue Shield of CA Q1-2023 Small Business Broker Roadshow, view the recording, presentation slides, and Q&A.

Broker Bonus Programs

• Earn points for qualified sales with the Small Business Incentive Program extended through June 30, 2023.
• Earn points for qualified Tandem PPO plan sales and additional points for dental, vision and/or life plans with the Renewal Rewards for Producers Program.
• Groups written through Claremont are eligible for both programs.

Get the details and contact us today for a Blue Shield quote today!

New Broker Bonus Program

Earn a Kaiser Permanente $100 bonus, per enrolled subscriber, when you sell new small group business through CaliforniaChoice or Covered California for Small Business, December 1, 2022 - January 1, 2023 effective dates.

Examples

1. Earn a $5,000 bonus when you sell a new group with 61 employees and enroll 50 subscribers with Kaiser Permanente.
2. Earn a $900 bonus when you sell a new group with 10 employees and enroll 9 subscribers with Kaiser Permanente.

This bonus is on top of your regular commission and standard broker reward programs. Get the details and contact us today for a quote.