Covered California SHOP Booklet

7/27/2019 Covered California SHOP Booklet

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Small BusinessHealth Options

Program (SHOP)

Health Insurance Plans

Aug. 1, 2013


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About the Small Business Health Options Program (SHOP)

The Small Business Health Options Program, or SHOP, allows small businesses

quality health insurance plans to their workers. SHOP coverage beginning Jan.

California. No region of the state will have fewer than three health insurance

choose from.

an anchor plan through SHOPs online marketplace. Employers can choose the

About Covered California

www.CoveredCA.com.


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How Will Covered Californias SHOP Help Small Businesses?

premium collection, so small businesses can focus on their core functions. SHOP

to manage their health insurance.

through SHOP.

How much could your small business pay?

The scenarios depict two small businesses:

1. a low-wage small business with nine employees

2. a mid-to-high-wage small business with 15 employees

coverage through SHOP.

www.CoveredCA.com.


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Kapt Auto Repair | | SAN BERNARDINO, CA

Low-Wage Small Business

2014 Scenario

Employer purchases the Silver plan through SHOP on Jan. 1, 2014

Employer anchors their contribution to the Kaiser Permanente HSA Plan

Employee average wages continue to be $24,000

All nine eligible employees will be enrolling

Employer continues to cover 50 percent of each employee premium cost

employer chosen anchor plan

Employees are free to pick any plan they want in the employers chosen tier

Employee

No.Age

Anthem

Deductible

3000

PPO Plan

(2013 Plan)

Health Net

PPO Plan

(Similar

SHOP plan)

Blue Shield

HMO Plan

Kaiser

Permanente

HMO Plan

Kaiser

Permanente

HSA Plan

(Anchor Plan)

7 26 $202 $251 $257 $220 $211

5 $202 $275 $281 $240 $230

1 31 $250 $285

33 $250 $301 $257 $247

2 36 $250 $302 $264 $253

6 44 $337 $343 $351 $300 $288

4 47 $337 $384 $335 $322

8 51 $455 $458 $468 $400 $384

3 54 $455 $524 $536 $458 $440

Total Premium $2,738 $3,116 $3,187 $2,613 $2,614

Total Employer Responsibility (50%) $1,307

Total Less Tax Credit (50% in 2014) $654

Kapt Auto Repair || SAN BERNARDINO, CA

Low-Wage Small Business

2013 Employee Health Benet Summary

Employee No. Age Monthly Premium

7 26 $202

5 $202

1 31 $250

33 $250

2 36 $250

6 44 $337

4 47 $337

8 51 $455

3 54 $455

$2,738

Total Employer Responsibility

2013 Premium Tax Credit Eligibility

Employee average annual wages are $24,000

Total premium contribution from employer for 2013 will be $16,428


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Fluor + Wahl Architects | | SAN JOSE, CA

Mid-to-High-Wage Small Business

2014 Scenario

Employer purchases the Silver plan through SHOP on Jan. 1, 2014

Coinsurance PPO plan

All 15 eligible employees will be enrolling

Employer continues of cover 50 percent of each employees premium cost Employees are free to pick any plan they want in the employers chosen tier

Employee

No.Age

Blue Shield

Base PPO 30

Plan (2013

Plan)

Blue Shield

HMO Plan

Kaiser

Permanente

HSA Plan

Kaiser

Permanente

HMO Plan

Health Net

PPO Plan

(Anchor

Plan)

14 22 $243 $313 $255 $265 $284

2 25 $243 $314 $256 $267 $285

6 28 $243 $340 $277 $308

3 30 $355 $301 $322

12 37 $387 $315 $351

10 38 $318 $331 $353

1 40 $326 $362

5 40 $326 $362

11 40 $326 $362

15 40 $326 $362

7 44 $437 $356 $371

45 $451 $368 $383 $410

4 50 $546 $558 $455 $474 $507

8 50 $546 $558 $455 $474 $507

13 58 $676 $723

Total Premium $5,836 $5,516 $5,894

Total Employer Responsibility (50%) $2,974

Fluor + Wahl Architects | | SAN JOSE, CA

Mid-to-High-Wage Small Business

2013 Employee Health Benet Summary

Employer currently covers 100 percent of the cost of each employees

Employee No. Age Monthly Premium

14 22 $243

2 25 $243

6 28 $243

3 30

12 37

10 38

1 40

5 40

11 40

15 40

7 44

45

4 50 $546

8 50 $546

13 58

$5,836

Total Employer Responsibility


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2014 SHOP Rates Compared to 2013 Small Group Market

The following table looks at average small group rates in select California

California SHOP rates for the same areas.

