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Covered California for Small Business –
New Blue Shield Plans

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.

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Industry News

Archive for the ‘Industry News’ Category

May is Mental Health Awareness Month

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Mental health significantly impacts worker productivity, engagement, and overall company success. Mental Health Awareness Month is an important reminder to prioritize mental wellness programs for the workforce by offering tailored solutions, including Employee Assistance Programs (EAPs), to your clients.

To promote mental health awareness, the Substance Abuse and Mental Health Services Administration (SAMHSA) is offering a comprehensive campaign during May. Each week focuses on a different group, starting with older adults, followed by children and teens, pregnant and postpartum individuals, racial and ethnic minority groups, and  LGBTQIA+ communities. The campaign provides actionable insights to help you and your clients address the unique mental health challenges faced by these demographics.

SAMHSA Mental Health Campaign

Week 1: May 1-4 (Older Adults)

Supporting the unique mental health needs of older adults.
As we age, we may experience life changes that impact our mental health.

Week 2: May 5-11 (Children and Teens)

Resources to help children and teens build resilience, self-care strategies, and skills for managing life stressors in healthy ways.
Supportive families, communities, and resources can help youth build strong foundations for lifelong well-being.

Week 3: May 12-18 (Pregnant and Postpartum People)

Recognizing the importance of maternal mental health among pregnant and postpartum people.
Pregnancy and giving birth can be joyful and can also present a variety of strong emotions for pregnant and postpartum people.

Week 4: May 19-25 (Racial and Ethnic Minority Groups)

The unique challenges, strengths, and contexts that affect mental health in people from racial and ethnic minority groups.
Everyone deserves access to respectful and culturally appropriate care.

Week 5: May 26-31 (LGBTQIA+ Communities)

Building support for mental well-being in the LGBTQIA+ community.
Inclusive families, schools, and societies can support mental health in the LGBTQIA+ community.

 


 

As one of the few Employee Assistance Programs (EAPs) that serve small employers, The Holman Group provides comprehensive and cost-effective behavioral health and substance use services to reduce healthcare costs and absenteeism, minimize turnover, and enhance employee well-being and performance.

The EAP can be offered as a standalone benefit or seamlessly integrated with other mental health and substance abuse programs, ensuring a holistic approach to addressing employee needs.

To request a Holman EAP quote, contact us today.

Contact Us For a Holman EAP Quote

 

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

 


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Emotional, Behavioral, and Mental Health – Carrier Resources Guide

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As mental health and well-being become higher priorities for employees, it is important for employers to understand the range of relevant services and benefits available through insurance carriers. Staying informed on these carrier offerings helps you provide guidance to your clients so they can support their workforce. 

Carriers offer a variety of programs that promote emotional, behavioral, and mental health. These may be included in existing policies or offered through additional coverage options.

Carrier Services and Benefits Include:

Regularly reviewing our Carrier Resources Guide can help you advise your clients on current services that align with their employee needs and preferences.

Carrier Resources Guide

Download our Guide by clicking on the image or button below.

Emotional, Behavioral, and Mental Health Resources

 

Carrier Resources Guide

Emotional, behavioral, and mental health resources are also available from government agencies, health systems, and others.

 

 

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

 


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RxDC Reporting Deadlines

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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.

General Information

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:

CMS Resources

Blue Shield

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

UnitedHealthcare

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

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.

Sutter Health Plus

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 + Oscar

Cigna is reporting on behalf of Cigna + Oscar groups, so no action is required by employer groups or brokers.

Covered California for Small Business

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

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).

Summary

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.

Contact us today for assistance.

 

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


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CAHIP-Golden Gate 2024 Symposium

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We’re proud to sponsor the CAHIP-GG Symposium focusing on “Transforming Organizations and Culture.” This year’s event combines insightful presentations, invaluable continuing education opportunities, and vendor showcases.

Symposium Agenda:

Details:

Don’t miss this opportunity to meet the Claremont team in-person at our exhibition booth.  To learn more, visit cahip-gg.org or contact CAHIP-GG at 800.488.2506, nathan@camgmt.com or info@ggahu.org. Register today.

