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PRISM - New Proposal Enhancements
PRISM, our free and easy online quoting system, now highlights differences between current and renewal medical plans in blue, making them easy to see. This update, available across multiple proposal formats, helps you create clearer, more effective proposals for your clients.
AB 1048 – a recently passed California state law – impacts dental insurance plans in 2025. AB 1048 prohibits fully insured large group dental plans from imposing a dental waiting period or preexisting condition provision for any plan year beginning on or after January 1, 2025.
Humana
Humana is updating their fully insured Group Benefits dental plans in California to meet new state regulations effective January 1, 2025.
Removed from plans:
Waiting periods for California Humana Group Benefits dental plans with 51+ enrolled employees.
Missing tooth exclusion for all California Humana Group Benefits dental plans.
Details important to you and your clients:
The changes apply to both new and existing fully insured Humana Dental groups starting January 1, 2025.
New dental plan groups with effective dates starting January 1, 2025, will include these updates.
The changes will automatically take effect on existing groups’ dental plans on January 1, 2025, no matter when their renewal dates are.
The updates will not apply to benefits before January 1, 2025. No retroactive changes.
You or your clients do not need to do anything.
Claremont will keep you updated as other carriers announce their updates in response to the law.
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.
Offer your clients premium mental health benefits with Beam’s new partnership with Headspace.
By uniting therapy, psychiatry, on-demand coaching, and guided meditations, Headspace Care delivers an affordable, accessible, and connected system tailored to meet the diverse needs of employees and their families.
Key Features Include:
6 virtual therapy sessions per year (no in-person sessions).
Unlimited access to mental health coaching.
Full access to the comprehensive content library.
$8.50 per employee per month, fully employer-paid, with 100% employee participation required.
Available as a standalone offering. If sold with Beam products, billing will be handled separately.
Enables employers to enhance their benefits package with mental health support without modifying their existing insurance coverage.
10% broker commission.
Learn more about the new premium mental health benefits, including the key differences compared to the Headspace benefits bundled with some California medical health plans.
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.
Humana continues to expand its dental network significantly, offering members more access and improved value. With an increased focus on delivering seamless experiences, brokers can rely on comprehensive tools, expert support, and efficient solutions to meet their needs and enhance member satisfaction during Q4 and beyond.
Dental Network Expansion
18,000+ net-new dentists added in 2024. Over 135,000 dentists nationwide.
Since 2016 the Humana dental network increased by 86%, far outpacing the competition.
Over 72% of claims processed in network at an average discount of 40%.
Ranked top 3 in over 80% of the top 250 Metropolitan Statistical Areas.
Reminder, Take Advantage of Humana Broker Bonus Programs
Disability Plans Bonus
Earn a bonus and provide extra financial protection for your clients’ employees. To earn a bonus, place NEW Humana short- and/or long-term disability with an initial effective date of coverage between October 1, 2024 through January 1, 2025. The bonus can be earned in one of two ways:
New 5-49 Enrolled Humana Disability Cases:
$200 bonus per bundled case.
Get an extra $200 on top of earnings through the Dental Bundling Bonus. This means you could get up to an $800 bonus between the two bonus programs.
Intended for specialty lines of coverage of all sizes, the Humana 2024 Group Benefits Growth Bonus (formerly known as the Specialty Growth Bonus) is paid once annually, within 60 days after the January 31, 2025 program end date.
Bonus Program Highlights
Tiered structure allows you to earn more as you climb to the next level.
Opportunities for selling new and retaining existing business – and for case sizes big and small.
Rewarded for multi-line sales year-over-year so you don’t have to start fresh each year.
Earn up to 7% book of business revenue.
Eligible Products
Group Term Life (Including AD&D)
Group Term Voluntary/Supplemental Life (Including AD&D)
Group Vision (Including Voluntary Vision)
Group Dental (Including Voluntary Dental)
Group Long-Term Disability (Including Voluntary Long-Term Disability)
Group Short-Term Disability (Including Voluntary Short-Term Disability)
The 2024 Group Benefits Growth Bonus qualifications remain the same as the 2023 Specialty Growth Bonus. To learn more, download the Group Benefits Bonus flyer and the 2024 Producer Partnership Plan brochure.
Dental Bundling Bonus – Extended Through January 2025
Sell a Bundle, Earn a Bundle! To earn a bonus, sell a new Humana dental line of coverage with at least one additional Group Benefits line of coverage with the same employer group with an initial effective date of coverage between April 1, 2024 through January 31, 2025.
