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7/27/2019 Covered California SHOP Booklet
1/13
p
Small BusinessHealth Options
Program (SHOP)
Health Insurance Plans
Aug. 1, 2013
7/27/2019 Covered California SHOP Booklet
2/13
1
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.
7/27/2019 Covered California SHOP Booklet
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32
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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54
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
7/27/2019 Covered California SHOP Booklet
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76
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
7/27/2019 Covered California SHOP Booklet
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8
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%
7/27/2019 Covered California SHOP Booklet
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1110
Region Counties Insurance Companies
6 Blue ShieldPPO (coinsurance)
Health Net
Kaiser Permanente
7 Santa Clara Blue ShieldPPO (coinsurance)
Health Net
Kaiser Permanente
8 Blue ShieldPPO (coinsurance)
Chinese Community Health Plan*
Health Net
Kaiser Permanente
9
San Benito
Blue ShieldPPO (coinsurance)
Health Net
Kaiser Permanente
10 San Joaquin
Stanislaus
Tulare
Blue ShieldPPO (coinsurance)
Health Net
Kaiser Permanente
Health Insurance Companies by Pricing Region
Region Counties Insurance Companies
1 Alpine, Del Norte, Siskiyou,Butte, Glenn, Sutter,Calaveras, Tuolumne
Blue Shield
Health Net
Kaiser Permanente*
Western Health Advantage
2 Napa
Sonoma
Solano
Blue ShieldPPO (coinsurance)
Health Net
Kaiser Permanente
Western Health Advantage
3 Sacramento
Placer
Blue ShieldPPO (coinsurance)
Health Net
Kaiser Permanente
Western Health Advantage
4 Blue ShieldPPO (coinsurance)
Chinese Community Health Plan
Health Net
Kaiser Permanente
5 Contra Costa Blue ShieldPPO (coinsurance)
Health Net
Kaiser Permanente
Health Insurance Companies by Pricing Region
HMO
HSA
PPO
7/27/2019 Covered California SHOP Booklet
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1312
Health Insurance Companies by Pricing Region
Region Counties Insurance Companies
17
Blue ShieldPPO (coinsurance)
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
Region Counties Insurance Companies
11
Kings
Blue ShieldPPO (coinsurance)
Health Net
Kaiser Permanente
12
Ventura
Santa Barbara
Blue ShieldPPO (coinsurance)
Health Net
Kaiser Permanente
13
Inyo
Imperial
Blue ShieldPPO (coinsurance)
Health Net
Kaiser Permanente
14 Kern Blue ShieldPPO (coinsurance)
Health Net
Kaiser Permanente
15 Blue ShieldPPO (coinsurance)
Health Net
Kaiser Permanente
16 Blue ShieldPPO (coinsurance)
Health Net
Kaiser Permanente
Health Insurance Companies by Pricing Region
HMO
HSA
PPO
7/27/2019 Covered California SHOP Booklet
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1514
SHOP Health Insurance Plans
Blue Shield of California
All
company. Our mission is to ensure all Californians have quality health care
Network
Hospitals: 223
7/27/2019 Covered California SHOP Booklet
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1716
SHOP Health Insurance Plans
Health Net
All
Network
Hospitals: 204
www.healthnet.com
SHOP Health Insurance Plans
Chinese Community Health Plan
4, 8
Network
Physicians: 315
www.cchphmo.com
7/27/2019 Covered California SHOP Booklet
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18
SHOP Health Insurance Plans
Sharp Health Plan
Network
Hospitals: 10
Physicians: 2,600
www.sharp.com
SHOP Health Insurance Plans
Kaiser Permanente
All
thrive.
Network
Hospitals: 35
www.kp.org
7/27/2019 Covered California SHOP Booklet
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2120
SHOP Health Insurance Plans
Western Health Advantage
1, 2, 3
Network
Hospitals: 15
Physicians: 3,000
www.westernhealth.com
7/27/2019 Covered California SHOP Booklet
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CoveredCA.com