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Why Choose Health Net?
✔ Lowest rates in the market – Affordable options without compromising quality.
✔ Robust PPO network – Competes with major carriers like Anthem and Blue Shield.
✔ Flexible HMO options – Networks to fit nearly every group statewide and every budget.
✔ Simplified underwriting – Only 25% participation required for groups with 5+ enrolling. No DE9C or prior carrier bill needed.
✔ Easy-to-sell benefits – $0 deductible HMO plans + four years of rate stability.
✔ Nationwide coverage – Cigna network access for out-of-state employees + state plurality rules for group qualification.
Start Including Health Net in Your Quotes Today!
Need guidance on networks, plan designs, or have questions? We’re here to help!
Call us at 800.696.4543 | Email us at info@claremontcompanies.com.
Login To PrismArticle last updated: March 4, 2025.
Most of your clients have upcoming deadlines under the federal prescription drug benefits reporting (RxDC) requirements. Here’s a summary of the requirements, carrier support initiatives, and critical submission deadlines to ensure timely compliance.
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.
The CMS requires the following information be submitted by insurance companies and employers:
Anthem will follow the same process as in prior years and will file on behalf of their fully insured and ASO clients for the benefits they administer and maintain. This includes ASO groups who opt-in to the D1 reporting. To submit all required information and ensure reporting accuracy, they will request some information from their clients.
Week of February 17th – Large Group, Small Group, and National Account clients were notified about required RxDC filings and necessary actions.
Early June 2025 – RxDC Filing Confirmation
For more information, please visit Anthem’s CAA/Transparency Resource Center.
Blue Shield will collect D1 Premium Contribution data from groups between February 19, 2025 and April 19, 2025. 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. 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.
Key Details
Who Needs to Submit The Survey?
Any group (or broker/delegate on behalf of the group) who would like Blue Shield to submit D1 Premium data on their behalf to the CMS. This includes:
Third-Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) may assist in reporting. Groups that miss the deadline will not be included in Blue Shield’s filing and may be subject to non-compliance if they do not report the required data directly to the CMS by the June 1, 2025 deadline.
Other Details
Information Requested
Health Net will not require any data from employer groups to complete Plan List (P2) and Data File (DI) submissions with the CMS on behalf of their clients. No action or any fees are required by employer groups or brokers. This includes groups with members enrolled in Health Net through CaliforniaChoice.
Fully insured employer groups will need to complete the Kaiser Permanente RxDC data collection form by March 31, 2025.
Information Requested
Self-funded groups: Kaiser Permanente representatives will reach out to each self-funded group, via email, with instructions and offline forms that will be prepopulated with the group’s information along with blank fields for the group to complete and return to Kaiser Permanente.
Specific CA Small Groups: Covered California for Small Business (CCSB) and CaliforniaChoice groups do not need to complete the form as these exchanges will be providing the needed data for all the employers they serve, aggregated at the exchange level, to Kaiser Permanente.
Kaiser Permanente plans to submit all applicable reports and required responses for all employer groups to CMS by the June 1, 2025 deadline. To learn more, view the Kaiser Permanente RxDC FAQs.
Sharp Health Plan will request employer contribution data via a Request for Information (RFI) survey and will file on behalf of the group. Deadline: April 18, 2025.
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, 2025, and March 31, 2025.
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 (2024). 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
Western Health Advantage will request employer contribution data via a Request for Information (RFI) survey and will file on behalf of the group. Deadline: April 15, 2025.
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’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.
Like last year, CaliforniaChoice is facilitating the RxDC for its employers and their plans for the 2024 reference year (reporting due June 1, 2025). CaliforniaChoice will coordinate directly with their carriers to facilitate all reporting obligations. There is no action required from the employer.
The carriers are actively assisting your clients with federal reporting compliance and will require specific information from each employer group. Watch for direct communication from the carriers and follow their instructions. If you or your clients need assistance we can connect you with appropriate carrier representatives.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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With tax deadlines approaching, eligible small businesses can qualify for federal tax credits of up to 50% on health insurance premiums–available exclusively through Covered California for Small Business (CCSB).