Groups with 5-49 eligible enrolled employees (must be at least 5 enrolled): – $100 bonus for dental + $100 for vision + $100 for life + $200 for disability coverage.
– $100 more if you place all four lines of coverage with the same employer for a total of $600!
Groups with 50+ eligible enrolled employees:
– $200 bonus for dental + $100 for vision + $100 for life + $300 for disability coverage.
– $100 more if you place all four lines of coverage with the same employer for a total of $800!
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.
Kevin has over 35 years of experience in the employee benefits industry, working with leading health and dental insurance companies, including California Dental Network and Humana. His expertise lies in consulting with brokers to develop tailored benefits solutions for their group clients across California.
Throughout his career, Kevin has built strong broker relationships by regularly attending networking events and staying engaged with the latest trends in employee benefits. His active presence on LinkedIn allows him to share valuable insights, helping brokers and industry peers navigate the evolving benefits marketplace. Kevin’s collaborative approach empowers brokers with the tools they need to grow their businesses.
Based in Huntington Beach, Kevin enjoys spending time with his family – his wife, Denise, and their two children, Taylor and Sean. He also loves exploring the natural beauty of Southern California, taking his French Bulldogs, Zoey and Lola, on walks around favorite local spots like the Bolsa Chica wetlands and Central Park.
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.
The small group Special Enrollment Period (SEP) is a valuable opportunity to grow your book and help small businesses that are typically ineligible for group coverage.
During the small group SEP, November 15 to December 15, insurance carriers are required by law to accept applications from small groups (1-100 employees) without participation or employer contribution requirements. This limited time opportunity is the perfect chance to offer coverage solutions, even to businesses that don’t meet the usual criteria.
Did You Know SEP Offers:
Zero participation requirements: Only one enrolled employee is needed.
No minimum employer contribution required: Greater flexibility for your clients.
Coverage effective date: January 1, 2025.
SEP Is a Great Solution For:
Small Business Owners Currently Enrolled in Individual Market Coverage The SEP permits small business owners to upgrade into group medical insurance, unlocking advantaged rates and plan offerings compared to individual and family policies. We can help you present these to your small business clients.
Dual-Carrier Groups Struggling to Meet Participation Thresholds Small employers offering coverage from two carriers (aka dual-carrier groups) where meeting enrollment quotas with one carrier is problematic. The SEP waives these requirements – making compliance much easier.
Groups Preferring Lower Employer Premium Contributions Than Are Otherwise Required Because the SEP eliminates monthly employer premium payment obligations, it empowers budget-conscious small businesses to enroll employees in group health benefits without increasing operating expenses.
Our easy-to-use Carrier SEP Guide for January 2025 medical coverage can help you and your small groups quickly compare carrier deadlines and details.
Please note: the Special Enrollment Period is different than the relaxed participation promotions. These carrier promotions are usually offered for a specific time period and may be discontinued at any time.
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.
In 2024, the average single premium increased by 6%, and the average family premium increased by 7% for employer-sponsored coverage. Over the last five years, the average premium for family coverage has increased 24%, compared to a 28% increase in workers’ wages and an inflation rate of 23%.
The KFF 2024 Employer Health Benefits Survey provides a comprehensive analysis of trends in employer-sponsored health coverage. This year’s report covers premium trends, employee contributions, cost-sharing provisions, wellness programs, and new questions on provider networks, abortion coverage, family building benefits, coverage for GLP-1 agonists (weight loss drugs), and programs for lower-wage workers. The 2024 survey was conducted through 2,142 interviews with non-federal public and private firms with three or more workers.
Key Findings
Premiums and Employer Contributions
The average annual premiums for employer-sponsored health insurance in 2024 are $8,951 for single coverage and $25,572 for family coverage.
The average premiums for covered workers in high-deductible health plans with a savings option (HDHP/SO) were lower than the overall average premiums for both single coverage ($8,275) and family coverage ($24,196).
Most covered workers contribute to the cost of the premium. On average, covered workers contribute 16% of the premium for single coverage and 25% of the premium for family coverage, which is lower than the contribution percentages in 2023.
37% of covered workers at small firms are enrolled in a plan where the employer pays the entire premium for single coverage. 26% of covered workers at small firms are in a plan where they must contribute more than half of the premium for family coverage.
