Archive for the ‘Carrier News’ Category

CAHIP Silicon Valley Holiday Party

Celebrate the holiday season with friends and colleagues at the festive CAHIP Silicon Valley holiday party and toy drive. This event is the perfect chance to take a break from the busy season to socialize and get into the holiday spirit while supporting children in need by donating a new toy for Santa Clara County Sheriff’s Office gift distribution.

Details:

• Date: December 7, 2023
• Time: 4:30 pm to 7:30 pm PT
• Place: Hapa’s Brewery, 460 Lincoln Avenue #90, San Jose, 95126
• Price: Free if You Bring a New Unwrapped Toy ($25+ Value) OR $25 Members, $35 Non-Members

To learn more, contact SVAHU at 877.748.0815 or info@svahu.org. Limited seating is available. Register now.

Register Now!

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

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Cigna + Oscar Q1-2024 Updates

Cigna + Oscar has announced two new plans for 2024, along with a new enhanced virtual primary care offering. Q1-2024 rates are now available through PRISM, our free and easy online quoting system. The Q1 statewide average rate increase across all metallic tiers is less than 1%.

Plan Updates

New HSA plans
Two new HSA plans have been added to the Open Access Plus PPO and LocalPlus® PPO networks, effective January 1, 2024:

• Gold $3500 HSA
• Gold $3500 HSA INF

New Oscar (Virtual) Primary Care
Available in all non-HSA plans (pending regulatory approval) for new groups effective January 1, 2024 and for existing groups on their 2024 renewal. Oscar Primary Care offers enhanced virtual visits by video, phone, or secure messaging and:

• $0 copay and unlimited comprehensive primary care focused on driving healthy outcomes for patients.
• Easy access through the Oscar Health App.
• Oscar (Virtual) Primary Care is in addition to Virtual Urgent Care which offers unlimited 24/7 care and $0 copay (a small fee for HSA members).

To learn more, download these flyers:

• Oscar (Virtual) Primary Care
• Virtual Urgent Care vs Oscar (Virtual) Primary Care

Reminders

With Cigna + Oscar, your groups get quality care and all of these (EPO) plan features:

• No referrals required to see a specialist.
• Access to Virtual Urgent Care, available 24/7 with a $0 copay via the Oscar app.
• Personalized Care Teams to help members manage their care.
• Savings on prescriptions with Express Scripts and easy prescription refills via the Oscar app.
• Access to Cigna’s behavioral health network for mental health resources.
• Step-tracking rewards (up to $100 per year).

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. Learn more about Cigna + Oscar.

Contact us today for a Cigna + Oscar quote!

Get a Quote

Note: to enroll your groups, you will need to have an appointment with Cigna + Oscar. Check out the Cigna + Oscar Appointments Guide for full instructions.

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

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Covered California for Small Business – Portal and Admin Updates

Covered California for Small Business (CCSB) has announced several new portal and administrative updates.

Portal Enhancements

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.

• When entering a new group, if the open enrollment date passes in the portal before you complete the submission and you need it reopened, please contact your Claremont team.
• Upload all business documents into the portal. Master App, DE9C, Late Submission Form (if required), and any other business documents.

SIC Requirement
The portal will now require the SIC when entering a new business case or completing a renewal when the SIC is missing.

Admin Updates

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).

• After the first occurrence, a notice will be sent to the employer mailing address on file, providing you with the reason for the returned payment.
• After the second occurrence, a notice will be sent to the employer mailing address on file, providing you with the reason for the returned payment and notice that all payments must be made with a cashier’s check or money order for a period of 12 months beginning the first of the month following the last paid through date. Payment made with business or personal checks will be returned to the sender.
• MyCCSB.com will automatically reinstate the ACH functionality after 365 calendar days from the last returned payment.

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.

‘A Partnership That Pays’ Broker Bonus Program

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:

• Full-network PPO from Blue Shield.
• HMO offerings from Blue Shield, Kaiser Permanente, and Sharp Health Plan.
• 4-tier selection.
• Single bill.

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.

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.

Contact us today for a Covered California for Small Business quote!

Get a Quote

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

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Claremont Welcomes Patricia Rodriguez

Patricia has decades of experience in healthcare and benefits administration. Her varied roles include provider, medical group and hospital contracting, multistate network development, national recruitment/contracting of mental health providers, and creating the state’s first network of complementary/alternative healthcare providers.

Her superior bilingual skills and firsthand knowledge of the cultural issues in the Hispanic community support her understanding of underserved community groups and the brokers who serve them.

