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Starting July 1, Covered California for Small Business (CCSB) is offering new Blue Shield plans, providing more options for enrollees. These plans include the Access+ HMO Network with Platinum, Gold, and Silver metal tier options, as well as the Bronze Trio HMO 7000/70. The two most popular Blue Shield High Deductible Health Plans (HDHP), Silver Full PPO Savings 2300/25% and Bronze Full PPO Savings 7000 plans, are also now available.
All of these plans offer benefits such as Wellvolution, Teladoc Mental Health, Nurse Help 24/7, LifeReferrals 24/7, and the Blue Card program for when members are outside of California.
For assistance, please contact our Quotes team at quotes@claremontcompanies.com or 800.696.4543.
Login To PrismWe are pleased to welcome Pauline Gonzales to our Service Team as our newest Broker Service Representative. In this role, Pauline will provide invaluable support and guidance to our clients in a variety of areas such as eligibility, enrollment, support, quoting, carrier knowledge, Ease, and more.
With over six years of experience in the small business health insurance sector, Pauline brings a wealth of knowledge and expertise. She most recently served as an Employee Benefits Account Manager at AssuredPartners, where she honed her skills in cultivating long-term broker and client relationships. Pauline is fluent in Spanish and brings exceptional communication skills in supporting brokers throughout the application process.
Pauline holds a Bachelor of Science in Business Administration with an emphasis in Finance. This background gives her a holistic understanding of how to build successful, collaborative partnerships. In her spare time, Pauline enjoys cooking new recipes and spending time with her three children.
You can reach Pauline at pauline@claremontcompanies.com or 925.296.8819.
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The Internal Revenue Service (IRS) has announced the Affordable Care Act’s (ACA) health plan affordability threshold for 2024 at 8.39%, a significant decrease from the 2023 figure of 9.12%.
The threshold is used in determining if Applicable Large Employers (ALE’s) health plans are considered affordable under the ACA employer mandate. This requirement does not apply to non-ALE businesses.
This is a significant reduction in the affordability threshold. Your ALE clients should be aware of the change, and may need to make changes to their health plan’s 2024 employee contribution in order to remain compliant.
For details, visit SHRM and Woodruff Sawyer, and the IRS website.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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Grab your clubs and join SVAHU for a delightful day filled with excitement and philanthropy. The SVAHU Board of Directors proudly presents the 5th annual golf tournament dedicated to honoring the memory and spirit of John Bobincheck.
John Bobincheck was a vibrant member of our insurance community, known for his outstanding work at BenefitMall and Claremont Insurance Services. He also served as President of the Silicon Valley Association of Health Underwriters from 2016 to 2017.
Come be a part of this amazing event as we celebrate John’s legacy while enjoying a day of fun on the greens. Your participation not only promises an exciting experience but also contributes to a meaningful cause.
To learn more, contact SVAHU at 877.748.0815 or info@svahu.org. Register now.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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Tens of thousands of California small businesses have at least some employees enrolled in Medi-Cal. The unwinding of Medi-Cal continuous coverage is not only affecting the disenrolled members. It is also impacting the small businesses that employ many of them. These businesses rely on a healthy and productive workforce to thrive and, in the face of this disruption, they are looking to experts like you for guidance and support.
Here’s the impact on California businesses by the numbers:*
For these employees, enrolling in their company’s health plan may be the best, or indeed the only, affordable option for health coverage following their loss of Medi-Cal benefits.
This disruption presents a unique opportunity for you to deepen your relationships with existing clients, attract new customers, and expand your business. We believe that with proper preparation and resources, you can turn this challenge into a catalyst for growth.
Schedule a 15-minute briefing with us to discuss in more detail the potential impact on your clients, the opportunity this presents for you, and the resources and services that Claremont has developed to assist you during this transition.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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*Estimates from the U.S. Department of Health and Human Services and the California Department of Health Care Services.
Check out these articles to learn more about the unwinding of Medi-Cal continuous coverage:
For many of the millions of Californians expected to lose Medi-Cal coverage, enrolling in their company health plan may be the best or only option for affordable coverage.
