Most employers struggle to comprehend the extent to which Obamacare has altered group health insurance in California and are curious about the reasons behind the significant changes in benefits and rates. Below, we provide a concise summary encompassing all the essential information you require.

4 Things You Need to Know About Obamacare And Group Health California

The following information is important to know and comprehend:


1. Obamacare Has Changed the Way Insurance Providers Calculate Rates for Group Medical Insurance

Prior to 2014, small-group medical insurance plan rates were determined according to an employee’s age. In other words, each age range, such as 20-29, 30-39, etc., had a designated rate.

Furthermore, the number of children an employee had or the age of their spouse was no longer a factor. Previously, the rate for family coverage was determined solely based on the employee’s age. However, the situation has changed as the small group medical insurance rate now takes into account the employee’s age, as well as the age of their spouse and children.

It is important to remember that the ACA also revoked the use of pre-existing medical conditions in determining health rates. In California, this implies that the removal of the “Risk Adjustment Factor” has resulted in uniform rates, regardless of the health status of your employees.

2. Obamacare Uses Standard Benefits and Metallic Tiers to Compare Health Plan Benefits

Not only is medical insurance complicated, but it is also costly. In order to facilitate comprehension and allow for plan comparison, Covered California employs a standardized model to establish the rates that insurance plans cover for different medical services such as physician visits, hospital stays, and additional benefits.

Categorized into Bronze, Silver, Gold, and Platinum, an AV (Actuarial Value) is determined as the outcome, indicating the level of benefits provided by each plan. For optimum coverage, a Platinum plan is highly advantageous, with the insurance provider assuming the majority of costs and the patient required to pay a minimal amount.

In a Platinum plan, the insurance company covers 90% while you contribute 10%. Conversely, in a Bronze plan, the insurance covers 60% and your responsibility stands at 40%. The ACA prohibits plans that offer coverage below 60% of health costs.

3. Insurance Providers Use Physicians and Hospital Networks to Reduce the Costs of Plans

There is a significant disparity in healthcare expenses among physicians and hospitals, with some offering affordable services and others charging higher fees. Health insurance policies that cover healthcare providers with lower costs have more affordable premiums compared to those covering providers with higher costs.

Employees can obtain comprehensive benefits at a reasonable price by joining a health plan that does not include costly doctors and hospitals.

4. Small Employers Can Offer a Range of Health Insurance Plans to Meet Employees’ Needs

When it concerns health insurance, employees’ needs vary. Certain employees rarely seek medical attention and solely require coverage for major emergencies. On the other hand, some employees have significant illnesses, such as diabetes, and necessitate a health plan that can extensively cover their requirements with minimal contributions. Fortunately, employers possess the ability to customize insurance plan benefits to cater to both the company’s and employees’ needs.

Employers have different options when it comes to offering insurance plans to their employees. While some choose a single plan for all employees, others may opt for either an HMO or PPO plan. Alternatively, certain employers might offer a range of four to six plans, enabling the employees to select the one that suits them best.

Although providing multiple choices can be overwhelming, insurance providers assist small employers in offering 15 or more plans while keeping costs to a minimum.

Top 6 Small Business Health Insurance Providers

1. UnitedHealthcare

UnitedHealthcare (UHC) can be regarded as one of the top health insurance companies for small businesses due to several reasons. As the nation’s largest health insurance provider, UHC offers group coverage plans in all 50 U.S. states.

  • National medical network – UHC has an extensive network of doctors and hospitals, making their health care services more accessible for members of small business plans.
  • Technology resources – Many UHC group plans include Virtual Visits, which facilitate online health care and doctor consultations through computers, mobile devices, or tablets.
  • Member wellness programs – UHC offers a wide variety of programs to keep its programs healthy. Partnerships with wellness and fitness companies such as Peloton encourage employees to set personal goals and get rewarded for reaching them. Members can also access benefits like counseling and coaching for smoking cessation and weight loss. 
  • Employer resources – UHC makes it easy for business owners to navigate benefits with employer tools like Employer eServices and other administrative tools.

UnitedHealthcare provides effective group coverage options for numerous small businesses overall.

2. Blue Cross Blue Shield

In addition to the aforementioned options, Blue Cross Blue Shield (BCBS) stands out as one of the top choices for small business health insurance. BCBS operates through the BCBS Association, which comprises 36 individual and autonomous companies, providing coverage across all 50 states in the United States. There are several compelling reasons why BCBS deserves recognition as one of the leading providers of benefits for small businesses.

  • Trusted by small businesses – Millions of small business employees receive their group coverage through Blue Cross Blue Shield companies.
  • Popular plan options – BCBS covers one in three Americans and has one of the country’s most popular PPO networks, the BlueCard® PPO.
  • Flexible care options – BCBS plans help you get the kind of care you need, whether that’s in-person, virtual, or emergency care. Blue Cross Blue Shield’s member website makes it easy to find primary care doctors, specialists, and more in your area. Some plan options offer round-the-clock nurse call centers or telehealthcare with licensed doctors from the comfort of your home.
  • Mental health resources – BCBS members may have access to wellness and mental health programs to support them in their health and fitness goals. Some programs, like SilverSneakers, specifically target older members.

