California Paid Sick Leave (AB1522) is Effective July 1st

An employee who, on or after July 1, 2015, works in California for 30 or more days within a year from the beginning of employment, is entitled to paid sick leave. Employees, including part-time and temporary employees, will earn at least one hour of paid leave for every 30 hours worked. Accrual begins on the first day of employment or July 1, 2015, whichever is later.

Exceptions: Employees covered by qualifying collective bargaining agreements, In-Home Supportive Services providers, and certain employees of air carriers are not covered by this law

An employer may limit the amount of paid sick leave an employee can use in one year to 24 hours or three days. Accrued paid sick leave may be carried over to the next year, but it may be capped at 48 hours or six days.

To get more information on paid sick leave click here

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California on Cusp of Offering Young Immigrants Health Care

In a move that adds momentum to efforts to integrate immigrants, California is on the cusp of extending state-subsidized health care coverage to children from low-income families who are in the country illegally.

Democrats, immigration groups and health care advocates celebrated the announcement as both a cost-saving move and social progress for the state’s estimated 2.5 million immigrants who are in the country illegally. Critics, however, worry that the overburdened state-funded health program can’t handle another 170,000 children.

Gov. Jerry Brown and legislative leaders announced a $115.4 billion budget agreement that for the first time includes state funding to cover low-income children under 19 regardless of their legal status in Medi-Cal, the state’s health care program for the poor.

“This is a historic day,” said Senate President Pro Tem Kevin de Leon, D-Los Angeles. “With this budget we’re saying that immigrants matter.”

To learn more about immigrant health care click here


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Taxpayers Pay Back Subsidies

Covered California and the Affordable Care Act are health reform initiatives meant to help Americans get access to quality and affordable medical benefits. One of the primary benefits of these initiatives is the ability to receive subsidies to help reduce the costs of monthly healthcare premiums.

However, according California Healthline and a recent study by H&R Block, nearly two-thirds of taxpayers who received a subsidy on the Covered California exchange are now having to repay taxes to the federal government.

Individuals who were granted too big of a subsidy had to repay about $729 on average compared to those who were given too little of a subsidy and were given back $429 on average.

You can qualify for a Covered California Subsidy if:

  • You are a US citizen, US National, or lawfully present immigrant who has purchased coverage through Covered California
  • You are not eligible for other public health coverage such as Medi-Cal or Medicare
  • You have an annual household income of 138% and 400% of teh Federal Poverty Level (FPL)

About 55% of people who received a subsidy on the exchange had to pay back the federal government. There were about 45% of people who were refunded since they should have been given a higher subsidy.

Get more information on subsidies and eligibility here.

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Covered California for Small Business

SHOP, also known as the Small Business Health Options Program, is getting a “rebrand” on the Covered California website. The new name of the program for small business will be called Covered California for Small Business. According to some officials, the naming and marketing of the program was not as straightforward as other programs. Therefore, they are hoping that this rebrand will market to a broader audience and entice more businesses to enroll in coverage.

About 2,289 small businesses are currently enrolled in Covered California for Small Business. One of the primary benefits of a small business enrolling in a Covered California health plan is the tax credits.

Small Business Employers who enroll in a Covered California health plan can receive tax credits if:

  • they have less than 25 full time equivalent (FTE) employees
  • the average wages per FTE are less than $50K
  • the employer pays 50% of the employee’s premium cost (minimum)

In order to offer coverage through Covered California for Small Business, employers:

  • must have 1-50 Full Time Employees (working at least 30+ hours/week)
  • must offer coverage to all Full Time Employees
  • *offering coverage to part time employees is optional

NOTE: In 2016, eligibility for Covered California for Small Business will change to include employers with 100 or less employees.

Have any questions regarding the upcoming changes for Covered California for Small Business? Give us a call to learn more!

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Prescription Drug Cap

About 7 out of 10 or 70% of Americans take prescription drugs, which is why the discussions surrounding prescription drug costs are so important.

Covered California officials recently proposed a limit on drug costs for consumers who have specialty prescriptions and purchase a 2016 health plan.Their goal is to give these individuals accessible and affordable coverage for their prescriptions.

The proposal would:

  • Place certain drugs in pricing tiers
  • Require health plans to publish pricing information about the prescriptions online
  • Mandate that there must be at least one drug for a particular condition in a lower tier

For example, this would mean that the cost of a prescription for diabetes would have to be published by the health plan online and there must be a prescription available for diabetes in a lower pricing tier (not all diabetes prescriptions could be offered in the highest tier).

According to Covered California officials, this would enable the the exchange to create better recommendations for specialty drug cost limits.

What else did the proposal say?

  • There would be a $500 limit per prescription for specialty drugs in 2016
  • Silver plans would pay $200 at most per specialty drug
  • Platinum plans would pay $300 at most per specialty drug
  • Bronze plans would pay $500 at most for any prescription
  • Gold plans would pay $500 at most per specialty drug

Overall, the primary purpose of these caps is to help decrease the gap of information between the drug maker and the consumer. Drug makers have been increasing the cost of drugs to the point where it is almost unaffordable to the consumer. This policy would better explain the cost of the drug and apply a pricing cap to it.

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