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Health insurance premiums are climbing fast, affecting both employers and employees. Rising medical costs aren’t new, but the pace of increase today reflects several powerful forces coming together at once, from high-cost specialty drugs to “nuclear” claims and labor inflation. Understanding why premiums are increasing is the first step to managing them.
One of the biggest drivers is the growing number of extremely high-cost claims – or “nuclear” claims. A small number of cases are reshaping the health insurance landscape. Gene therapies often run $2 million or more per treatment, and other “miracle treatment” technologies come with high price tags. These advances improve outcomes, but their costs flow into premiums.
Prescription drug costs are another major factor. Drug spending continues to grow faster than overall medical inflation. More people are taking medications for more conditions, and specialty drugs, especially cancer therapies, carry steep price tags. GLP-1 drugs, used for diabetes and weight management, are adding additional pressure. They are widely used and carry a high cost, which creates both frequency and cost challenges.
At the same time, people are using more healthcare overall. Rates of obesity, diabetes, cardiovascular disease, and inflammatory conditions are contributing to more doctor visits, more tests, more hospitalizations, and more prescriptions. When utilization climbs, premiums follow.
Healthcare is heavily impacted by labor costs. Hospitals and medical groups face higher wages for nurses, physicians, and technicians. Because provider contracts are typically renegotiated every few years, recent inflation is now reflected in new pricing agreements.
Regulatory changes also play a role. New state and federal mandates, even well-intentioned ones, add cost. California’s requirements for IVF coverage and caps on insulin spending are recent examples. Each mandate contributes to what many call the “regulatory stack,” appearing in the premium cost structure.
Prescription drugs now account for roughly 20% of total medical spending. A small percentage of people drive more than half of all prescription drug costs, largely due to specialty treatments that can run $200,000–$400,000 (or more) annually. GLP-1 utilization continues to expand. Generics and biosimilars provide some relief, but for every drug that comes off patent, a more expensive one often takes its place.
Insurance companies are often blamed for rising costs, but many standard plan elements were originally created by them to control unnecessary spending and protect members from unknown prices and unneeded medical services. Examples include:
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- Prior authorizations and utilization reviews
- Second surgical opinions
- Provider networks (PPOs) with negotiated allowable charges
- Case-rate agreements and billing compliance standards
Out-of-network providers typically avoid these controls, which is why their services cost more.
On the pharmacy side, Pharmacy Benefit Managers (PBMs) use formulary management, generic substitution, step therapy, GLP-1 oversight, and rebates to help contain costs. While not perfect, these strategies are designed to balance access and affordability.
For employers and individuals, the challenge is not just understanding why costs are rising, but how to respond. Many receive just 3–6 months’ notice of annual premium increases. We know healthcare inflation is unpredictable, so having informed estimates can help prevent scrambling at renewal time.
Cost sensitivity continues to drive decisions. Whether selecting a plan as an employer or choosing coverage as an individual, there is often a focus on keeping premiums low. The key is to balance that with the level of financial risk you are willing to take on. Looking at total cost, not just premiums, can help you make an informed decision.
Guidance matters. Employers benefit from internal expertise or strong broker support, and individuals benefit from taking the time to understand their coverage. Health insurance is one of the largest expenses most people will face, and being informed can make a meaningful difference.
Many employers and employees “overbuy” or misjudge the trade-off between premiums and out-of-pocket exposure. Choosing a lower premium option with higher out-of-pocket exposure, or vice versa, should be done with a clear understanding of how the plan will be used. HSA-compatible plans can be effective, especially when used by participants who understand how to use them and take advantage of preventive care and cost comparison tools.
Guidance helps. Employers benefit from in-house expertise or strong broker support or other external resources. Individuals also benefit when they invest time in understanding their coverage and plan options. Health insurance is one of the largest lifetime expenses for most households, and being informed can make a meaningful difference.
When premiums spike, employers often explore alternative solutions. These options can offer savings in certain situations, but they also come with risk and should be carefully reviewed. ICHRAs (Individual Coverage HRAs) are also gaining attention, but in California they have not consistently proven to be cost-effective at scale.