As a member of the Claremont Insurance general agency family, she is focused on bringing education, advocacy and differentiation to the agent and broker community throughout California.

Patricia and her family enjoy the beautiful surroundings throughout the state. Big Sur and Mendocino coasts are among her favorite locations to explore with beach walks and hikes in the mountains and trails on her weekends. She also enjoys serving her local community by volunteering through local agencies and her community of faith.

You can reach Patricia at patricia@claremontcompanies.com or 925.296.8817.

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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.

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Small Group Special Enrollment Period Starts November 15

The 2024 Small Group Special Enrollment Period (SEP) starts November 15, 2023.

The Small Group SEP is the opportunity for employers to enroll in coverage with a $0 contribution requirement and no minimum participation requirement (at least 1 employee must enroll). The limited application period is from November 15 to December 15, 2023, for coverage effective January 1, 2024. Learn more.

Contact us to help your clients take advantage of the SEP.

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

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2024 Small Group Special Enrollment Period: Carrier Guidelines

By law, all carriers are required to offer the small group Special Enrollment Period (SEP) one time per year to allow employers to enroll in coverage with a $0 contribution requirement and no minimum participation requirement. The application period is from November 15 to December 15, 2023, for coverage effective January 1, 2024. Carrier administration of the SEP may vary slightly, including recertification at renewal.

The SEP provides several year-end sales opportunities and solutions for employers with unique needs, such as:

• Small Business Owners Currently Enrolled in Individual Market Coverage
  Group health benefits provide many advantages for small businesses. We can help you present these to your small business clients.
• Dual-Carrier Groups
  Small employers offering coverage from two carriers (aka dual-carrier groups) sometimes struggle to meet carrier participation requirements with one of the carriers. If you have dual-carrier groups such as these, then the SEP may be a good option for them.
• Groups Preferring Lower Employer Premium Contributions Than Are Otherwise Required
  Groups struggling to meet carrier premium contribution requirements may find the SEP a viable option. There is no employer premium contribution requirement when enrolling during the SEP.

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.

Quickly compare carrier deadlines and details with our Carrier SEP Guide:

• Special Enrollment Period for January 2024 Coverage – Small Groups 1-100, Medical Carriers

Carrier SEP Guide

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

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KFF 2023 Employer Health Benefits Survey

Average premiums for employer-sponsored health insurance jumped 7% for both individual and family plans this year — a significant increase after last year’s negligible growth. As disclosed in the 2023 Kaiser Family Foundation (KFF) survey, rising employer healthcare premiums have resumed, a reminder that while there has been great progress expanding coverage, people continue to struggle with medical bills.

The 25th annual KFF 2023 Employer Health Benefits Survey, conducted between January and July 2023, of 2,133 randomly selected private and non-federal public firms of three or more workers, provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs, and employer practices. This year’s report also looks at abortion coverage, mental health and substance use services, and wellness programs.

Key Findings

• The average annual premium for employer-sponsored health insurance in 2023 is $8,435 for single coverage and $23,968 for family coverage. A 7% increase over last year.
• Covered workers contribute 17% of the premium for single coverage and 29% of the premium for family coverage, similar to the percentages contributed in 2022.
• Deductible amounts have been growing relatively slowly. The average deductible in 2023 for single coverage among those with a deductible ($1,735) is similar to the amount last year ($1,763) and only 10% higher than the amount five years ago.
• 30% of covered workers at small firms are enrolled in a plan where the employer pays the entire premium for single coverage. This is the case for only 6% of covered workers at large firms.
• PPOs remain the most common plan type. In 2023, 47% of covered workers are enrolled in a PPO, 29% in a high-deductible plan with a savings option (HDHP/SO), 13% in an HMO, 10% in a POS plan, and 1% in a conventional (also known as an indemnity) plan.
  
• Employers may be reluctant to reduce the value and attractiveness of their coverage offerings during this long period of low unemployment and intense competition for labor.

Additional Findings

• Employer-sponsored coverage availability.
  
