What are the metal tiers?

Covered California plans are organized into categories of coverage, called metal tiers,
based on actuarial value. The idea is to make it easier for consumers to compare coverage
options and tradeoffs. More information on metal tiers can be found on pages 8 and 9 of the Covered CA Plan options participant guide.

An employee wants a different metal tier than is available to him through his employer’s Covered California for Small Business plan. Can he opt out and buy an individual Covered California plan?

Yes, the employee can decline his employer’s coverage and purchase a Covered California individual plan. Agents should bear in mind:

• the employee will not be eligible for subsidies if he is eligible for his employer’s plan and it is of minimum value and is affordable
• employees that decline coverage to go to the individual exchange count against the employer’s participation requirement for Covered California for Small Business coverage.

Are there tax advantages to the employer for participating in Covered California for Small Business?

The employer may be eligible for the small business health care tax credit, in addition to the tax advantages in offering any employer-sponsored health insurance to employees.

Why are small businesses not able to qualify for the small business tax credit if they have group coverage outside the exchange?

Beginning in 2014, eligible small businesses can secure the tax credit only if they purchase coverage for their employees through Covered California for Small Business. The small business health care tax credit is a provision of the Affordable Care Act. This requirement is part of the legislation.

Are provider networks driven by metal levels?

No. The metal tiers (Platinum, Gold, Silver, Bronze) are determined by the Actuarial Value of the plan, which is independent of the provider network.

If someone has a grandfathered plan, can they cancel that plan to get premium assistance with Covered CA?

Yes, an individual can cancel their Grandfathered plan and enroll in Covered California. Subsidy eligibility will be determined by the regular criteria, and not related to any previous enrollment in an (individual) Grandfathered plan.

I have two licensed staff who are not Certified with Covered California. How much can they say and do? Should they get Certified?

They can do all typical broker activities except the actual enrollment of either individuals or employer groups in Covered California.

Cadillac Plan Tax penalties?

The “Cadillac Tax” is an excise tax on high-cost health plans. Starting in 2020 an excise tax of 40% will be assessed on the cost of coverage for health plans that exceed a certain annual limit ($10,200 for individual coverage and $27,500 for self and spouse or family coverage).

Can an individual change the plan they are enrolled in mid-year?

Plan changes can only be made during open enrollment, or during special enrollment periods after certain qualifying events.

For a list of qualifying events see page 6 of the module: “Eligibility for Individuals and Families” participant guide.

Is there a table which breaks out income levels for subsidies instead of using the Covered California calculator?

Yes. You can find a table of eligibility by FPL here:

https://www.claremontcompanies.com/wp-content/uploads/2013/10/Job-Aid_Program-Eligibility-by-FPL_8.13.17_FINAL.pdf