The healthcare system is complicated, and most people have little training in how to navigate it. Being an informed consumer means understanding how your plan works, knowing where to find value, and making informed decisions.
For employers, health insurance is often the second-largest expense after payroll. For individuals, it is one of the top costs in the household budget. Taking the time to build knowledge or access reliable guidance can have a real impact.
Premium increases reflect a mix of breakthrough treatments, rising chronic disease, regulatory mandates, pharmaceutical inflation, and higher provider costs. While these trends are not likely to slow immediately, employers and individuals have options. Through thoughtful planning, proactive decision-making, and access to knowledgeable guidance, it is possible to manage these costs more effectively.
This article reflects data and trends from CMS, KFF, PwC Health Research Institute, and national pharmacy and actuarial reports.
Misinformation is everywhere—and navigating the healthcare system can feel like a second job. This episode is about empowering listeners to cut through the noise. Learn how to identify trustworthy health sources, prepare for medical appointments, and advocate effectively for your needs. We’ll also share tips on having tough conversations with doctors and pharmacists.
Topics Covered:
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- How to spot credible health news
- Red flags in medical misinformation
- Preparing for appointments (health journaling, family history)
- Patient-provider communication strategies
- Questions every patient should ask
In this energizing episode, we dive into the science behind cardiovascular health and the essential role of movement in protecting your heart. We’ll break down how different forms of cardio benefit your circulatory system, boost your mood, and increase longevity. Whether you’re already active or just starting out, you’ll gain actionable tips to build a heart-healthy routine that works for you.
Topics Covered:
- How cardio strengthens your heart
- Debunking fitness myths
- Everyday ways to get your heart rate up
- Motivation for consistency
This episode kicks off your journey toward healthy living. We’ll explore how to build sustainable habits, set realistic goals, and shift limiting belief systems. Learn how to use time management, habit stacking, and the power of small wins to drive lasting change. This motivational episode includes reflection prompts to help listeners take control of their health-starting with that first step.
Topics Covered:
- The psychology of change and behavior
- Habit stacking & micro-goals
- Overcoming common barriers
- The role of belief systems
- Reflective journaling prompts for listener
It’s on every headline in the newspaper and on the news – healthcare costs in the U.S. continue to rise sharply. It is affecting the entire country, and there seems to be no end in sight to the continued rise in costs. In 2023, national healthcare spending surged 7.5% to $4.9 trillion, accounting for 17.6% of U.S. GDP[1] [2]. That’s nearly one-fifth of the economy, and it’s projected to rise even higher in the years ahead.[3]
Prescription drug costs alone rose 11.4% in 2023, resulting in drugs now making up 9.2% of total health spending [4]. According to PWC, “Drug spending in the US grew by $50 billion (11.4%) from $437 billion to $487 billion in 2024 at net manufacturer prices, up from $20 billion of growth (4.9%) in 2023. The trend is expected to extend into the coming years, driven by growth in oncology, immunology, cardiovascular, obesity, and diabetes drugs.”
New for 2026: Copay-Only Alternative Health Plans (AHPs)
To help employers manage rising costs and expand plan options, CalCPA Health is introducing a suite of Alternative Health Plans (AHPs) through Anthem Blue Cross, powered by Coupe Health™. These tiered, copay-only PPO designs emphasize clarity, quality, and cost control, with no gatekeeper required. Members can view provider tiers and their out-of-pocket costs before scheduling care, which enables smarter, value-driven decisions that can lead to savings for both employers and employees.
While AHPs are not new, CalCPA Health’s offerings stand out by including Small Group and HSA-compatible options—a rare find in the market. Learn more about these plan offerings and search for in-network healthcare providers.
Benefits for Employees
- No deductibles* or coinsurance on most plans.
- Access to California’s largest provider network – Anthem Blue Cross.
- Cost transparency tools to view provider rankings and exact costs upfront.
- Tiered provider rankings highlight quality and value.
- Comprehensive coverage of ACA essential health benefits: including preventive care, hospital/urgent/emergency services, specialty care, pharmacy, maternity, behavioral health, and more.