  • While nearly all large firms (200 or more workers) offer health benefits to at least some workers, small firms (3-199 workers) are significantly less likely to do so.
  • In 2023, 53% of all firms offered some health benefits, similar to last year (51%).
  • Across firms that offer health benefits and firms that do not, 53% of all workers are covered by health plans offered by their employer –  similar to last year.
• Telemedicine.
  • Among firms with 50 or more workers offering health benefits, 91% cover the provision of some health care services through telemedicine in their largest health plan, similar to 2022 (90%). Large firms are more likely than small firms (50-199 workers) to cover telemedicine services (97% vs. 89%).
  • Overall, 28% of firms say that telemedicine will be “very important” in providing access to enrollees in the future, and another 32% of firms say that it will be “important.”
• Health and wellness programs.
  Most firms offering health benefits offer programs to help workers identify and address health risks and unhealthy behaviors. 62% of small firms and 80% of large firms offer a program in at least one of these areas: smoking cessation, weight management, and behavioral or lifestyle coaching.
• Mental health.
  The sufficiency of mental health providers in plan networks remains a concern for employers in 2023, with only 59% of large employers offering health benefits believing that there are a sufficient number of behavioral health providers in their plan’s network to provide timely access to services for workers and their family members.
• Disease management programs.
  Among firms that offer health benefits, 36% of small firms and 64% of large firms offer disease management programs. These programs aim to improve health and reduce costs for enrollees with certain chronic illnesses by educating them about their disease and suggesting treatment options.

Check out the KFF 2023 Employer Health Benefits Survey to stay updated on the latest employer-sponsored coverage trends and help employers recruit and retain workers with quality plans that employees value. Contact us today to develop tailored benefits solutions that address your clients’ needs.

KFF 2023 Employer Health Benefits Survey

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

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Claremont Welcomes Rebecca Hernandez

Claremont is excited to welcome Rebecca Hernandez as the newest member of the Service Team. Rebecca brings with her 6 years of industry experience. Most recently she held the position of Small Business Senior Renewal Specialist with eHealth Insurance, where she provided service in all 50 states, to over 9,000 groups. “Rebecca is the perfect addition to help round out our team,” says Laura Hogsed, Service Manager. “Her experience in renewal analyzation is a great asset which will take our ability to provide wholistic service to our brokers to a higher level.”

In her spare time, Rebecca enjoys taking Zumba classes, gem collecting or listening to self-improvement books.

You can reach Rebecca at rhernandez@claremontcompanies.com or 925.296.8822.

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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.

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Blue Shield of California Q1-2024 Updates

Blue Shield of California remains committed to providing your small group clients with comprehensive benefits that prioritize the well-being of employees. Here’s a summary of the changes for the first quarter of 2024.

Q1-2024 Rates

• Rates are now available through PRISM, our free and easy online quoting system.
• The Q1-2024 rate action is a statewide average of 3%.
• More information can be found on Broker Connection.

Q1-2024 Renewals

• January 2024 renewals are now available. February and March 2024 renewals will be available on November 9th.
• Visit the Renewal Center page on Broker Connection for more information.

Medical Plans

• 2 new Virtual Blue^SM plans are available:
  – Virtual Blue Platinum Tandem PPO 250/20
  – Virtual Blue Silver Tandem PPO 2700/75
  Virtual Blue plans are now offered on all 4 metal tiers.
• There are minimal portfolio and plan design changes for 2024.
• The 2024 medical plan names have been mapped to the 2023 plan names.
• 2024 Medical Plans at a Glance provides a list of all 2024 plans with descriptions, value-add, and select benefit cost shares.
• 2024 Medical Plan Cheat Sheet is an easy to share list of all 2024 plan offerings.
  
• Q1-2024 Medical Sales Guide provides comprehensive information about selling Blue Shield of CA products and the value proposition.

Dental Plans

• 13 DPPO plans and one DINO plan will be withdrawn from the Specialty portfolio January 1, 2024.
• The dental plan mapping grid for withdrawn plans.
• Q1-2024 Specialty Sales Guide includes all the dental and vision plan offerings.

Vision Plans

• EyeMed is the new vision network provider, replacing MES Vision. EyeMed and MES have been working together to ensure a smooth transition.
• Portfolio vision changes include:
  • Optometric out-of-network (OON) visits now match ophthalmologic cost share.
  • Eyeglass frame OON allowance has increased.
  • All vision plans include both Standard and Progressive lenses (no-line bifocals) benefits.
  • Contact lens benefit updates:
  – Electives – reduce OON allowance to match OON frame allowance.
  – Non-elective (medically necessary) – same cost share for hard and soft contacts.
• Q1-2024 Specialty Sales Guide includes all the dental and vision plan offerings.

Small Business Incentive Program

• The bonus program is in effect from February 1, 2024 through January 31, 2025.
• Brokers can earn points for every new Tandem and Virtual Blue PPO membership for renewing groups.
  • 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.
  • 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, 2024. The new program above includes a change in points earned for non-Tandem and Virtual Blue plans.

Renewal Rewards Program

Brokers can earn points for every new Tandem and Virtual Blue PPO membership.

