• Spouse: the plan participant’s spouse under a legally valid marriage.
  • Domestic partner: the plan participant’s domestic partner under a legally registered and valid domestic partnership.
  • Child: the plan participant’s, spouse’s or domestic partner’s natural child, stepchild, or legally adopted child.
    • Children are eligible up to the age of 26. Coverage ends on the first of the month following their 26th birthday.
    • Disabled children of eligible employees who, with appropriate medical certification, are eligible for coverage up to any age, only if they were originally enrolled before turning 26.

What forms need to be completed?

  • Form B1: Subscriber Change Request Form

When do the forms need to be submitted to Banyan Administrators?

  • The Subscriber Change Request Form must be submitted to Banyan Administrators within 31 days of the Qualifying Event. Qualifying Events include marriage, divorce, birth, adoption, loss of other coverage, etc.

When is their coverage effective date? 

  • Coverage will become effective on the first of the month following the qualifying event.
  • The one exception is the birth or adoption of a child. The coverage effective date will be the date of birth or adoption. If the date of birth is on or before the 15th, the rate change will be applied that month. If it is after the 15th, the rate change will be applied in the next coverage month.

How will the change be reflected on the premium invoice?

  • The coverage tier is listed above the premium amount. E for employee only, ES for employee and spouse, EC for employee and child, ECN for employee and children, and F for family.
  • Please note that invoices are generated a month before the due date. If a change form is submitted after the invoice is generated, the change will be reflected on the following invoice. For example, a change that is submitted on July 2nd will be reflected on the September invoice.

CalCPA Health is available to accounting firms in public practice or firms offering general financial services, both of which must be headquartered in the state of California.

To be eligible and retain such eligibility, more than 50% of all of the firm’s owners (principals, proprietors, partners, shareholders, or other owners) must be CPA members of CalCPA, or Associate members of CalCPA. All CPA owners must be members of CalCPA in good standing.

More than 50% of the group’s enrolled employees must reside in California.

Firms with one Eligible Employee:

If you are the only Eligible Employee (as defined on the next page), you are eligible to enroll in the CalCPA Health Vision and Dental plans.

If you would like to enroll in Medical coverage, Banyan can assist you in choosing and applying for an Individual plan through Anthem Blue Cross. Banyan would continue to be your point of contact for customer service inquiries.

Individuals must enroll during the Open Enrollment Period, or when there is a qualifying life event that creates a Special Enrollment Period. Individual Medical coverage cannot be obtained mid-year without a qualifying life event.

Employer Contribution Requirements:

An employer must contribute a minimum of 50% of the cost of employee’s medical premiums, and 100% of employee’s dental, vision, life or long term disability premiums. This does not include the cost for dependents. Payroll deduction is required for employee contributions that are withheld to pay premium costs. If an employer pays 100% of the premiums, 100% employee participation is required.

The Patient Protection and Affordable Care Act (ACA) was passed more than five years ago. Never has a piece of federal legislation been in the controversy spotlight for this length of time.

Typically, new federal and state laws require some tweaking before, during or after they are implemented. Fix-it bills can clarify the original intentions of lawmakers, correct mistakes and make the legislation practical to implement. In the ACA’s circumstance, be-cause of the high level of animosity surrounding the law’s fundamentals, significant fixes are not politically feasible. Read more

by Gregory M. Burke, CPA, MS (Tax)

The stated intent of the Patient Protection and Affordable Care Act (ACA) of 2010 was to increase health care insurance coverage with respect to the millions of uninsured Americans and control runaway health care costs. As part of the effort to meet these goals, the ACA enacted interrelated subsidy, penalty, and information reporting provisions. This article will focus on the information reporting provisions impacting “applicable large employers” in 2015. Read more

Four years after the passage of the Affordable care Act (ACA) there is still great debate on the law’s outcomes. How many uninsured will enroll? Will ACA create doctor shortages? Will death panels ration medical care? And the trillion dollar question: will the cost of health insurance go up, down or stay about the same?

Stay tuned to read the full article in the June issue of the CalCPA Magazine.

The Patient Protection and Affordable Care Act (ACA) is exceedingly vast. It deals with all aspects of the medical delivery system including insurance. Combine this with the numerous changes California is implementing and the result is tens of thousands of pages, comprising both federal and state regulations.

This book focuses on the key elements that affect California CPAs. Therefore, we will concentrate on those ACA regulations that are being adopted and implemented in California. And, while other states may have slightly different implementations, they will not be specifically addressed here.

Our intent is that you may use this book as a reference for the areas that are of particular interest to you, or those areas that expressly affect you. For example, if you are with a small firm and do not have any “large employer” clients, the large employer sections may be of less value to you than the information on small employers.

Download Now

Ron Lang, CEO of the California Society of CPAs Group Insurance Trust, discusses how health care reform has changed the face of health care plans by covering the following topics: plan designs and pricing, network options, California Health Benefit Exchange, current and future regulatory changes and what we can expect for 2015. (Video taken at CalCPA Education Foundation’s Health Care Conference on 4/29/2014).

The Patient Protection and Affordable Care Act (ACA) drastically changes all the business rules and now many seem surprised at the displacement it is causing. Policy cancelations, and plan changes for 2014 are being widely reported in the individual and small group markets. While the ACA is providing access to coverage for folks with pre-existing conditions and premium subsidies to lower income levels; high percentages of the currently insured are being regulated into different benefit and rate structures. 

The ACA and California regulations that are primarily responsible for this displacement are: Read more

Health Care Reform