Benefits for Employers
- Premium savings potential, thanks to more efficient plan design and guiding members to high-performing providers.
- Smarter employee healthcare choices—when costs are visible before care, usage aligns with value.
- Plans that align with expectations—transparency, convenience, and choice.
- Improved employee retention by offering flexible, cost-effective options.
With healthcare spending and pharmacy costs continuing to rise, firms seek innovative, value-driven approaches rather than traditional plans with higher price tags. CalCPA Health’s AHPs offer CalCPA member firms a compelling alternative: Anthem’s provider network, combined with Coupe Health’s™ cost-transparency capabilities. These plans deliver what today’s market is looking for: affordability, clarity, quality, and flexibility.
*Two AHPs are HSA-compatible HDHPs, which do include a deductible.
[1] https://www.pgpf.org/article/healthcare-spending-will-be-one-fifth-of-the-economy-within-a-decade
[3] https://www.pgpf.org/article/healthcare-spending-will-be-one-fifth-of-the-economy-within-a-decade
[4] https://www.chcf.org/resource/national-health-spending-almanac
Open Enrollment is the annual opportunity to review your health insurance options and make changes for the upcoming year. For most of us —whether employers, solo practitioners, or employees —open enrollment typically occurs in the fourth quarter, and new benefits take effect on January 1st of the new year.
This period is especially important because outside of open enrollment, you can only make changes to your coverage if you experience a qualifying life event (such as marriage, divorce, birth of a child, or loss of other coverage). That means this is your chance to:
- Reevaluate whether your current plan still meets your needs.
- Compare costs and coverage options, including PPOs, HSAs, EPOs, HMOs, or Alternative Health Plans (AHPs).
- Add or adjust coverage for dependents.
- Research Health Savings Accounts (HSAs) and the tax-advantaged options these plans provide.
- As an employer, evaluate your current plan offerings and consider what adjustments may be needed, and if new options are available that would improve employee retention and satisfaction.
Why It Matters This Year
Healthcare costs and coverage trends continue to shift, with rising pharmacy and claim expenses, as well as evolving provider networks. More employers are introducing an array of choices, including innovative alternatives that emphasize transparency and cost savings. Employees may be seeking ways to get the most value from their benefits and manage their premium costs – and know the cost before a visit. (Learn about the new Alternative Health Plans – AHPs – that CalCPA Health is offering for 2026!)
Reviewing your options before open enrollment deadlines is key, so you have enough time to research and understand what’s available to you, your family, and your firm. Becoming your best advocate on health insurance can lead to lower out-of-pocket costs, access to preferred providers, and greater financial protection for the year ahead.
Tips for Open Enrollment Readiness
- Start early. Don’t wait until the final days of enrollment—give yourself time to compare and select the best plan.
- Review your healthcare usage. Think about your doctor visits, prescriptions, and family needs over the past year – did you use these benefits?
- Look at the long term. HSAs, for example, may offer both immediate premium savings and future tax advantages, allowing you to save now for future medical expenses.
- Ask questions. Your HR team, broker, or plan administrator can help explain plan differences and benefits.
NOTE: CalCPA members can reach out to CalCPA Health with their health insurance benefit questions – whether you are enrolled with us or not – by email info@CalCPAHealth.com or call 866-730-3593.
Open enrollment is an opportunity to align your health coverage with your personal, family, and financial needs. By researching and asking questions, you’ll enter the new year with confidence, knowing you made the best choice available to you.
Via an Interview with Ron Lang (CEO of CalCPA Health), By Phil Calhoun (CEO of California Broker Media)
CalCPA Health Coverage Options: A Deep Dive into Plan Variety and HSA Leadership (Part 2 of 3)
In the second installment of our in-depth look at CalCPA Health, CEO Ron Lang discusses the breadth of coverage options available to California’s CPA and financial professional firms. This part of the interview explores the organization’s philosophy on plan design, its industry-leading approach to Health Savings Account (HSA) plans, and how CalCPA Health’s flexibility and integration set the plans and support as a leader in the competitive group health market for many businesses in the financial services industries.
