Exciting news: Chuck Gielow received the CalCPA Distinguished Service Award!

Exciting news: Chuck Gielow received the CalCPA Distinguished Service Award! Here at CalCPA Health, CalCPA member firms have access to quality health insurance and benefit products. Chuck is one of CalCPA Health’s first Board members and was the Board Chair from 2013-2018. He is a huge advocate for CalCPA members and deserves this special recognition!

Thank you, Chuck, for all that you have contributed to the CPA profession and to CalCPA Health!

New California Law SB 1375 – Affects Many Small Firm’s Group Health Insurance

The new California Law, SB 1375, was signed by Governor Brown on September 22, 2018 and will affect many small firm’s group health insurance. SB 1375 changes the Health Insurance Code to reclassify certain small employer groups as individuals. The affected firms will have to obtain individual health insurance in 2019, rather than the small employer group plans they currently have. Individual health insurance is typically more expensive with less provider network and benefit plan choices than small group plan offerings.

Fortunately, for CalCPA members and their firms, CalCPA Health received certain exemptions from SB 1375, which generally allows us to treat the affected firms as groups, and not as individuals. Commercial carriers (Blue Shield, UnitedHealthcare, Anthem, etc.,) must comply with the new regulations and reclassify these groups as individuals.

SB 1375 defines groups that consist entirely of owners/partners, and/or W-2 employees that are spouses of owner/partners, as not eligible for group health coverage. Even though these entities may be classified as employer/employees by other regulations, (e.g. Workers’ Comp, payroll tax, etc.,) SB 1375 specifically states they do not qualify for group health coverage and may only purchase individual plans.

Read more

Anthem Blue Cross Supporting People Affected by California Wildfires

Anthem is taking action to help people affected by the wildfires in Lake, Mariposa, Mendocino, Napa, Riverside and Shasta counties by revising medical and pharmacy guidelines that will help ensure members can continue care and access needed prescription medications. The items pertaining to pharmacy apply to Anthem’s relationship with Express Scripts. It’s important that our members know what Anthem is doing for our members in the above mentioned areas during this critical time.

For impacted members, Anthem is:

  • Relaxing time limits for prior authorization, pre-certification and referral requirements – there will be no late penalties.
  • Suspending early refill limits for prescriptions.
  •  Allowing replacement of medical equipment or supplies.
  • Extending filing deadlines for claims.

These medical and pharmacy guidelines are effective from July 26, 2018 until August 25, 2018, unless further extended.

For additional questions, members should call the phone number on the back of their membership card as associates are standing by to help.

shutterstock_34708720

What’s the Buzz Around Health Insurance Captives?

Health Insurance Captives are being touted as the new, hip way for firms to beat the Affordable Care Act.  Captives are insurance arrangements owned/controlled by its participating employers, and while they may not be new, they’re complicated.

Although many terms are used interchangeable, the flavor we’ll discuss in this article is the Group Medical Stop Loss Captives. These are typically used for small and mid-sized employers, which include all but a handful of CPA firms.

With a captive, the employer is at risk and therefore can benefit from the overall underwriting performance as well as income generated by invested reserves.  The captive group is made up of companies that are too small to self-insure and are typically in the same industry.  By combining a number of employers together, critical mass to self-insure as a group is achieved.  The carrot is that employers will (somehow) achieve a lower cost of claims and administration for their employees than they could through traditional market options.

Read more