To be eligible, businesses must:
The tax credit is calculated on a sliding scale—smaller businesses with lower average wages qualify for higher credits. Employers can apply the credit directly to their Federal Tax Return. Use the CCSB Tax Credit Calculator to estimate potential savings.
To learn more, download the Small Business Tax Credit flyer and the How to Apply For The Tax Credit flyer.
Since 2014, thousands of small businesses have trusted CCSB for quality, flexible health coverage. With consistent double-digit membership growth, here’s why CCSB stands out:
Employee-Only Coverage
CCSB provides flexibility for employers to apply their full budget to employee coverage while dependents can access separate coverage and subsidies on the individual marketplace.
No Admin or Late Fees
Every dollar goes directly toward employer premiums.
Streamlined Onboarding
Quick quoting, simplified applications, and easy invoicing. Start-up groups need just two weeks of payroll, with monthly ACH payments accepted.
Fast Certification
No testing or annual re-certification—just a one-hour course to get started.
Multi-Carrier Portfolio
Employers and employees can choose from the top-tier PPOs and HMOs with affordable access to the broadest network of physicians and hospitals in California. Multi-state coverage is available for groups with employees out of state.
Exclusive Tax Credit
Eligible small businesses can qualify for federal tax credits up to 50% on premiums to help pay for the cost of providing quality health coverage for employees. (Contact us for help in determining employer eligibility.)
MyCCSB Portal
Employers and brokers can enroll employees, update plans, manage renewals, and more—all within 24 hours.
With California’s most comprehensive access to doctors and hospitals, CCSB offers flexibility, control, and convenience, including:
Claremont has been a trusted CCSB partner since its 2014 launch, and we are a 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 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.
With an effortless transition process for your Cigna + Oscar (C+O) groups, Covered California for Small Business (CCSB) simplifies enrollment by using the group’s prior C+O invoice.
CCSB provides a variety of health plans tailored to the unique needs of small businesses. By partnering with industry-leading insurance carriers, they guarantee your clients access to high-quality, affordable health coverage options.
Maximize your earnings with CCSB’s broker bonus program. For new small group business placed from July 1, 2024 to January 1, 2025, you can earn up to a $12,000 bonus per group, in addition to competitive commissions. Download the flyer for details.
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.
With the Covered California for Small Busines (CCSB) bonus program, agents who place new small group business from July 1, 2024 – January 1, 2025, can earn up to a $12,000 bonus per group, in addition to competitive commissions. To qualify for the first bonus tier of $1,000, agencies must submit a minimum of three groups with four enrolled employees. Best of all, the bonus is per group with no maximum number of groups! Download the flyer for details.
In addition to California’s most comprehensive access to doctors and hospitals, CCSB health plans offer choice and control, with:
As a trusted CCSB partner since its 2014 launch, we are a 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 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.
Article 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.
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.
Covered California for Small Business (CCSB) has announced several new portal and administrative updates.
New Renewals
Starting with January 2024 renewals, CCSB has updated the format and included employee worksheets based on the current offerings. The renewals and Employee (EE) Worksheets can be found through the Employer Dashboard on MyCCSB.com under “Documents > Letters.” The Employer Proposal and the Employee Renewal Worksheets will be listed separately. The Employee worksheets are only available through the portal and will not be physically mailed with the Employer Renewal.
New Business Submission Deadlines
The workaround is no longer needed when submitting a new business case after the 25th of the month. You can now submit your new business cases through the portal for your intended effective date, through the end of the day on the 7th (includes weekends and holidays). The system will now require the Late Submission form when submitting past the initial deadline (2023 and 2024 deadlines). With this enhancement, employee applications/waivers will not be required with your submission if the employee enrollment is completed online.
SIC Requirement
The portal will now require the SIC when entering a new business case or completing a renewal when the SIC is missing.
Disabled ACH Feature and Reinstatement Policy
Effective immediately, CCSB will begin to enforce their policy on payments that have been returned unpaid and the number of times a policy can be reinstated after termination for non-payment.
Returned Payment Policy
The ability to enter one time or recurring ACH payments through MyCCSB.com will be restricted for 12 months (365 days) when two returned payments have occurred on the account within six months (183 calendar days).