Blue Cross Blue Shield has established partnerships with the majority of hospitals and doctors across the United States, ensuring that employers have easy access to their group health insurance plans.

3. Anthem

Anthem, the largest for-profit managed healthcare company in the Blue Cross Blue Shield Association, is present in 14 U.S. states. With one of the most comprehensive networks in the country, Anthem offers the possibility that your small business employees might already have their doctors affiliated with Anthem.

  • Integrated health care – Anthem takes an integrated approach to medical care through combined health plans, which connect patient data in order to more effectively manage care.
  • Smart tools – With Anthem’s online tools, employees can conveniently find doctors, schedule video visits, or have their questions answered by calling Anthem’s 24/7 NurseLine.
  • Members also have access to Anthem’s Sydney Health app, which makes it easy to schedule visits, access benefits information, and attend telehealth visits from one location.
  • Health resources – Anthem’s website has a large collection of resources to help its members stay healthy, active, and informed. Find information on topics like mental health, Medicare, caregiver support, navigating health insurance, and more. Anthem even has an easy-to-use Health Care Calendar that lets you enter your age and gender to get recommendations on preventive screenings and immunizations that are tailored for you, based on current health guidelines.

By choosing Anthem, both you and your employees can enjoy the benefits of a substantial medical network along with helpful resources for effectively managing your group medical plans.

4. Humana

Due to the variety of group coverage plans they offer, Humana can be regarded as one of the top health insurance companies for small businesses in America. When it comes to providing benefits for small businesses, Humana’s plans typically encompass the following advantages:

  • Preventative care advantages – In-network preventative care appointments are 100 percent covered by all Humana group medical plans. This may include services such as diabetic retinal eye exams, bone density tests to check for osteoporosis, mammograms, and more.
  • Humana Neighborhood Centers – one unique feature about Humana plans is that members may have access to its “Neighborhood Centers.” These are sites that offer various programs, events, exercise classes, and other services to help members stay healthy and active. The centers are meant to foster community, and most services are available for free. Many locations also have on-site customer care to help members with their Humana benefit questions.
  • Convenient plan features – Other features in all Humana group health insurance plans include wellness rewards, virtual doctor visits, and access to Humana Pharmacy services.

Humana is a competitor when it comes to offering a range of cost-effective health insurance plans for small businesses and their staff, making it worth considering if you want the top-notch option.

5. Kaiser Permanente

Kaiser Permanente, a leading health insurance company, offers excellent group health plans to its members in eight states across the U.S. as well as the District of Columbia.

  • Affordability – Since Kaiser Permanente is the largest managed care organization in the nation, it can offer a significant number of affordable small business health insurance plans and options.
  • Flexibility – Many Kaiser Permanente HMO group health plans, HSAs, and HRAs feature lower premiums and tax savings, and their PPO plans include added flexibility when choosing doctors.
  • Online tools – Kaiser offers many online tools to help you care you need. You can search your care options by symptom and receive recommendations for treatment.  Kaiser’s My Doctor Online app lets you message your doctors and nurses 24/7, access virtual services, or get appointment reminders from the convenience of your phone. 
  • Health and wellness resources – Kaiser has one of the largest databases of health information. Learn more about mental health, caregiving, life care planning, and more in one location. You can also find programs if you need assistance with healthcare costs, food, housing, and more.

Kaiser Permanente group coverage plans rank among the top options for employers seeking one of the best small business health insurance companies specializing in managed care services.

6. Aetna

Aetna is a great option for small businesses seeking group health insurance plans as they offer coverage across the entire United States. With an extensive network of doctors, hospitals, and specialists nationwide, Aetna stands out among benefit providers for small businesses.

  • Quality balanced with cost – Aetna has affordable and competitive health plans for small business employers, including wellness offerings and funding options.
  • Self-funded coverage – Aetna Funding AdvantageSM health plans provide the benefits of self-funding to small businesses, as well as stop loss protection and cost control.
  • Member support services: Aetna’s member portal makes it easy to manage benefits, check claims information, and more. Members may also have access to benefits such as gym memberships, health coaching, 24/7 nurse hotlines, and weight management programs. You’ll need to check your specific plan for benefits information, as plan benefits may vary.

Aetna, being one of the biggest health insurance providers nationally, is an excellent choice for small business owners looking for high-quality group medical benefits.

Where To Find Affordable Small Business Health Insurance

ICHRA (Individual Coverage Health Reimbursement Arrangement) plans could be a suitable option for small business owners seeking a more cost-effective alternative. Under this arrangement, employers provide their employees with a fixed sum of money to be utilized in purchasing healthcare.

Employees are then reimbursed by the employer using pre-tax funds after acquiring their own health plan.

ICHRA plans are often preferred by small business owners due to their competitive pricing compared to traditional employer group plans. Similarly, employees may favor this option as it allows them the freedom to select their desired plan and decide on the allocation of reimbursement funds.

{"email":"Email address invalid","url":"Website address invalid","required":"Required field missing"}