Your employer clients and prospects look to you for guidance and support in maintaining a healthy and productive workforce. This is a singular opportunity to deepen your client relationships, acquire more customers, and grow your business.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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Article last updated: April 27, 2023.
Most of your clients likely have upcoming deadlines under federal prescription drug benefits reporting requirements. Here’s a summary of the requirements, how carriers can help, 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.
Enforcement of the requirements was relaxed for reports due in 2021 and 2022. The requirements for reports due in 2023 are being enforced. Failure to report can lead to a penalty of $100 per day per affected individual.
A detailed summary on the requirements can be found in this helpful Mercer article (many carrier communications that you and your clients are receiving refer to technical terms such as “P2,” “D2-D8,” etc. This article explains these terms).
Each carrier is taking action to support your employer clients with the federal reporting requirements. In order to do so, they require information from each employer group. The approach being taken by each carrier is similar, but varies in detail, including important deadlines. Here’s a summary:
Aetna
Plan sponsors should fill out this RxDC Plan Sponsor Data Collection form with the required data by April 1, 2023. The required data includes the:
Anthem
Anthem is sending emails to Small Group and Large Group fully insured clients and Anthem Balanced Funding clients, asking them to submit monthly average premium information required for Prescription Drug Data (RxDC) reporting. Anthem clients should complete this form before March 24, 2023.
Blue Shield of California
Blue Shield is providing fully-insured groups and self-funded ASO group plan clients an option for collecting and reporting all the required information on their behalf. Groups electing this option must complete a Blue Shield Intake Form. Blue Shield has provided an Intake Form FAQ.
Blue Shield will submit the data report on behalf of fully-insured and self-funded ASO group plans only if the group provides a complete response to the questions on the intake form by March 31, 2023 by 6:00 pm PST. By completing the form, the employer consents that Blue Shield will submit the data on their behalf to the CMS.
If the employer group does not complete the intake form by March 17, 2023, then the employer group will be responsible for submitting all required data directly to the CMS by June 1, 2023.
More details can be found in emails sent recently by Blue Shield directly to brokers and employer groups.
CaliforniaChoice
The information above from CaliforniaChoice was provided verbally. Until this information is formally posted on the CaliforniaChoice website and especially for employers with Kaiser and Sutter enrollment, who are being advised that no action is required, Claremont strongly recommends that brokers contact the carrier and get formal confirmation as to what reporting assistance the carrier will or will not provide. In all cases, it is strongly recommended that the broker or employer request a receipt that the necessary reporting was indeed filed by the carrier. Keep that receipt in the event of a CMS audit.
Cigna+Oscar
Cigna intends to file on behalf of plan sponsors. No action is required of brokers or employers at this time. Look out for future communications from Cigna and Cigna + Oscar.
Covered California for Small Business
Covered California for Small Business (CCSB) is an administrator of its participating health plans and is not subject to RxDC data collection requirements on behalf of employer groups. CCSB has provided the following information for each of their participating health plans:
More details can be found in this April 11, 2023 CCSB broker email.
Kaiser Permanente
Kaiser Permanente (KP) needs to collect certain data in order to submit all applicable reports and required responses on behalf of employers. Employers with KP coverage in 2022 should complete this form no later than April 3, 2023. The broker can also complete the form on behalf of the employer. Once KP has the necessary data, it will submit all applicable reports and required responses to the CMS by the June 1, 2023 deadline.
Note: Kaiser asks for the data in a different way than other carriers. To help simplify the process, Claremont has created a worksheet (Excel, PDF) with instructions. If the broker or employer can assemble three pieces of data for each month in 2022, they can enter those into the worksheet and it will calculate the answers for Questions 8 and 9 which can then be entered into the Kaiser form.
Sharp Health Plan
Sharp Health Plan will be contacting their employer groups directly to obtain the required information. In addition, they will be sending a broker and employer alert informing all brokers and employers of the RxDC reporting requirement.