A Broad Spectrum of Plans: Choice and Customization
CalCPA Health offers an exceptionally wide range of medical plans with about 40 in total. The plans span from Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPOs), Health Maintenance Organizations (HMOs), and an extensive suite of HSA-eligible high-deductible health plans. This variety is designed intentionally to meet the diverse needs of small and mid-sized firms that often have employees with different healthcare preferences and financial situations.
While some national insurers may abruptly cancel plans and move members to new options, CalCPA Health takes a more measured approach. The organization is mindful about removing plans from the market and prefers to maintain continuity for its members, even as it regularly reviews and refines its offerings to avoid overwhelming employers and employees with too many choices.
HSA Plans: A Core Strength and Differentiator
One of the standout features of CalCPA Health is its strong emphasis on HSA-eligible plans. Roughly half of CalCPA Health’s insured population is enrolled in an HSA plan, a figure far above the national average of approximately 24 percent (and even higher compared to California’s average). This is no accident; as Lang explains, the CPA and financial professional audience is uniquely positioned to appreciate the tax advantages and long-term savings potential of HSAs.
Why HSAs Are So Popular with CalCPA Health Members
- Tax and Savings Benefits: HSAs allow for pre-tax contributions, tax-free investment growth and tax-free distributions to cover qualified medical expenses. Unused funds roll over year-to-year, accumulating for future healthcare needs.
- Financial Literacy: CalCPA Health’s clients, primarily CPAs and financial professionals, tend to understand and value these benefits, making them more likely to enroll and actively use HSAs as part of their overall financial planning.
- Talent Attraction and Retention: Many firms use HSA plans as a recruitment and retention tool, offering employer contributions to HSAs outside of 401(k) plans and without running afoul of discrimination rules. This flexibility is highly valued by both owners and employees.
A Wide Range of HSA Plan Designs
CalCPA Health offers the largest selection of HSA-eligible plans in the state, starting at the federal minimum deductible and increasing in increments as high as $6,500. This allows firms and employees to select plans that match their risk tolerance and financial goals. Many members start with lower deductibles as they build up their HSA balances, then move to higher deductible plans as their comfort with the HSA model grows and balances in the account total more than the plan deductible.
Fully Integrated HSA Administration
CalCPA Health’s HSA plans are fully integrated with HealthEquity, streamlining administration for both employers and employees. Employees can pay providers directly from their HSA, reconcile debit card transactions, and manage their accounts online. Employers benefit from simplified processes for adding new hires, changing contribution amounts, or deleting HSA contributions, which reduce administrative burdens.
Other Plan Types: PPOs, EPOs, and HMOs
In addition to high-deductible PPO plans which are HSA eligible, CalCPA Health provides a full suite of traditional PPO plans, which offer flexibility to see any provider but with cost savings for using in-network doctors and hospitals. EPO plans are also available, providing in-network-only coverage without the requirement for primary care physician referrals, which isa popular choice for firms that want simplicity without the restrictions of an HMO.
For those who prefer the predictability and coordinated care of an HMO, CalCPA Health partners with Anthem Blue Cross to offer HMO and Select HMO plans. These plans require members to choose a primary care physician and obtain referrals for specialty care, but they offer no-claims paperwork for in-network services and comprehensive coverage, including mental health and substance abuse services.
Mix-and-Match Flexibility and Kaiser Integration
One of CalCPA Health’s unique features is its willingness to allow firms to “mix and match” plan types. Employers can offer any combination of copay, HSA, and Anthem Blue Cross HMO plans, tailoring benefits to the needs of their workforce. Furthermore, CalCPA Health will write plans alongside Kaiser Permanente, accommodating employees who prefer to stay with Kaiser without imposing participation requirements, as long as adverse selection is avoided. This flexibility is rare among group health providers and demonstrates CalCPA Health’s commitment to meeting member needs.
Network Strength and Member Experience
All CalCPA Health plans leverage the Anthem Blue Cross provider network—the largest in California—ensuring broad access to doctors, specialists, and hospitals. Members also benefit from value-added services like LiveHealth Online, which provides telemedicine and online mental health visits, and a single point of administration for medical, dental, vision, life, and disability plans.
