A Few Months In: Are You Using Your Health Plan?

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We are a few months into the year, which makes this a good time to pause and take a closer look at how you are using your health plan.

Whether you selected new coverage this year or have been on the same plan for a while, this is often when expectations meet reality. You may have filled a prescription, visited a provider, received a bill, or you may not have used your plan at all.

Wherever you are, now is a good time to check in.

Are you actively using your benefits, or are you only thinking about your plan when something comes up? Health insurance is often treated as something you deal with when you need care, but it is meant to be used throughout the year.

Some questions to ask yourself:

  • Have you scheduled your annual wellness visit?
  • Are you using in-network providers?
  • Do you know what your copay is and whether you have coinsurance? Do you understand the difference between the two?
  • Do you know how much of your deductible you have met?
  • Do you understand what services are considered preventive care?
  • Do you know where to go depending on the situation, such as telehealth, urgent care, or the emergency room?

If any of these are unclear, you are not alone. Many people do not fully understand their coverage until they need to use it.

One area that is often overlooked is preventive care. Routine exams, screenings, and labs are often covered at little to no cost when done in-network. Taking care of these early can help you stay ahead of potential health issues.

If you have already used your plan this year, your claims can give you a clearer picture of how your costs work. This includes how your deductible applies and what your copays look like.

Small decisions can affect your costs. Where you go for care, whether a provider is in-network, and whether you ask questions ahead of time can all impact what you pay. Before your visit, consider asking about expected costs, whether prior authorization is required, and whether the service will be considered preventive or diagnostic. Writing your questions down in advance can help you feel more prepared and confident in your decisions.

If you have not spent much time thinking about your health plan yet, that is okay. There is still plenty of time to make the most of it.

Start by taking a look at your plan details, such as your Summary of Benefits or plan documents, so you understand what is covered and how your costs are structured. It can also be helpful to check your progress by seeing how much of your deductible you have met and where you stand in relation to your out-of-pocket maximum.

Scheduling preventive care is one of the easiest ways to use your benefits and stay on top of your health. If you expect to need services later this year, take time to plan ahead by confirming providers and facilities in advance, making sure they are in-network, and understanding what your costs may be.

Your health plan is something you can use to support your health and make more informed decisions about care. Taking a few minutes now to understand how your plan is working can help you avoid surprises and feel more confident in your choices throughout the year.

 

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CalCPA Health + GoodRx

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Helping Lower Your Pharmacy Costs — Automatically

CalCPA Health PPO and HSA medical plan enrollees now benefit from built-in GoodRx prescription pricing (when available) as part of their pharmacy coverage through Express Scripts Rx.

There’s nothing you need to do. No coupons. No discount cards. No separate enrollment.

When you present your CalCPA Health plan ID at the pharmacy, your prescription is automatically processed through your benefit. If the GoodRx price is lower than your plan’s already negotiated cost, you will automatically receive the lower GoodRx price.

What This Means for You

Lowest Available Price on Eligible Generic Medications

Eligible generic medications (excluding specialty generics) are automatically compared to GoodRx pricing to ensure you receive the lowest available price.

Effortless Member Experience

No need to search for GoodRx coupons or present a discount card. The comparison happens automatically through your CalCPA Health benefit.

Supports Medication Adherence

You receive discounted medications without delay, helping you stay on track with your prescribed treatments.

Claims Count Toward Your Plan

Unlike stand-alone discount programs, prescriptions processed through this partnership apply toward your deductible and out-of-pocket maximum.

This program ensures you receive competitive pricing while maintaining the protections and accumulators of your CalCPA Health pharmacy benefit.

Reminder: Mail Order Savings

For many maintenance medications, the Express Scripts mail-order pharmacy offers lower copays and overall drug costs. Be sure to compare your options for additional savings.

Questions? If you have questions about your pharmacy coverage:

CalCPA Health remains committed to helping members access care affordably and confidently.

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CalCPA Health Coverage Options: A Deep Dive into Plan Variety and HSA Leadership (Part 2 of 3)

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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

https://issuu.com/articles/112224906

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CalCPA Health: 66 Years of Service & Stability for California’s Financial Professionals

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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

https://issuu.com/articles/105432896

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Selling Health Savings Accounts to CPAs and Financial Professionals in California: A Guide for Health Insurance Brokers

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Health Savings Accounts (HSAs) are valuable for managing healthcare costs, offering tax advantages and long-term savings opportunities. As a health insurance broker in California, you can leverage HSAs to build relationships with qualified* Certified Public Accountants (CPAs) and financial professionals (wealth management, advisors, financial institutions, etc.) who advise their clients on financial matters. Here is a guide on effectively selling HSAs to CPAs and financial professionals in California.