Nearly a third (32%) of workers at small firms have deductibles of $2,000 or more for single coverage, which is similar to last year’s percentage (31%).
PPOs remain the most common plan type. In 2024, 48% of covered workers are enrolled in a PPO, 27% in a HDHP/SO, 13% in an HMO, 11% in a POS plan, and 1% in a conventional (also known as indemnity) plan.
In 2024, 54% of all firms offered some health benefits, similar to the percentage last year (53%). Large firms (200 or more workers) are much more likely than small firms to offer health benefits to at least some of their workers (98% vs. 53%).
Additional Findings
Health and Wellness Programs
Many small businesses are expanding health and wellness programs to enhance employee well-being and engagement. These initiatives often focus on physical, mental, and preventive health measures, though the scope and investment in these programs tend to be smaller compared to large firms.
54% of small firms and 79% of large firms offer a program in at least one of these areas: smoking cessation, weight management, and behavioral or lifestyle coaching.
Telemedicine
Telemedicine has become a crucial benefit for small employers, providing cost-effective and convenient access to healthcare. A growing number of small businesses are adding telemedicine options to their plans, allowing employees to consult with healthcare providers remotely, often with reduced or no copays, which helps manage rising healthcare costs while improving access.
Tiered and Narrow Networks
Small businesses are increasingly adopting tiered and narrow network health plans to manage costs. These plans limit the choice of healthcare providers in exchange for lower premiums, offering a more affordable option for both employers and employees. Narrow networks focus on a select group of healthcare providers, while tiered networks offer varying levels of coverage based on the provider chosen.
GLP-1 Drug Coverage for Weight Loss
Coverage for costly GLP-1 drugs, like Wegovy, remains limited among small employers.
Only 18% of large firms (200+ workers) cover these drugs.
53% of those covering the drugs impose conditions, such as dietitian consultations or participation in weight-loss programs.
Check out the KFF 2024 Employer Health Benefits Survey summary and news releaseto stay up to date on the latest employer-sponsored coverage trends and guide your groups through the evolving health care marketplace. Contact us today to develop tailored benefits solutions that address your clients’ needs.
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.
Blue Shield of California continues to deliver comprehensive health benefits tailored to the needs of small businesses and their employees – offering healthcare that is accessible, affordable, high quality, and universal. Here’s a summary of the changes for 2025.
Q1-2025 Rates
Q1 plans are now available through PRISM, our free and easy online quoting system.
The Q1-2025 rate action is a statewide average of 1.3%.
Effective January 1, 2025, all three HMO networks (Access+, Local Access+ and Trio) can be sold alongside each other. This will be applicable to new sales and renewals.
Accolade Virtual Providers All Trio HMO members can now access virtual health services including primary care physician visits, behavioral health, and specialty care through Accolade Care.
DispatchHealth At-Home Care At-home medical support post-hospitalization is now available at $0 for all PPO members.
2025 Dental Plan Updates
Blue Shield is withdrawing three dental plans effective January 1, 2025:
• Smile℠ Deluxe 50/1500/Ortho/MAC
• Smile℠ Deluxe Gold 50/1500/Ortho/U85/NR
• Ultimate Dental Plus PPO for Small Business 50/2000/Ortho/MAC/NR
The new bonus program is in effect from February 1, 2025 through January 31, 2026.
Brokers can earn points for each new member as follows: • 25 points per new enrolled medical member on all plans as part of the initial sale. • 10 points per new enrolled member in a small business dental plan. • 5 points per new enrolled member in a small business vision plan. • 5 points per new enrolled member in a small business life insurance plan. • 2x points for each new member enrolling in all three: dental, vision, and life (40 points total).
The current Small Business Incentive Program is good through January 31, 2025. It includes the following: • 100 points per new enrolled member in a Tandem PPO or Virtual Blue plan as part of the initial sale. • 50 points per new enrolled medical member on all plans, excluding Tandem and Virtual Blue PPO plans as part of the initial sale.
The 10% specialty discount is a perpetual program that is applied to the dental and/or vision premium when a dental and/or vision plan is added to a new or existing small business medical group. Learn more.
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.
Miss the Q1-2025 Blue Shield Small Business Broker Roadshow? Watch it on demand for valuable insights and updates to help you during the upcoming open enrollment period.
Highlights Include:
Competitive rate adjustments, both for the quarter and the year.
Actuarial trends impacting 2025 healthcare costs.