Conclusion
CalCPA Health’s approach to plan design is rooted in flexibility, member education, and a deep understanding of its professional audience. By offering a broad spectrum of PPO, EPO, HMO, and especially HSA-eligible plans, with fully integrated administration and unmatched customization, CalCPA Health empowers CPA and financial services firms to provide high-quality, cost-effective benefits that attract and retain top talent. In the final part of this series, we’ll examine the value-added services, wellness programs, and future trends shaping CalCPA Health’s ongoing evolution.
https://calcpahealth.com/about-group-insurance-trust-calcpa-health/
https://calcpahealth.com/shop-for-a-plan/medical-plans/
https://calcpahealth.com/pdf/Plan_Brochure/2025_CalCPA_Health_Plan_Brochure.pdf
Part 3 Coming Next Month
CalCPA Health Coverage Options: A Deep Dive into Plan Variety and HSA Leadership (Part 2 of 3)
Via Interview with Ron Lang By Phil Calhoun
When you’re sick or injured, knowing where to go for care isn’t always easy — especially when you’re in discomfort and distracted. Knowing how to choose where to go for the right care can save you time, money, and stress.
At CalCPA Health, we believe education is one of the best tools you can use to take charge of your health. Here’s a guide to help you decide when to visit your primary care doctor, head to urgent care, or go to the emergency room, as well as what each might cost under most health plans.
Your Doctor (Primary Care Physician)
Best for: Routine care, chronic conditions, preventive visits, and minor issues during business hours.
Your doctor knows your medical history and can treat you more personally than in other care settings. For non-emergency symptoms like a mild rash, cough, cold, or stomach bug, this is often the best first stop if you can get an appointment. Primary Care Physicians are usually available during normal business hours and may also provide medical advice by phone after hours or even email you.
Typical cost with insurance:
Usually, it is a $$ copay, depending on your plan. *
Virtual Care (Telehealth)
Best for: Cold/flu symptoms, rashes, UTIs, minor infections, allergies, or when you need care quickly but it’s not an emergency.
Telehealth is available 24/7 with Anthem’s Sydney Health app (available to CalCPA Health members) or other virtual platforms. You can see a doctor at your convenience without leaving your home. It’s usually faster and lower cost than in-person visits.
Typical cost:
Often $ copay — check your plan summary for details. *
Retail Clinics (Walk-In)
Best for: Sore throats, earaches, pink eye, minor cuts or burns.
Located in places like CVS or Walgreens, these clinics are staffed by nurse practitioners or physician assistants and are great for quick, simple care when your doctor’s office is closed. This option is usually at a lower cost and wait time than urgent care but may have limited scope.
Typical cost:
Around $$ if self-pay, or your copay if using insurance.*
Urgent Care
Best for: Sprains, strains, minor broken bones, infections, moderate flu symptoms, or nausea that’s not life-threatening.
Urgent care is typically open daily, nights, and weekends, with access to lab tests, X-rays, and treatments not usually available at retail clinics. It’s a good choice when you need attention right away, but it’s not a 911-level emergency. Urgent care visits tend to be faster and more affordable than a visit to the ER.
Typical cost with insurance:
The copay is often $$$, depending on plan and services rendered. *
Emergency Room (ER)
Best for: Serious or life-threatening situations such as chest pain, breathing difficulties, heavy bleeding, signs of stroke, or major trauma.
Emergency Room visits should be reserved for true emergencies and will cost significantly more. They also often involve longer waiting times unless your condition is severe.
Typical cost with insurance: $$$$
ER visits can result in copays plus coinsurance (often a percentage of total charges), unless you’re admitted to the hospital for inpatient care, in which case the ER copay may be waived. *
Things to keep in mind
- Use virtual care because it is fast, affordable, and covered under most CalCPA Health plans as well as under other carriers.
- If it’s not urgent and it’s during business hours, check in with your doctor.
- Going to the ER for non-emergencies leads to higher costs and delays, care for those who have true emergencies.
- Understand your provider’s Summary of Benefits and Coverage to know your exact copays and coverage rules. (Summary of Benefits and Coverage for CalCPA Health medical subscribers)
- Be prepared and locate the nearest urgent care or 24/7 virtual care option now before you need it, and make sure that you share the information with your family so that they are ready for different medical situations that may arise.