The average premium between equivalent plans shows that in these areas,

Averages for 40-year-old Employee Health Care

Assumptions:

2014

Lowest

Silver

Plan

2014

Second-

Lowest

Silver

Plan

2014

Third-

Lowest

Silver

Plan

2014

Average

of Three

Lowest-

Priced

Silver

Plans

Average

of 2013

Comparable

Small

Group

Plans

Between

Average

Silver Plans &

Comparable

Small Group

Plans

Region 3 Sacramento County

KaiserPermanente

HSA

$295

HSA

$328

Health NetPPO

$365

$329 $334 2%

Region 4 San Francisco County

ChineseCommunity

$223

KaiserPermanente

HSA

$326

Health NetPPO

$399

$316 $403 28%

Region 6 Alameda County

KaiserPermanente

HSA

$310

Health NetPPO

$368

$474

$384 $340 12%

Region 15 Los Angeles County (partial)

KaiserPermanente

HSA

$263

$272

Health NetPPO

$288

$274 $311 13%

Region 16 Los Angeles County (partial)

$287

KaiserPermanente

HSA

$290

Health NetPPO

$349

$309 $362 17%

Region 19 San Diego County

KaiserPermanente

HSA

$263

SharpHSA

$288

Health NetPPO

$320

$290 $324 12%


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Region Counties Insurance Companies

6 Blue ShieldPPO (coinsurance)

Health Net

Kaiser Permanente

7 Santa Clara Blue ShieldPPO (coinsurance)

Health Net

Kaiser Permanente


Chinese Community Health Plan*

Health Net

Kaiser Permanente

9

San Benito

Blue ShieldPPO (coinsurance)

Health Net

Kaiser Permanente

10 San Joaquin

Stanislaus

Tulare


Health Net

Kaiser Permanente

Health Insurance Companies by Pricing Region


1 Alpine, Del Norte, Siskiyou,Butte, Glenn, Sutter,Calaveras, Tuolumne

Blue Shield

Health Net

Kaiser Permanente*

Western Health Advantage

2 Napa

Sonoma

Solano


Health Net

Kaiser Permanente


3 Sacramento

Placer


Health Net

Kaiser Permanente



Chinese Community Health Plan

Health Net

Kaiser Permanente

5 Contra Costa Blue ShieldPPO (coinsurance)

Health Net

Kaiser Permanente


HMO

HSA

PPO


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17


Health Net

Kaiser Permanente

18 Orange Blue ShieldPPO (coinsurance)

Health Net

Kaiser Permanente

19 San Diego Blue ShieldPPO (coinsurance)

Health Net

Kaiser Permanente

Sharp Health Plan


11

Kings


Health Net

Kaiser Permanente

12

Ventura

Santa Barbara


Health Net

Kaiser Permanente

13

Inyo

Imperial


Health Net

Kaiser Permanente

14 Kern Blue ShieldPPO (coinsurance)

Health Net

Kaiser Permanente


Health Net

Kaiser Permanente


Health Net

Kaiser Permanente


HMO

HSA

PPO


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SHOP Health Insurance Plans

Blue Shield of California

All

company. Our mission is to ensure all Californians have quality health care

Network

Hospitals: 223


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1716


Health Net

All

Network

Hospitals: 204

www.healthnet.com


Chinese Community Health Plan

4, 8

Network

Physicians: 315

www.cchphmo.com


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Sharp Health Plan

Network

Hospitals: 10

Physicians: 2,600

www.sharp.com


Kaiser Permanente

All

thrive.

Network

Hospitals: 35

www.kp.org


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1, 2, 3

Network

Hospitals: 15

Physicians: 3,000

www.westernhealth.com


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CoveredCA.com

Covered California SHOP Booklet

Documents

Transcript of Covered California SHOP Booklet