“Pharmacy Reimagined” and enhancements to the digital member portal. These include one-click access to pharmacy tools, proactive notifications about lower-cost drug options, and integration with Amazon Pharmacy for home delivery.
Updates to the broker digital portal to improve your efficiency and workflow. Learn about single sign-on capabilities, a “renew as is” checkbox for easier book of business management, and dedicated support teams.
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.
CaliforniaChoice has announced the following Q1-2025 updates:
Q1-2025 Rates
Q1 plans are now available through PRISM, our free and easy online quoting system.
There are new rates for all health plans.
Medical Plans/Networks (Effective January 1, 2025)
Cigna + Oscar will be exiting the small group market.
The following plans will no longer be available:
Anthem Blue Cross: Silver HMO C, Gold PPO F, Gold PPO G
Health Net: Bronze HMO A, Silver HMO C, Silver HMO D, Gold HMO F, Platinum HMO D
Kaiser Permanente: Bronze HMO B
Reminders
Anthem Platinum HMO B (includes the Vivity network) became available on September 1, 2024.
CaliforniaChoice is offering a streamlined underwriting process for groups with Cigna + Oscar (C+O) direct coverage. This special promotion applies to new business effective dates from July 1, 2024 to December 1, 2024. Get the details and contact us for assistance with your Cigna + Oscar groups.
CaliforniaChoice Portfolio
CaliforniaChoice is the only small group (1-100 employees) private exchange for employee benefits in California. Partnering with seven top health plans, CaliforniaChoice offers a variety of full and limited network HMOs, PPOs, and other benefit options to choose from – all at different price points so you can help your clients control costs and offer their employees choices. Learn more.
With CaliforniaChoice, 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.
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.
ChoiceBuilder has announced the following Q1-2025 updates:
Q1-2025 Rates
Q1 plans are now available through PRISM, our free and easy online quoting system.
Dental: Ameritas and MetLife Platinum Plus PPO plan rates have changed.
There are no rate changes for the other carriers.
Benefits
Ameritas Dental: Employer Sponsored and Voluntary Plans
Platinum Plus PPO option has been added, effective January 1, 2025 and later.
$3,000 annual maximum.
Orthodontic takeover credit has changed from 10+ to 5+ eligible employees.
Pre-existing conditions (missing tooth) coverage.
Delta Dental: Employer Sponsored and Voluntary Plans
Congenital missing tooth coverage for Silver PPO (voluntary only).
No waiting periods for major and orthodontic benefits for in- and out-of-network.
MetLife: Employer Sponsored and Voluntary Plans
Dental:
– All Plans: The orthodontic take over credit has changed from “Does Not Apply” to “Automatic.”
– Platinum Plus PPO (employer sponsored only): The annual maximum benefit has changed from $2,500 to $5,000 for (IN) and from $2,000 to $2,500 for (OON).
Life: Employee Assistance Program (EAP), provided through TELUS Health, is now included at no additional cost (employer sponsored only).
Landmark Healthplan: Chiropractic/Acupuncture Employer Sponsored and Voluntary Plans
The New Patient Evaluation & Management benefit has changed from $65 to $80 per visit.
The following benefits have changed from $50 to $65 per visit:
– Established Patient Re-Examination & Management
– Modalities
– Therapeutic Procedures
– Chronic Manipulative Treatment
– Special Services
ChoiceBuilder (2-500 Employees) Portfolio
Advantages
Available to small businesses (2-500 employees), ChoiceBuilder is the best ancillary exchange in California, offering the nation’s premier dental, vision, chiropractic/acupuncture, and life insurance benefits in a single easy-to-manage program – with both employer-sponsored and voluntary coverage options. Plus, ChoiceBuilder can be offered alongside any medical plan, including CaliforniaChoice®.
It’s a great way to enhance your clients’ employee benefits package without the high cost of additional benefits or the difficulties of managing different services. There’s one application, one bill, and one point of contact for administration.
With more than 8,000 employers and 130,000 members across the state, ChoiceBuilder offers freedom, simplicity, and affordability.
Reminders
ChoiceBuilder can be sold up to 500 employees.
NO DE9C/payroll required.
No wait for major services on all employer-sponsored benefits.
Write ChoiceBuilder alongside CaliforniaChoice for a waived admin fee.
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.
In our library, you’ll find carrier forms, applications, enrollment kits, broker bonuses, marketing resources, and more (video tutorial). However, not all carrier forms are available online.
