If you’re a small business owner or manager and you’re thinking about offering employee benefits to your workers, there are some things you will want to know.

First and foremost, if you have fewer than 50 full-time and full-time equivalent employees, you’re not required to offer health benefits to your workers. That requirement of the Affordable Care Act (ACA) applies to Applicable Large Employers (ALEs) only.

Under the ACA’s employer shared responsibility provisions, ALEs must offer health insurance to at least 95% of eligible employees and dependents. If coverage is not offered – or it does not meet minimum standards concerning affordability and value – the employer could face penalties.

Reasons to Offer Health Insurance Coverage Even If Not Required

While there’s some uncertainly about the future of the ACA in light of the recent election results, right now the ACA still applies. And many small and mid-size businesses voluntarily make health insurance available to their employees. That’s because it’s part of their recruitment and retention strategy.

Even if President-elect Trump wants to force some ACA changes, it could take time before it’s fully felt by employers and employees. It’s no secret that during his first term as president he tried repeatedly to repeal it. He did eliminate the individual mandate for coverage but fell short of total repeal. Of course, at that time, he was working with a divided House of Representatives and Senate. With some races not yet called, it appears the GOP will control the White House, Senate, and House in 2025.

Easier Now to Get Health Coverage

Since the ACA became law, the number of Americans without health insurance has declined. In 2022, the latest full year for which detailed information is available, about half (48.7%) of residents with insurance got it through their employer. Another fifth (21.2%) had coverage through the Medicaid program. That’s the joint federal and state program for low-income individuals. Roughly 15% had health coverage through Medicare. That covers seniors and those under 65 with long-term disabilities. Six percent plus had non-group coverage on their own or through the ACA marketplaces (like Covered California). Military coverage was 1.3% of the population. The remaining eight percent lacked health insurance.

Since the ACA was enacted, it’s easier now for Americans to get health insurance. That’s because of the

pre-existing health condition prohibition. The ACA does not allow insurers to deny coverage due to a prior health condition. It also prevents individuals from paying more if they have a health condition. It prohibits insurers from refusing to pay for treatment for a condition that exists before coverage began. And, once enrolled, a plan cannot deny coverage or raise rates based on a person’s changing health.

ACA Plans Must Offer “Essential Health Benefits” (EHBs)

Employers and employees also appreciate the ACA requirement that plans include coverage for 10 “Essential Health Benefits,” including:

• Ambulatory patient services (outpatient care you get without being admitted to a hospital)
• Emergency services
• Hospitalization (like surgery and overnight stays)
• Pregnancy, maternity, and newborn care(both before and after birth)
• Mental health and substance use disorder services, including behavioral health, counseling, and psychotherapy
• Prescription drugs
• Rehabilitative and habilitative services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills
• Laboratory services
• Preventive and wellness servicesand chronic disease management
• Pediatric services including oral and vision care

ACA-compliant plans must also include birth control benefits and breastfeeding coverage.

When you’re shopping for coverage and comparing plans from different companies, be sure you know exactly what each plan offers. Your broker will help you sort it out – and find a plan to match your specific health care needs and budget.

You Choose the Contribution to Employees’ Coverage

Controlling your benefits costs is an important consideration for employers. Another advantage of selecting CaliforniaChoice for your employees is Defined Contribution. With it, you decide how much you want to contribute to employees’ health insurance premiums. You can select a Fixed Percentage Amount (50% to 100%) toward a specific benefit, or a Fixed Dollar Amount, for each employee. (Your contribution has to be the same for all employees.)

Another advantage of CaliforniaChoice is you and your employees have access to 100+ coverage options. Depending on where your business is and where employees live, they can choose from multiple health plans. CaliforniaChoice offers seven health plans statewide, including:

• Anthem Blue Cross
• Health Net
• Kaiser Permanente
• Sharp Health Plan
• Sutter Health Plan (formerly Sutter Health Plus)
• UnitedHealthcare
• Western Health Advantage

Quality Heath Care Is Just the Beginning

In addition to outstanding health benefits, CaliforniaChoice offers a variety of valuable extra benefits through the CaliforniaChoice Business Solutions Suite and Member Value Suite:

• Flexible Spending Accounts (FSAs) Available to groups with 15 or more employees
• Premium Only Plans
• Cal-COBRA or COBRA administration
• Savings on entertainment, sporting events, travel, wellness, and more
• Discounts on Dental, Vision, and Hearing care
• Prescriptions drugs savings

Talk With Your Broker to Learn More

Group Medical doesn’t have to be complicated. Your health insurance broker can provide you with guidance and a custom CaliforniaChoice quote for your business. Available since 1996, CaliforniaChoice delivers benefits to more than 23,500 small businesses in California and 380,500+ members. And, of course, CaliforniaChoice is easy to manage and renew, too. Act now to get details.

If you don’t have a current broker, we make it easy to search for one.