UnitedHealthcare
UnitedHealthcare (UHC) will assist clients by submitting all required information to the CMS if the employer completes UHC’s Pharmacy and Benefits and Costs Survey by March 10, 2023.
UHC sent an email communication on February 3, 2023 to all brokers/groups with fully-insured and Level-Funded plans instructing them of the data collection and action required to complete the Survey. Here is a link to the FAQs from UHC. It also links to the survey. Once the survey is complete, UHC will submit the necessary data to the CMS on behalf of the employer prior to the June 1, 2023 deadline.
The carriers are taking action to support your clients with the federal reporting requirements. In order to do so, they require information from each employer group. Look out for emails directly from the carriers, and follow their instructions. If you or your clients have questions, we can help direct you to the right contacts at the carriers.
Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.
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Starting April 2023 and continuing for one year, Medi-Cal, in a process called continuous coverage unwinding (CCU), will re-assess eligibility for 15 million Californians. For upwards of one million of them, it’s expected that enrolling in a group health plan will be their best, and maybe only option for affordable coverage. This is a singular event that gives you an opportunity to deepen client relationships, acquire more customers, and grow your business.
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.
As the leading social platform focused on business and professional networking, LinkedIn (830 million users) is one of the top places to reach decision makers, influencers, and practitioners. In fact, B2B blogs and websites receive most of their social media traffic from LinkedIn, according to a 2022 LinkedIn study. 43% attribute their sales to LinkedIn, Facebook followed at 24%, and Twitter at 20%.
If your prospects are active on LinkedIn, chances are they’re talking about the issues you can solve. So, if you can find them, reaching out becomes easier because you know they are more likely to be open to your solutions.
To start building an organic audience that will later convert to clients, follow the tips below.
Now you have a list of potential prospects who follow your competitor(s). Make sure to remove any employees or founders from the followers list. LinkedIn doesn’t have an export feature, but you can use a third party app like PhantomBuster.com.
LinkedIn member’s networks are searchable (if they haven’t opted to hide them).
Before requesting connections and reaching out to any prospects, use our profile optimization framework to Turn Your Profile Into a Business Growth Machine.
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.
Tune in to this NABIP Compliance Corner webinar on Thursday, March 16th at 10:00 am PDT, when NABIP members Barb Gerken and Samantha Malovrh walk you through what you need to know about RxDC Reporting and the end of the COVID public health emergency.
Don’t miss out. Register now!
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.
It’s now even easier to present compelling quotes and proposals to your clients when you log into PRISM, our (no-cost) quote service, with these new enhancements.
1. Easily export multiple reports on the Table Rates & Benefits Report page (available before selecting a group) into Excel.
Once you checkmark the corresponding outputs, you will be able to select “Excel Export (beta).”
This feature can be used with multiple reports at once, and will export all selected reports into a combined Excel spreadsheet with each tab being its own report.
2. Filter Current Plans on the Review Group Data page by Carrier, Plan Type, and Metallic Tier. Previously, you could only filter Current Plans by Carrier. This update allows the user to narrow their filtering significantly while searching for their group’s current plan selections. This feature not only makes plan mapping more efficient and user friendly, but also helps avoid errors in plan selections due to too many options.
3. Sort the Side-by-Side reports so the Current and corresponding Renewal Plans are next to each other. Previously, that report would show all Current plans and then all Renewal plans before including any alternative plans. The image below shows where you select this option in the Medical Plan Reports.
Side-by-Side example of the new Current/Renewal on the left. On the right, there is no sorting by Current/Renewal.
4. Narrow down the plans to include on the Employee Worksheet ACA report in two ways (by Package or now by Plans selected during the quoting process). You can also narrow down the Base Plan for that report in two ways (by Package or now by only the selected/highlighted Plans within the Package).
Selecting the package will ensure mixed packages are not offered.
If you ran a quote previously, you can choose “By Selected Plans from Above” and this will shorten the time instead of having to re-select the plans individually.
5. The cost comparison now includes the Network. This allows you to identify if the Network is full (Broad) or skinny (Narrow).
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.
To 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.