- Keep your medical card handy, preferably via a mobile app. CalCPA Health medical members should download the Sydney App if they haven’t done so already.
- Use the “Find Care” tool to locate in-network providers.
CalCPA Health members have access to:
- The largest PPO provider network in California through Anthem Blue Cross
- 24/7 virtual care options
- One point of contact through our customer support team (Banyan Administrators) to help you with benefits, claims, or locating care
If you’re unsure where to go, call the customer support number on your ID card — they can guide you to the right care setting.
* If you are on an HSA-compatible HDHP, you might have to satisfy your Calendar Year Deductible before the Copay amount applies.
Most people think of an eye exam as a quick check to update their glasses or contact prescription. But it is way more than that.
According to the American Optometric Association (AOA), an eye exam can reveal more than 270 serious health conditions, often before you notice a single symptom. Your eye doctor can detect early signs of such diseases as diabetes, high blood pressure, autoimmune disorders, and even certain cancers. An annual eye exam could be one of the most valuable preventive health screenings available.
During a comprehensive eye exam, your optometrist isn’t just checking your vision. They’re examining your retina, optic nerve, and blood vessels, which can reveal early signs of:
- Diabetes: changes in tiny blood vessels can appear before other symptoms develop.
- High blood pressure: narrowing or bleeding in eye vessels can be an early warning sign.
- Multiple sclerosis: inflammation in the optic nerve may be one of the first indicators.
- Certain cancers: tumors can sometimes be detected through changes in the eye’s appearance.
The AOA stresses that annual exams are one of the most effective ways to catch health problems early. Many of these conditions, if detected soon enough, can be treated or managed before they cause lasting damage.
Annual exams are important no matter what, but certain changes should prompt an immediate appointment because they can signal medical issues that need attention:
- Sudden blurry vision
- Double vision
- Drooping eyelids
- Flashes of light or sudden floaters
Your annual eye exam isn’t about just your eyes and your vision; it is about protecting your overall health. If it’s been more than a year since your last appointment, schedule one today.
Via an Interview with Ron Lang, By Phil Calhoun
As CalCPA Health celebrates its 66th anniversary, its story stands as a testament to the power of community-driven solutions in the often-turbulent world of health insurance. In this first installment of a three-part series, California Broker Media CEO Phil Calhoun sat down with Ron Lang, CEO of CalCPA Health, to explore the unique structure, mission, and value CalCPA Health brings to California’s financial professionals. This article also incorporates insights from industry sources and regulatory data to provide a broader context.
A Unique Legacy Born From Necessity
CalCPA Health was founded in 1959 by the California Society of Certified Public Accountants (CalCPA) to address a persistent problem: small employers, especially in financial services, had difficulty obtaining and maintaining health insurance. According to the U.S. Small Business Administration, small businesses have historically faced higher premiums and fewer choices than larger employers, due in part to limited bargaining power and risk pools (SBA, 2023). Ron Lang, who has led CalCPA Health for 13 years, explained, “Not very many businesses make it 66 years, especially in the health insurance business where we’ve had the government trying to put us out of business for the last years.
So, it’s quite an accomplishment.” The organization’s model was to pool together small firms—often with fewer than 100 employees, and sometimes just three or four partners and staff—to create the critical mass needed for large employer-style benefits and rate stability. Lang emphasized, “The whole idea behind CalCPA Health was to bring together a large volume of these smaller firms, to create critical mass to be able to provide them with large employer-style benefits and spread that risk out to provide rate stability and a really large group product to these small employers. And it’s worked for decades, obviously, we’re still around.”