• 100 points per new enrolled member in a Tandem PPO or plan. February 2023 – January 2024 effective dates.
• 100 points per new enrolled member in a Virtual Blue plan. March 2023 – January 2024 effective dates.
• Specialty plans. February 2023 – January 2024 effective dates.
  • 10 points per new enrolled dental member.
  • 5 points per new enrolled vision member.
  • 5 points per new enrolled life member.

Bundled Saving Program

The 10% specialty discount is a perpetual program that is applied when a dental and/or vision plan is added to a new or existing small business medical group.

Relaxed Participation Promotion

The Relaxed Participation Promotion has been extended through December 31, 2024.

Enhanced Plan Comparison Tool

• Download market-ready slides for presentations (PPTX compatible) in addition to PDFs.
• Compare up to six plans at a time, instead of four plans.
• Compare year-over-year for dental plans and include the withdrawn plans. There’s an option to auto-select a mapped dental plan or a new plan for the withdrawn dental plans.
• New Blue Shield brand style.

More information and plan summaries can be found in Blue Shield’s Q1-2024 Medical Sales Guide and Specialty Sales Guide.

Contact us today for a Blue Shield quote.

Get a Quote

Resources

• Q1-2024 Medical Sales Guide
• Q1-2024 Specialty Sales Guide
• 2023 Broker Renewal Guide
• 2024 Medical Plans At-a-Glance
• 2024 Medical Plans Cheat Sheet
• 2024 Medical Plan Names
• Small Business Incentive Program
• Blue Shield News Center
• Product Cycle Updates
• Employer Connection Plus (EC+)
• Employer Enrollment Platform Resources
• Broker Communications
• Broker Connection
• Plan Comparison Tool and Network Comparison Tool
• Small Business Plan Documents
• Relaxed Participation Program
• Teledoc
• Wellvolution Mental Health
• Mandates
• Renewal Center
• Broker Bonus Calculator
• Forms and Applications
• Blue Shield Small Business Library
• Small Business Service Support

COVID-19 Resources

• COVID-19 Member Resource Page
• California Coronavirus Response Website
• California Department of Managed Health Care (DMHC) FAQs
• DMHC COVID-19 Response and Guidelines
• CDC COVID-19 Testing Overview

Contact us today for a Blue Shield quote.

Get a Quote

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.

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CaliforniaChoice Q1-2024 Updates

Miss the October 11th webinar?

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.

View The Webinar

Summary of Q1-2024 Plans and Rates

CaliforniaChoice Portfolio

Eight health plans, 136 different plan designs (HMO, PPO, EPO and HSAs) and 20 different provider networks.

Q1-2024 Rates

• CaliforniaChoice plans are now available through PRISM, our free and easy online quoting system.
• Q1 statewide rate actions:
  • Anthem Blue Cross HMO 0.4%
  • Anthem Blue Cross PPO 4%
  • Cigna + Oscar -1.6%
  • Health Net 2.6%
  • Kaiser Permanente 8.8% (annual, which equates to 2.2% per quarter)
  • Sharp Health Plan -0.5%
  • Sutter Health 3.1%
  • United Healthcare 0.2%
  • Western Health Advantage 2.9%

2024 New Networks, New Plans

• Kaiser Permanente added a new full network Platinum HMO C plan.
• Cigna + Oscar is consolidating their plan offering within CaliforniaChoice by:
  – Adding four new plans with the Open Access Plus network: Gold EPO A, Silver EPO A, Bronze EPO A, Bronze EPO B.
  – Removing five plans: Platinum EPO D, Gold EPO E, Gold EPO G, Bronze EPO E, Bronze EPO F.
• United Healthcare Alliance network added one zip code. The Harmony network added two zip codes, and the Signature Value network added two zip codes.

Reminder

• Effective July 1, 2023, CaliforniaChoice introduced the Anthem Platinum PPO plan, making Anthem available on all four metal tiers and two networks: Prudent Buyer PPO Full Network and Select PPO.

ChoiceBuilder (2-500 Employees) Portfolio

Q1-2024 Updates

• ChoiceBuilder Q1-2024 plans are now available through PRISM, our free and easy online quoting system.
• No plan changes, just benefit enhancements to VSP and EyeMed plans.
  • EyeMed – Platinum, Gold, and Silver – standard progressive lenses change to now covered.
  • VSP – Platinum and Gold increased frame allowance and contact lenses benefits.
• Rate pass for most carriers into 2024. A 2-3% rate change for Anthem dental plans.
• Download the ChoiceBuilder brochure to learn more.

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.
• eSignatures accepted.

Contact us today for a CaliforniaChoice and/or ChoiceBuilder quote!

Get a Quote

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.

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