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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At the recent CalCPA Council meeting members asked about how the CPA population was fairing health wise in the COVID pandemic. Ron Lang C.E.O. of CalCPA Health told Council that based on the data from their population of approximately 800 firms, that we are fairing a bit better than the general population. This is to be expected because COVID 19 has affected older, non-working populations more. Mr. Lang stated that to date CalCPA Health has had no fatalities and he would post a data update on clips for all members – so here it is.

As of November 2, 2020, 10.2% of CalCPA Health’s population has received at least one COVID test, with 11.6% of those tests positive. That equates to 1.2% of the total population testing positive. About a quarter of the tests and confirmed cases are antibody tests. About 3.5% of the cases have required hospitalization.

Also, more 25% of CalCPA Health’s population has used some sort of telehealth/virtual doctor visit since the pandemic started, up from less than 1% prior.

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!

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.

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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.