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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 PrismThis week we celebrate Kim Dinh’s 25-year work anniversary. “Kim is an invaluable member of our team and we are incredibly grateful for her hard work, dedication, and positive contributions,” says Michael Traynor, President of Claremont Insurance. “She has consistently gone above and beyond, and we appreciate her commitment to Claremont.”
Kim is responsible for company IT, connectivity, and computer security. She can take great pride in her accomplishments and the respect that she has earned from her peers over the past 25 years.
Please join us in congratulating Kim on her 25 years of service at Claremont!
You can reach Kim at kim@claremontcompanies.com or 925.296.8833.
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Join CAHIP – Golden Gate for an insightful exploration of how technology is transforming healthcare and extending human longevity at the 2025 Symposium. Connect with industry professionals while earning valuable continuing education credits.
Complimentary breakfast and lunch will be provided, offering excellent networking opportunities throughout the day.
Don’t miss this opportunity to stay ahead of industry trends and enhance your professional knowledge. Register today to secure your spot! To learn more, visit cahip-gg.org or contact CAHIP-GG at 800.488.2506 or info@ggahu.org.
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.
Article 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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We are excited to welcome Elisha Youngman to our Service Team as our newest Broker Service Representative. With a background in medical office administration, Elisha managed patient appointments and insurance verifications before advancing to the billing department of an infertility clinic, where she gained in-depth expertise in insurance processes. Now transitioning into employee benefits, Elisha is eager to expand her knowledge of the market, our carrier partnerships, and strategies to support brokers in growing their business.
Outside of work, she enjoys strength training, cooking, caring for plants, and spending time with friends.
You can reach Elisha at elisha@claremontcompanies.com or 925.296.8819.
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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.
After nearly six and a half years of dedicated service as a Broker Service Representative, Beverly Daniel-Patton is retiring. She has been a valued member of our team, making a positive impact on colleagues, broker customers, and business partners alike. Her contributions will be greatly missed. Please join us in wishing Beverly all the best as she begins her next chapter!
Please email your congratulations and best wishes to Beverly at beverly@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.
Exciting updates to PRISM, our free and easy online quoting system, make it easier than ever to create and present medical proposals to your clients. These enhancements are designed to help you quickly identify key benefit plan changes and communicate them clearly.
PRISM now highlights differences between current and renewal medical plans in blue when generating proposals, making comparisons simple and straightforward. This update ensures clearer, more effective proposals, improving client understanding and decision-making.
The new highlighting feature is available across multiple proposal formats (report examples below):
Log in to PRISM today and take advantage of these changes.
1. Side by Side Comparison
2. Side by Side Detail
3. Employee Rate Side by Side
Whether you need help onboarding new staff or learning how to use PRISM’s advanced features, our short on-demand video tutorials will quickly get you the training you need when you need it.
Take advantage of PRISM, our free online quoting system, or request a quote by contacting us at 800.696.4543 or quotes@claremontcompanies.com.
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.
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.
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.
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.
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 is updating their fully insured Group Benefits dental plans in California to meet new state regulations effective January 1, 2025.
Removed from plans:
Details important to you and your clients:
Claremont will keep you updated as other carriers announce their updates in response to the law.
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.
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.
You can reach Kevin at kevin@claremontcompanies.com or 925.296.8820.
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.
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.
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.
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.