Using the Shop and Compare Tool requires information about household income. How does an employer know household income? If they ask the employee, is that a privacy issue?

The Shop and Compare Tool is available for the Individual Marketplace, not for Covered California for Small Business.

What happens if half of an employer’s employees would be better off applying for individual coverage rather than group coverage, because they could be eligible for premium assistance and cost-sharing reductions?

Waiving coverage to enroll in the Individual Marketplace is not a valid waiver. Hence, 50% participation due to employees enrolling in the Individual Marketplace will make the employer ineligible for Covered California for Small Business since the participation requirement for Covered California for Small Business is 70%. However, the group can enroll during the special open enrollment period. In the small group market, a health insurance issuer may limit the availability of coverage to an annual enrollment period from November 15 till December 15 of each year if the employer is unable to meet employer contribution or group participation requirements.

If a group has 60 full-time employees, but only 30 enroll for group coverage, is the group eligible for a Covered California for Small Business plan?

No, small businesses are eligible to purchase Covered California health insurance plans through Covered California for Small Business if they have 1 to 50 eligible employees. An eligible employee works an average of 30 hours per week over the course of a month. Employers may also choose to offer coverage to their part-time employees who work between 20 and 29 hours a week.

Are there any gross income or sales thresholds applied to small businesses in order to qualify for Covered California for Small Business?

No. Small businesses eligible to purchase health insurance through Covered California for Small Business are those that:

1. Have 1 to 50 eligible employees. An eligible employee works an average of 30 hours per week based on a month of work. Employers may also choose to offer coverage to their part-time employees who work between 20 and 29 per week.
2. Elect to offer, at a minimum, all full-time employees coverage in a Covered California Health Insurance Plan through Covered California for Small Business;
3. Meet a minimum employee participation rate of 70%;
4. Contribute a minimum of 50% of the employee-only premium amount of the employer’s selected anchor plan in the metal tier the employer selects; and
5. Have the majority of and their employees employed in California.

In Covered California for Small Business, how does the employee select coverage (plan)?

On the employee application, the employee will specify the name of the health plan selected.

Will the exam include questions on navigating through the portal?

Yes, there are questions related to the online modules on the CalHEERS system.

What happens after the agent has completed the certification process?

Once the agent has completed the certification process, the agent’s name and contact information is added to the Covered California website.  Click “Find an Agent” on this page: https://www.coveredca.com/enrollment-assistance/

What are the turnaround times for the different steps in the Certification process?

Per Covered California, agents may expect the following turnaround times for important steps in the Certification process. (Please note that these are best estimates, and many times are much shorter.)

2-3 days – Time from attending instructor-led class to being credited with that attendance in Covered California’s Learning Management System (LMS).

5-7 days – Time from passing the exam until agent receives “congratulations and next steps” email.

5-7 days – Time from submitting agent agreement and associated paperwork (assumes correctly completed) and paying fee to receiving notice that agent is certified.

Under 30 days – Time for CE credits to be posted.

Click here for more information on Covered California Agent Registration, Training and Certification.

Covered California for Small Business is for small businesses with up to 100 employees, where do groups go that have over 100 employees? When did Covered California for Small Business expand to 100 employees?

If the small employer has more than 100 eligible employees, the small employer will be able to buy insurance through Covered California starting in October 2015 for coverage that begins in 2016.

Meanwhile, the employer with more than 100 eligible employees can continue to buy health coverage in the private marketplace.

Is there a cost calculator for Covered California for Small Business like for individuals?

Not currently.