Notices will be sent out based on the mode of delivery selected by the employer. For example: If the employer is opted into paperless delivery, they will only get an email notice with their agent cc’d if one is attached. If they are not opted into paperless delivery, notices will be physically mailed to the employer only. View the Partner Alert for details.
Policy Reinstatement After Termination for Non-Payment
A qualified employer terminated due to non-payment of premium may only reinstate once during the 12-month period beginning at the time of their original effective date or from their most recent renewal date, whichever is more recent. Exceptions will be considered on a case-by-case basis. View the Partner Alert for details.
With the CCSB bonus program, agents who place new small group business with CCSB from July 1, 2023 – January 1, 2024, can earn up to a $12,000 bonus per group, in addition to competitive commissions. To qualify for the first bonus tier of $1,000, agencies must submit a minimum of three groups with four enrolled employees. Best of all, the bonus is per group with no maximum number of groups! Download the flyer for details.
In addition to California’s most comprehensive access to doctors and hospitals, CCSB health plans offer choice and control, with:
As a trusted CCSB partner since its 2014 launch, we are a 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 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.
Covered California for Small Business (CCSB) is pleased to introduce several new Blue Shield of CA plans that are now available for quoting. Carefully designed to meet the diverse needs of your valued employers, these plans are available for both new business enrollments and existing business renewals effective July 1, 2023.
With these upgrades, your small business clients across California can offer their employees even more healthcare options, providing them with greater flexibility and choice. To learn more, download the flyer.
All Blue Shield plans through CCSB provide members access to Wellvolution (including Headspace and Ginger), Teladoc Mental Health, Nurse Help 24/7, LifeReferrals 24/7, and the Blue Card program for when members are outside of California.
With the CCSB bonus program, agents who place new small group business with CCSB from July 1, 2023 – January 1, 2024, can earn up to a $12,000 bonus per group, in addition to competitive commissions. To qualify for the first bonus tier of $1,000, agencies must submit a minimum of three groups with four enrolled employees. Best of all, the bonus is per group with no maximum number of groups! Download the flyer for details.
In addition to California’s most comprehensive access to doctors and hospitals, CCSB health plans offer choice and control, with:
As a trusted CCSB partner since its 2014 launch, we are a 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 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.
Effective July 1, 2023, Covered California for Small Business (CCSB) is adding two of Blue Shield’s most popular high deductible health plans (HDHPs) to its portfolio:
Both plans feature the Full PPO network. The deductible and out-of-pocket maximum are the same in both plans. And, there are no additional costs to the member after the deductible is met.
The recently announced large increases in HSA contribution limits for 2024 are likely to generate even more interest in HDHPs and HSAs. Now is a good time to discuss these new plan options with your clients and prospects.
In addition to California’s most comprehensive access to doctors and hospitals, CCSB health plans offer choice and control, with:
As a trusted CCSB partner since its 2014 launch, we are a 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 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.
Effective July 1, Blue Shield’s full Access+ HMO provider network is available in Platinum, Gold, and Silver metal tier plans in Covered California for Small Business (CCSB). Previously, these plans had been available only through the Trio HMO network.
Blue Shield Full Network Access+ Plans:
Plus, all Access+ plans include the richer Rx Ultra pharmacy network.
With this network upgrade, your small business clients across California can offer their employees even more healthcare provider options, providing them with greater flexibility and choice.
In addition to the full Access+ network, effective July 1, 2023, CCSB is introducing three new popular Blue Shield plans to its portfolio:
All Blue Shield plans through CCSB provide members access to Wellvolution (including Headspace and Ginger), Teladoc Mental Health, Nurse Help 24/7, LifeReferrals 24/7, and the Blue Card program for when members are outside of California.
With the new CCSB bonus program, agents who place new small group business with CCSB from July 1, 2023 – January 1, 2024, can earn up to a $12,000 bonus per group, in addition to competitive commissions. To qualify for the first bonus tier of $1,000, agencies must submit a minimum of three groups with four enrolled employees. Best of all, the bonus is per group with no maximum number of groups! Download the flyer for details.
In addition to California’s most comprehensive access to doctors and hospitals, CCSB health plans offer choice and control, with:
As a trusted CCSB partner since its 2014 launch, we are a 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 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.