1. Understand the Benefits of HSAs
Just because a CPA or financial professional may have a strong understanding of finances and taxes does not mean they understand the full benefits of HSAs.
Before you approach these clients, ensure you have a comprehensive understanding of HSAs and the benefits they can provide:

*Tax Advantages: Contributions to HSAs are tax-deductible, grow tax-free, and can be withdrawn tax-free for qualified medical expenses. This means money can be earned (income), invested (investment returns), and used to pay expenses without ever being taxed.

*One way to look at the HSA tax advantage:
Example: An HSA subscriber in the 25% tax bracket is enrolled in a $2000 deductible qualified HDHP. Since they pay the deductible with pre-tax dollars, the $2000 deductible would be comparable to a $1500 non-HSA deductible plan. The tax-preferred effect (savings) continues beyond the deductible, all the way up to their out-of-pocket maximum. An $8,000 OOP max would behave like a $6,000 OOP max in a non-HSA plan.

*Cost Savings: HSAs are paired with qualified high-deductible health plans (HDHPs), which typically have lower premiums than comparable non-HSA plans.

*Tax-free Investment Returns: HSA funds can be invested, growing into a retirement nest egg similar to a 401K or IRA, except there are no Required Minimum Distributions, and you do not pay tax on the investment earnings when you use the money for qualified health care expenses.

*Flexibility and Ownership: The employee owns HSA funds and stays with them throughout their career (from job to job) and into retirement. There are no use-it-or-lose-it provisions like FSA’s.

Attract and Retain: HSAs have become a valuable tool in today’s tight labor market for employers to attract and retain talent. With no discrimination tests like 401K plans, employers easily add a valuable employee benefit to their benefits package.

Important Note: The tax effects mentioned above are federal taxes. California is one of only two states that do not recognize HSAs. Given this, the benefit from the federal tax effect is typically good enough to make the HSA math work for most companies and employees.

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Understanding Heart Health: A Guide for Heart Health Awareness Month (Part 1)

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February marks Heart Health Awareness Month, a time dedicated to raising awareness about cardiovascular health and encouraging individuals to take proactive steps toward maintaining a healthy heart. Heart disease remains one of the leading causes of death globally, highlighting the importance of understanding how to care for our hearts. According to the Centers for Disease Control and Prevention (CDC), about 695,000 people died from heart disease in 2021 in the United States which is 1 in every 5 deaths. * This month we will look at some important aspects of heart health, risk factors for heart disease, and tips for maintaining a healthy heart. Read more

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A Note To Our Members Regarding Dignity Health

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GOOD NEWS: Anthem Blue Cross announced it has reached a new agreement with Dignity Health (Dignity) for all commercial products and networks including HMO, PPO and EPO. This agreement returns Dignity facilities to Anthem health plans, while protecting affordability for consumers. This agreement is retroactive to July 15, 2021, which means any care provided to CalCPA Health medical subscribers since that date, will be considered in-network.

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Important Health Plan Information

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by Ron Lang, CEO of CalCPA Health

This time of the year, with most firms renewing their employee benefit plans, there is a big uptick in questions regarding managing health plans. For CalCPA members, CalCPA Health is an available resource; our tag line is “we answer questions for your firm, your clients and your family” (or at least try to answer anyway).

Health plans are a unique blend of Internal Revenue Service, Department of Health and Human Services, Department of Labor, California Department of Insurance, and other California agencies regulations. Buried in each of these, is the Affordable Care Act’s (ACA) code. Because of this complexity and liability, when providing answers and insights we always must disclose that we do not provide tax or legal advice (lol).

 

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COVID-19’s Impact – Are Health Insurance Rates Going Up in 2021?

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By Ron Lang, CEO of CalCPA Health
For more information, email questions@calcpahealth.com.

With doctor office and medical facilities shuttered for much of the second quarter, many were thinking their health insurance rates may not be going up for their 2021 renewal. But most everyone will see increases for next year. Why?

The Affordable Care Act (ACA) established mandatory operating margins for health insurance companies. These regulations mean that premium increases are driven almost exclusively by underlying medical expense increases. This is the short answer: Insurance premiums increase because medical expenses are continuing to increase.

 

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HSA Contribution Extension for 2019

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In response to the current conditions surrounding the COVID-19 pandemic, IRS Notice 2020-18 postpones the April 15, 2020 due date for filing federal income tax returns, deferring payments to July 15, 2020. The IRS has added information regarding this notice under “Filing and Payment Deadlines Questions and Answers” which addresses contribution extensions for those in Health Savings Account plans.

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