SHOP is the Small Business Health Options Program operating under Covered California that will begin in 2015 for businesses with 50 or fewer employees. Small businesses will have the option to offer insurance plans through SHOP rather than through carriers not on the Covered California plan. According to Covered California Executive Director Peter Lee, this gives employers more flexibility in the types of plans and quality of coverage they are offering to employees.
How will the SHOP work?
Under SHOP, employers will be able to offer employees coverage from two pre-selected metal tiers similar to the individual tiered plan under Covered California. Unlike the individual market where consumers can select among one of four options, employers who choose to participate in SHOP must offer plans that are adjoining such as Bronze and Silver, Silver and Gold, or Gold and Platinum. An employer cannot select a Bronze plan and a Platinum plan to offer employees. While this is meant to make employee benefits more competitive and valued, in reality this limits the flexibility of the employer to appease individual employee needs.
5 Things You Need To Know About SHOP:
- Employers have the option to offer additional benefits like dental plans for adults in 2015 (Dental benefits will be employee paid only)
- There are 6 health plans and 10 dental plans
- Businesses with 50 or fewer employees are not required to get benefits through SHOP and there is no penalty for choosing not to enroll in coverage with SHOP
- Businesses with 25 or fewer employees who choose to enroll in SHOP will be eligible for a tax credit
- Open enrollment for SHOP is available year round (1,714 businesses are currently enrolled)
For a list of the health plan carriers and dental providers covered through SHOP in 2015, click here
There has been quite a bit of debate on Prop 45. If you are unfamiliar with this ballot initiative, get the facts here. Essentially, Proposition 45 is a November 2014 ballot proposition that would give ONE politician control over healthcare costs. This means one politician would control the insurance rates and the quality of what they consider “acceptable” care. If approved, this could, and most likely will, result in increased costs of healthcare and a decrease in the quality care.
Covered California and the purpose of the Affordable Care Act was to encourage affordable, quality care for all. That is why California has an insurance commission that helps negotiate rates on behalf of the consumer. If Proposition 45 passes, the elected politician would be able to campaign and accept money from special interest groups, therefore creating bias when it comes to determining costs of coverage. If a special interest group helps a politician win the election by sponsoring his or her campaign, they may have an underlying agenda that does not have our state’s best interest in mind. However, the current insurance commission has an opportunity to work together and negotiate on behalf of all individuals residing in the state of California without outside influence.
Why is the law flawed:
- Gives one politician too much power
- One politician would control your premiums, treatment options, coverage, etc.
- California would create another state bureaucracy which means higher costs for residents (most likely paid by higher insurance premiums)
- Special interest groups can make profits on this measure by campaigning against reform measures and giving politicians money
More information on why you should vote no on Proposition 45 here.
There has been a lot of debate over California Proposition 45, the Public Notice Required for Insurance Company Rates Initiative. Prop 45 would require certain regulations on health insurers similar to homeowners insurance and automobile insurance industries. Essentially, the initiative would give the elected Insurance Commissioner a pretty broad authority to either approve or disapprove anything affecting health insurance. This not only includes rates but also coverage for individuals or small group plans.
If approved, Prop 45 would:
- Mandate that any changes regarding health insurance rates be approved by the California Insurance Commissioner prior to taking effect
- Require that the public be notified of any health insurance rate changes
- Prohibit health, auto, and homeowners insurance from denying coverage or determining enrollment eligibility based on credit history or previous coverage
- Health insurers would be required to give a sworn statement regarding the accuracy of their proposed rates and justification of any changes
- Large group employer health plans would be exempt (this proposition only applies to small group business and individual policies)
Why are people opposed to Prop 45?
- Individuals and organizations would be able to collect fees and challenge insurer rates in front of a court room (Similar to how Consumer Watchdog does this to keep home and automobile rates down)
- There are concerns that the Insurance Commissioner will change over time and thus may side differently (either with consumers or with the insurers)
- The Insurance Commissioner will be an elected official who can receive funding for his or her campaign from insurers or people with special interests which may cause bias
What are your thoughts on Prop 45?
October is when the open enrollment period kicks off. This is the time where people are eligible to either renew their current plans or enroll in other health care options. It’s also a time when new applicants are eligible to get coverage. This is an opportunity for participants in the Covered California exchange to modify their current health plan options or elect a different carrier. If you are unhappy with your plan, now is the time to think about what you want to change it to.
What does this mean for Covered California?
- Navigators on the California exchange will be responsible for educating consumers about the open enrollment period and help them get coverage.
- More importance is also placed on the navigators to help retain the current participants enrolled in a Covered California policy.
- If consumers aren’t enrolled in a policy, they could face penalties so get prepared ($95/adult and $47.50/child).
- Covered California is also working on improving call centers and their website chat since they were inundated last year. This caused frustrations for applicants who were waiting for hours to get assistance and complete applications.
Are there any changes to expect in this open enrollment period?
- The period to register for a health care policy under Covered California will be three months shorter than last year.
- Anyone enrolled in a current Covered California plan who does not make a change to their policy by December 15th will be automatically re-enrolled for 2015.
Advice before entering this open enrollment period:
- Evaluate your current health policy. Are you happy with it or is there something you would like to change?
- Get educated. If you are thinking of modifying your health plan or look into alternative options, do some research. Navigators are also there to help you find the plan that fits your needs.
- Be prepared. If you want to change your plan, do so before December 15th. If you want a certain expense covered, find out which policies will help you get the best coverage for that need.
If you have any questions regarding a health policy, please feel free to contact our office. We’d be happy to help.
On Monday September 8, 2014, Health and Human Services (HHS) agreed to give $60 million in federal grants to help navigator programs on the health care exchange. Last year, HHS awarded states $67 million dollars in grants to help build out the navigator programs. Navigators are individuals who help consumers with questions regarding enrollment. They are trained individuals who are able to assist consumers, small businesses, and their employees looking into health care options. Navigator grants are only permissible in states where the federal government is setting up the exchanges. States with their own healthcare exchanges (like California) must set up their own navigator education program to assist individuals during the enrollment process.
Last year, it was reported that the navigators helped around 10.6 million U.S. residents during the initial open enrollment period of the ACA. This year they are hoping that even more navigators will get involved with the program to help consumers get covered.
Navigator grants are awarded to:
It is important to note that there are some new rules and requirements to be eligible to become a navigator including:
- Navigators must reside in the area they serve
- Navigators must submit weekly progress reports to HHS
- Navigators who are grant recipients must receive formal training and adhere to privacy standards
Despite these new navigator eligibility rules and the funding made available for the navigator programs, there is still some concern from many regarding the training and confidentiality of information when working with navigators. These navigators will be responsible for handling very private and secure personal information for millions of Americans. It is important to look into the training and background of each navigator to ensure that there will not be a breach of security with this private information.