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Starting July 1, Covered California for Small Business (CCSB) is offering new Blue Shield plans, providing more options for enrollees. These plans include the Access+ HMO Network with Platinum, Gold, and Silver metal tier options, as well as the Bronze Trio HMO 7000/70. The two most popular Blue Shield High Deductible Health Plans (HDHP), Silver Full PPO Savings 2300/25% and Bronze Full PPO Savings 7000 plans, are also now available.
All of these plans offer benefits such as Wellvolution, Teladoc Mental Health, Nurse Help 24/7, LifeReferrals 24/7, and the Blue Card program for when members are outside of California.
For assistance, please contact our Quotes team at quotes@claremontcompanies.com or 800.696.4543.
Login To PrismArticle last updated: March 19, 2024.
Most of your clients likely have upcoming deadlines under the federal prescription drug benefits reporting (RxDC) requirements. Here’s a summary of the requirements, how carriers are helping, and the deadlines.
Under Section 204 of the 2021 Consolidated Appropriations Act (CAA), insurance companies and employer-based health plans must submit information regarding prescription drug benefits and health care spending. The information must be submitted to the Centers for Medicare and Medicaid Services (CMS) by June 1st of each year for the prior year’s coverage.
According to the CMS, the information that is required to be submitted by insurance companies and employers are:
Blue Shield will collect D1 Premium information from groups between February 5, 2024 and April 19, 2024. Blue Shield will also submit D2 for all groups and D3-D8 for groups with prescription drug benefits under a Blue Shield health benefit plan, and P2 accordingly. If a group does not have prescription drug benefits with Blue Shield, they should coordinate submission of D3-D8 with their pharmacy/prescription drug benefits carrier, and P2 accordingly.
Key Details
Other Details:
Information Requested
Due to technical issues on their end and updated guidance from CMS about the 2024 submission, below are revised dates:
UnitedHealthcare will complete the CAA Prescription Drug (RxDC) reporting for its fully insured and self-funded/level funded groups, including those with OptumRx as the integrated PBM. However, groups with these will need to complete the Request for Information (RFI) tool for RxDC reporting between February 1, 2024, and March 31, 2024. The March 31, 2024, deadline is firm.
To support its customers with this important filing, UnitedHealthcare will be submitting the P2 (Group Health Plan), D1 (Premium and Life Years) and D2 (Spending by Category) files for all employers who had active coverage during the reference year (2023). However, completion of the submission requires gathering some information not currently maintained in their system.
UnitedHealthcare will also submit the D3-D8 data files for customers with OptumRx as an integrated PBM. UnitedHealthcare has access to all data required to complete the submission of the D3-D8 data files. Customers who use any other PBM, including OptumRx Direct, must work with that PBM to submit the D3-D8 files.
Resources
Kaiser Permanente is required to submit information on prescription drugs and healthcare spending to CMS. On February 1, 2024 Kaiser Permanente began to send out a survey form from Kaiser-Permanente-RxDC@kp.org to all contract signers to request this information. The form must be completed by March 15, 2024.
Information Requested
Kaiser Permanente plans to submit all applicable reports and required responses for all employer groups to CMS by the June 1, 2024 deadline.
Employer groups must submit information to Sutter Health Plus regarding the average monthly premiums paid on behalf of enrollees and the amount paid by enrollees each year.
For calendar year 2023 reporting, employers or brokers are to submit the required information through the online Premium Reporting Form.
Submissions are due no later than March 1, 2024.
Cigna is reporting on behalf of Cigna + Oscar groups, so no action is required by employer groups or brokers.
Covered California for Small Business (CCSB) serves as an administrator of their participating Health Plan Issuers and is not an insurance company nor an employer-based health plan. Therefore, CCSB is not subject to RxDC data collection requirements on behalf of their employer groups. Claremont recommends that the employer follow the reporting guidelines for the enrolled carrier(s).
CCSB Resources – CCSB’s Small Business Service Center is available to help with questions at 855.777.6782.
CaliforniaChoice serves as an administrator of their participating Health Plan Issuers and is not an insurance company nor an employer-based health plan. Therefore, CaliforniaChoice is not subject to RxDC data collection requirements on behalf of their employer groups. Claremont recommends that the employer follow the reporting guidelines for the enrolled carrier(s).
The carriers are taking action to support your clients with the federal reporting requirements. In order to do so, they require information from each employer group. Look out for emails directly from the carriers, and follow their instructions. If you or your clients have questions, we can help direct you to the right contacts at the carriers.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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View the webinar on-demand to learn what’s new and changing for 2024, important health plan updates and reminders, the marketplace, and what you can expect from CaliforniaChoice. Below is a brief summary of what was covered in the webinar.
Eight health plans, 136 different plan designs (HMO, PPO, EPO and HSAs) and 20 different provider networks.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
Staying current in the evolving health insurance landscape is key to your success. To get exclusive need-to-know updates for January 1, 2024, join the CaliforniaChoice broker webinar on October 11th at 10:00 am.