Register Today

 

 

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


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Claremont Promotes Nicole Allyn

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With a focus on market expansion and stronger customer relations, Claremont has promoted Nicole Allyn to Director of Sales. Nicole is responsible for leading Claremont’s strategic approach, driving growth, and shaping the company’s sales direction. Nicole joined our team in 2020 as a Regional Sales Manager.

A collaborative and team-focused manager who leads by example, Nicole excels at building strong partnerships with her team, brokers, and carrier partners. She is skilled at developing sales strategies and providing top-notch service and solutions to clients. Nicole derives great satisfaction in helping her team and partners succeed.

Outside of work, Nicole is a devoted mother to her teenage son, Joey. In her free time, she enjoys staying active by lifting weights and pursuing creative outlets like playing guitar and singing. We are thrilled to have Nicole step into this new role and look forward to her continued contributions.

You can reach Nicole at nicole@claremontcompanies.com or 925.296.8818.

 


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Gone Fishing! Wishing Ken Ruotolo a Very Happy Retirement

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Claremont COO, Ken Ruotolo, is retiring at the end of the year after more than twelve years of company service. Ken’s been a huge part of the Claremont family since 2011, helping us hit some major goals and inspiring us all with his focus and determination.

“Ken’s contributions to Claremont have been numerous,” said Michael Traynor, Claremont President. “From leading us through ACA implementation, to his commitment to customer service excellence, and his development of strategic business partnerships, Ken has been key in advancing our company mission. We wish him all the best in his upcoming world travels, continued community work, and exploration of California’s best salmon runs.”

“Moving into this next phase is bittersweet,” said Ken. “While I look forward to spending more time on personal and family activities, I will genuinely miss engaging with our clients and partners, and I will especially miss my coworkers. They are some of the most professional, dedicated and nicest people I’ve worked with in 40 years as a business professional. They always put our clients and partners first by bringing thoughtful solutions to both challenges and opportunities. It’s rare that one has the opportunity to be part of such a special team.”

Please email your congratulations and best wishes to Ken at kruotolo@claremontcompanies.com.

 

 


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New California Law Regulates Balance Billing of Ambulance Services

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A new California law bans ground ambulance operators from balance billing patients starting January 1, 2024. Signed into law by Governor Newsom on October 8, 2023, AB-716 limits how much a non-network ambulance operator can charge patients to the amount they would pay for an in-network ambulance. The law applies to state-regulated commercial health plans, including fully insured Small Group plans.

While federal and some state laws ban balance billing for hospital and air ambulance charges, most states, until now, allowed the practice for ground ambulance services – despite patients having no control over which ambulance provider responds in an emergency.

In California, nearly three-quarters of ground ambulance rides result in surprise out-of-network bills, with average charges over $1,200 – the highest in the U.S. Under the new California law, over 14 million state residents with commercial health plans will save an average of nearly $1,100 per emergency ambulance ride and over $800 for non-emergency transports. Health plans will be required to pay county-set ambulance rates, which are approximately $2,000 higher than current insurer payments per ride. But with ambulance services accounting for a small fraction of overall health spending, premium increases should be minimal. Get the details.

Contact us today for help with you employer groups.

 

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


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Claremont’s Holiday Office Schedule

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Christmas

New Year’s

Wishing you and your loved ones a happy, healthy, and restful holiday season as we look forward to serving you in the new year.

 

 

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


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2024 Small Group SEP Carrier Guide

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All health insurance carriers have a legal obligation to provide small businesses (1-100 employees) with a Special Enrollment Period (SEP) once per year, from November 15 through December 15, 2023 – for medical coverage starting January 1, 2024. This limited opportunity allows employers to enroll in coverage with no minimum participation requirements or employer premium contributions.

Our easy-to-use Carrier SEP Guide for January 2024 medical coverage can help you and your small groups quickly compare carrier deadlines and details.

Carrier SEP Guide

SEP delivers sales opportunities and solutions for:

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.

Contact us today 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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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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CAHIP Silicon Valley Holiday Party

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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:

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.


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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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.

If you don’t find what you are looking for, contact our team for help at 800.696.4543 or materials@claremontcompanies.com.