Where can I find the carrier contracts for group coverage for Covered California for Small Business?

The Health and Dental Plans page on the Covered California for Small Business (CCSB) web site provides a wealth of information about the carriers and plans sold through CCSB:

• Click on the first set of logos to download:
  • Carrier contracts for CCSB small group health plans. These are called Group Service Agreements (GSA’s). Let us know if you need Blue Shield GSA’s which are not posted online.
  • A combo document containing the Summary of Benefits and Coverage (SBC) and the Evidence of Coverage (EOC) for each plan.
• View the Network Summary to learn which networks are available for each plan type by carrier.
• Download the Plan and Benefit Summary to view the plan designs and key benefits for each plan available through CCSB.
• View dental plans, benefit descriptions, exclusions and availability by geography.
• Click the dental carrier logos to view detailed plan descriptions and EOC’s.
• Download a list of plans offering Medicare Part D Creditable and Non-Creditable Coverage.

We recommend you bookmark CCSB’s Health and Dental Plans page. At Claremont, we use the resources contained in it extensively.

Are plan changes permitted by Covered California for Small Business after coverage has started?

Yes. Plan changes are permitted under the following conditions:

• The plan change must be with the same carrier;
• The change must be requested within the first 30 days of coverage;
• Plan changes submitted between days 1-15 will be retroactively effective to the first day of the same month;
• Plan changes submitted after day 15 will be effective the 1st of the following month.

This policy applies to both new and renewing CCSB groups.

I’ve been told that Covered California for Small Business is an option only for employers eligible for the Small Business Health Care Tax Credit. Is this correct?

No, that’s incorrect. Covered California for Small Business is a health insurance marketplace that offers any California small business (1-100 employees) a choice of quality, affordable health insurance from multiple trusted carriers.

A wide range of California employers benefit from the many advantages offered by Covered California for Small Business. Discover the advantages here.

Are individuals enrolled in retiree coverage eligible for the premium tax credit?

Individuals enrolled in an employer-sponsored plan, including retiree coverage, are not eligible for the premium tax credit, even if the employer plan is unaffordable or fails to provide minimum value. The individual may be eligible for a premium tax credit for another family member who enrolls in Marketplace coverage and is not enrolled in the employer plan

The individual may be eligible for the premium tax credit if the individual declines the coverage from a former employer, such as COBRA or retiree coverage, even if it is affordable and provides minimum value.

Can an individual get the premium tax credit subsidy if the individual is eligible for COBRA?

If the individual declines the COBRA coverage, even if it is affordable and provides minimum value, the individual may be eligible for the premium tax credit.

Does each person/agent within a company need to be appointed with a carrier or can appointments continue with the company/agency?

What is the Marketplace Identifier employers should use on IRS Form 8941 when claiming the tax credit?

Assuming they purchased coverage through Covered California for Small Business (CCSB), the CCSB market identifier is: 0CA (the first character is a zero).

Are employer premiums paid toward dependent coverage included in the calculation for the small business tax credit? Is the employer required to pay at least 50% of dependent coverage to be eligible to claim the credit?

An employer may include amounts paid toward dependent coverage when determining employer premiums paid for purposes of the small business tax credit. To get the credit, an employer is not required to pay for all or even a portion of dependent coverage, but to the extent the employer pays these amounts, they may be included in employer premiums paid when calculating the credit.  Additionally, the employer will not fail to satisfy the uniform percentage requirement by contributing different amounts toward dependent coverage under I.R.C. § 45R.

What Covered California for Small Business form should be used to make mid-year enrollment changes such as a new hire employee, marriage, birth or adoption?

Mid-year enrollment changes should be communicated using the Covered California for Small Business Change Request Form for Employees.

Can Covered California for Small Business groups make enrollment changes within the first 30 days after coverage becomes effective?

Per Section 6526 and pursuant to Health and Safety Code 1357.504 (d) and Insurance Code Section 10753.06.5 (d), once coverage is approved and effectuated, the employer can exercise the right to change coverage with the same carrier within the first 30 days. Other changes, such as requesting to change from one carrier to another, requesting to add dental, requesting to add members/dependents, are evaluated as an exception.