This 30-minute webinar will give you:
By attending, you’ll gain exclusive intel to outpace your competitors in 2024. And you’ll leave informed and equipped with the knowledge to thrive next year and beyond.
Register now for this must-attend webinar! Seats are limited.
What makes CaliforniaChoice different for your clients:
With CaliforniaChoice, employees get:
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Get The Latest News with Text Messaging!
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
Earn a Kaiser Permanente $100 bonus, per enrolled member when you enroll at least 10 members from a qualified, new small group through CaliforniaChoice, Covered California or Kaiser Small Business. October 1, 2023 – January 31, 2024 effective dates.
Earn a $2,100 bonus when you sell a new group with 30 full-time employees and enroll 21 new members with Kaiser Permanente.
21 enrolled members x $100 = $2,100.
This bonus is on top of your regular commission and standard broker reward programs such as the Total Replacement and Group Production rewards. Download the flyer for details.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Get The Latest News with Text Messaging!
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
Sutter Health Plus is now accessible to employees, regardless of their employer’s location, for new and renewing CaliforniaChoice groups effective October 1, 2024.
Example: Employers located in Los Angeles County, outside the Sutter Health Plus Service Area, can now offer Sutter Health Plus coverage to their employees who are located within the service area. This option is especially appealing to employees seeking access to esteemed healthcare providers like Brown & Toland Physicians, Mills-Peninsula Physician Network, Palo Alto Medical Foundation (PAMF), Sutter East Bay Medical Foundation and Sutter Medical Group (Solano/Redwoods).
For more information on CaliforniaChoice and Sutter Health Plus, including Q4 details, rating region information, and quotes, contact us today.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
Effective July 1, 2023, CaliforniaChoice has expanded its portfolio to include an Anthem Blue Cross full network Platinum PPO plan. The newly introduced Platinum PPO A plan offers access to the full statewide Prudent Buyer PPO network. The plan is also available to out-of-state employees. For details, download the Q3 Benefit Summaries brochure.
Rates are now available for quoting through PRISM, our free and easy online quoting system.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Get The Latest News with Text Messaging!
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
With complex provider networks and competing underwriting requirements of the various carriers in California, selling group health insurance isn’t easy. That’s why CaliforniaChoice, the private exchange with the state’s largest portfolio of plans and networks, has spent 26 years simplifying the employee benefits process so you can focus on building your business.
Medical Partners
You can offer multiple health plans side-by-side in a single employee benefits package. That means you only have to learn one product and run one quote, while still giving your clients the value of choice.
Optional Benefit Partners
Dental, vision, chiropractic, acupuncture, and life benefits that can be bundled in a single package.
Additional Product and Service Partners
Your clients have access to a range of value-added benefits at no extra cost.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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CaliforniaChoice medical clients can now offer enrolled employees the new Member Marketplace, an employee-friendly portal for purchasing and enrolling in popular, vetted and affordable supplemental products directly from MetLife. Typically these products are only available to large group clients.
These products are only available to members enrolled in a CaliforniaChoice medical plan. Employees waiving medical coverage will not have access to the Member Marketplace.
Broker Advantages
Member Advantages
Download the Member brochure for details.
CaliforniaChoice is a private exchange employee benefits program specializing in saving small businesses on healthcare costs while offering more choices than any single health plan option.
What makes CaliforniaChoice different for your clients:
With CaliforniaChoice, employees get:
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Get The Latest News with Text Messaging!
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
View the webinar on-demand to learn what’s new and changing for 2023, important health plan updates and reminders, the marketplace, and what you can expect from CaliforniaChoice. Below is a brief summary of what was covered in the webinar.
4 New Anthem Blue Cross Plans
8 New Cigna + Oscar Plans
5 New Health Net Plans
3 New UnitedHealthcare Plans
Features additional products and services from MetLife to enhance your clients’ protection, such as accident, hospital indemnity, and critical illness coverage, and legal plans.
DeltaDental
Ameritas
MetLife
Anthem Blue Cross
VSP
EyeMed
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.
CaliforniaChoice
ChoiceBuilder
CaliforniaChoice is a private exchange employee benefits program specializing in saving small businesses on healthcare costs while offering more choices than any single health plan option.
What makes CaliforniaChoice different for your clients:
With CaliforniaChoice, employees get:
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Get The Latest News with Text Messaging!
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.
Earn a Kaiser Permanente $100 bonus, per enrolled subscriber, when you sell new small group business through CaliforniaChoice or Covered California for Small Business (CCSB), December 1, 2022 – January 1, 2023 effective dates.
This bonus is on top of your regular commission and standard broker reward programs such as the Total Replacement and Group Production rewards. Download the flyer to learn more.
Kaiser Permanente Broker Bonus
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
Get The Latest News with Text Messaging!
Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.