Not-for-Profit and Standalone: A Different Kind of Carrier
Unlike many association health plans, CalCPA Health is a licensed, admitted, not-for-profit insurance carrier domiciled in California. This distinction is significant. While association health plans have drawn scrutiny from regulators for sometimes lacking transparency or sufficient consumer protections (Kaiser Family Foundation, 2022), CalCPA Health operates under strict state oversight. Lang clarified, “We are an insurance carrier. We’re domiciled in the state of California, we’re licensed, we’re an admitted carrier. Although we are married to the CalCPA, the society, we are a standalone entity. We’re a not-for-profit. So, our loss ratios and things are much better than what the national commercial insurance companies put out there.” This not-for-profit status allows CalCPA Health to focus on long-term rate stability and value-added services, rather than maximizing shareholder returns. “We’ve been able to offer long-term rate stability, products that are tailored to the industry, and a lot of additional value adds—what we call non-premium value adds—to the mix. We give a good value proposition to these employers,” Lang said.
Leveraging Anthem’s Network for Nationwide Access
A key feature of CalCPA Health’s offering is its partnership with Anthem, one of the largest provider networks in the country. According to the California Department of Managed Health Care, broad network access is a top priority for employers and employees alike (DMHC, 2024).
Lang explained, “We rent Anthem’s large group provider network, and there’s a couple reasons for that. One is that we wanted to give the best access to our members to providers in the state of California and nationally, because a lot of firms are domiciled here but have employees scattered around the country. That provides us with that national network.” He added that this arrangement also streamlines the member experience: “When they walk in with our logo and the Anthem logo on that card, the doctor immediately knows how to get access to the benefits and if there’s authorizations or deductibles. That’s all immediately accessible to the docs because we’ve partnered with Anthem.” This partnership has been in place since at least the late 1960s, giving CalCPA Health members reliable access to care for decades.
Plan Design and Transparent Underwriting
CalCPA Health designs and rates its plans internally, using in-house actuaries and external consultants. This is a departure from many association plans, which often rely on external carriers for plan design and pricing. “We design and rate the plans from scratch ourselves. We have in-house actuaries and then we have an actuarial consulting firm to sign off on things. So, we create the plans, design the benefits, and then we do the ratings on all of our plans,” Lang said. Membership eligibility is broad, encompassing not only CPAs but also a range of financial professionals, including wealth managers and insurance agencies. For partnerships and S-corps, at least half the ownership must be CalCPA members; for publicly traded companies, the executive teams qualify.
“Our data has shown that people tend to go to the doctor around their home rather than necessarily their place of work”.
On the underwriting side, CalCPA Health has always been 100 percent community rated, even before the Affordable Care Act (ACA) required it. Community rating, as defined by the ACA, means that premiums are not based on an individual group’s health status but rather on broader risk pools, promoting fairness and stability (Healthcare.gov, 2024). Lang noted, “Whether it’s a large group or small group, we community rate across the entire book of business and we’ve always had to file all of our rates with the Department of Insurance. It’s all very transparent as far as what our rates are.”
CalCPA Health also rates employees based on their home zip code, which often results in more competitive rates. “Our data has shown that people tend to go to the doctor around their home rather than necessarily their place of work. By rating at the employee zip code, we’re segmenting better and it tends to make us a little bit more competitive,” Lang shared.
Rate Stability: A Key Value
CalCPA Health’s record of rate stability is especially important for small businesses. According to a 2023 survey by the National Federation of Independent Business, unpredictable health insurance costs remain a top concern for small employers. Lang explained, “The last time we were in double digits was coming out of the Affordable Care Act when we had total chaos. Over the last eight or nine years, if you add up each of the increases, we come out below four percent over that period of time.”
He continued, “If you’re running a business, particularly a small business, and you get hit with a 15 or 20 percent rate increase, I’m just not sure how you run your business while you’re doing that. For most of these financial services and CPA firms, their health plan costs are usually higher than IT, higher than rent. The only cost that’s more than that is salaries. So, it’s a big number.”
Looking Ahead
As CalCPA Health continues its mission, its not-for-profit model, transparent practices, and commitment to member value remain its guiding principles. In the next installment of this three-part series, Ron Lang will discuss the evolving challenges facing California’s financial professionals and how CalCPA Health is adapting to meet those needs in a changing healthcare environment.
Part 2 Coming Next Month
CalCPA Health: 66 Years of Service & Stability for California’s Financial Professionals
Via Interview with Ron Lang By Phil Calhoun