Know Where to Go: Doctor, Urgent Care, or ER?

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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.

 

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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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You Can’t Use What You Don’t Understand: Get to Know Your Health Plan

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What is the name of your health plan? Who’s your insurance carrier? If you had to look it up right now to check, you’re not alone; many people are not sure. If you don’t know the basics, you won’t be able to take full advantage of your benefits.

Health insurance is a tool—but only if you know how to use it. You don’t want to be like so many people out there who experience a health emergency and must deal with the stress of not understanding their health care coverage in a time of trauma.

Knowing your health plan matters

Surprise Bills

  • You may get a procedure for which you need pre-authorization, and did not know until you received an unexpected bill. This happens more often than you can imagine.
  • If you don’t know whether your provider is in-network or out-of-network, or how your plan covers care, you are more likely to pay out-of-pocket for services that should have been covered.

Miss Out on Preventive Services

  • Many plans offer 100% coverage for preventive services (such as mammograms, colonoscopies, and annual physicals), virtual visits, and wellness programs. But you can’t use benefits you don’t know you have.

You Can’t Advocate for Yourself Without the Basics

  • Here are just a few of the ways understanding your plan helps you:
    • Ask the right questions and go through the proper channels for care; reach out for help by calling your insurance provider
    • Spot billing errors
    • Take advantage of telehealth, HSA options, or mental health coverage (to name a few)

What You Need to Know – Today

At the very least, every health insurance subscriber should know:

  • Your carrier (the company providing your insurance, such as Anthem, Delta Dental, and VSP)
  • Your plan type (Health Maintenance Organization – HMO, Preferred Provider Organization – PPO, Exclusive Provider Organization – EPO, or Health Savings Account – HSA)
  • Whether your plan is individual, employer-sponsored, or part of an association

How to Find These Items Quickly

  • Check your insurance ID card – it typically lists the plan name and carrier
  • Log in to your carrier’s member portal (the website usually is on the ID card) – this is where you will find your plan documents, benefits, and provider network information
    • Download your carrier’s app and create an account so that you have access to your ID card at all times, as well as to your health and benefit information and plan summary (Summary of Benefits and Coverage – SBC)
  • Ask your HR or firm administrator if you’re part of an employer or association plan

Then, take a few minutes to review your SBC, as it outlines the services that are covered, excluded, and the pre-authorization requirements. It also helps you understand what your plan will cover and what you may need to pay out-of-pocket for. Knowing the basics gives you power as a healthcare consumer and enables you to become your own best advocate.

Please don’t wait for an emergency to try and understand your health plan; familiarizing yourself with it now is a smart way to save time, avoid stress, and ensure you get the most from your benefits.

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Created by CalCPA in 1959 as The Group Insurance Trust of the California Society of CPAs, CalCPA Health has remained steadfast in its mission to provide quality “boutique style” health care solutions—from medical, dental and vision to life and long-term disability—with unparalleled convenience and stability. It helps ensure that members can navigate the challenges of health care with confidence and peace of mind. CalCPA Health offers exclusive health and benefit plans to members, and there is a high level of trust knowing that these plans are operated by individuals who understand the unique needs of the profession – CalCPA members.

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IRS Announces 2026 HSA Contribution Limits

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The IRS recently released the contribution limits for Health Savings Accounts (HSAs) for 2026. In the upcoming year, we will see an HSA  contribution limit increase to $4,400 for individuals and an increase to $8,750 for a family. The IRS implemented inflation-adjusted parameters for health savings accounts in Revenue Procedure 2025-19.

For 2026, individuals with self-only coverage can contribute up to $4,400 to their HSAs, up from $4,300 in 2025. Family plans can contribute up to $8,750, up from $8,550 in 2025. The IRS also noted that the 2026 catch-up contribution for those aged 55 and older will remain $1,000 for 2026, unchanged from 2025.

According to Fidelity Investments’ 2024 Retiree Health Care Cost Estimate, a single 65-year-old retiring can expect to spend an average of $165,000, or $330,000 per couple, in health care and medical expenses throughout retirement. These figures are up nearly 5% over 2023 and more than doubled from the first estimate in 2002. Understanding how to save and invest with an HSA plan is key to helping you plan for future expected and unexpected medical expenses.

If you are in an HSA and have questions about how to get the most out of the plan, CalCPA Health can help answer your questions. CalCPA Health is at the forefront of HSA adoption, offering the most HSA plan options in California. CalCPA members have a strong understanding of the tax benefits HSAs provide. Education is key, and CalCPA Health is here to help whether or not you are in one of our plans. We are a resource for you, so please feel free to ask questions by emailing info@calcpahealth.com.

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IRS Announces 2025 HSA Contribution Limits

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The IRS has recently released the contribution limits for Health Savings Accounts (HSAs) for 2025. In 2024 we saw a significant increase, mainly in response to continued pressures from inflation. In the upcoming year, we will see another adjustment upwards, yet smaller than the 2024 increases.

For 2025, individuals with self-only coverage can contribute up to $4,300 to their HSAs, up from $4,150 in 2024. Family plans can contribute up to $8,550, up from $8,300 in 2024. This change reflects a steady acknowledgment of the need for greater financial flexibility in managing health expenses.

The IRS hasn’t released the 2025 catch-up contribution yet for those age 55 and older. It is currently set at $1,000 for 2024, unchanged from 2023.

According to Fidelity Investments’ 2023 Retiree Health Care Cost Estimate, a 65-year-old retiring this year can expect to spend an average of $157,500, or $315,000 per couple, in health care and medical expenses throughout retirement. Understanding how to save and invest with an HSA plan is key to helping you plan for future expected and unexpected medical expenses.

If you are in an HSA and have questions about how to get the most out of the plan, CalCPA Health can help answer your questions. Approximately 45% of CalCPA Health medical subscribers are enrolled in a Health Savings Account. Education is key and CalCPA Health is here to help – whether you are in one of our HSA plans or not. We are a resource for you – feel free to ask questions by emailing info@calcpahealth.com.

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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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2024 Contribution Limits for Health Savings Accounts (HSA) Announced

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The Internal Revenue Service released the annual maximum 2024 contribution limits for HSAs under high deductible health plans (HDHPs). For 2024, we will see the largest jump in recent years for contribution limits – mainly due to continued high inflation. The annual limit on HSA contributions for an individual will be $4,150 (up from $3,850 in 2023) and $8,300 for family coverage (up from $7,750 in 2023).  HSA “catch-up” contribution for participants 55 and older, can contribute an extra $1,000 to their HSA, which is the current amount in place for 2023.

Effective January 1, 2024 – Contribution Limits for Health Savings Accounts

Tax Year Individual Coverage Limit Family Coverage Limit
2024 $4,150 $8,300
2023 $3,850 $7,750
2022 $3,650 $7,300
At age 55, members are allowed to contribute an additional $1,000 

What is a HSA? It is a tax-advantaged account, paired with a high-deductible health insurance plan (HDHP), that allows you to save pre-tax dollars for future qualified medical expenses. You can invest the funds in the HSA account tax-free and grow your savings. You own the account, it travels with you if you change jobs, change your health plan, or retire.

 

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2023 Health Savings Accounts Limits Are Released By The IRS

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The IRS has released the contribution limits for Health Savings Accounts (HSA) for 2023 and the numbers are significantly higher than in prior years, as you can see from the chart below. Knowing these numbers will help employers prepare for open enrollment and think about their contribution levels as well as help employees understand the benefits of contributing to their HSAs.

Tax Year Individual Coverage Limit Family Coverage Limit
2023 $3,850 $7,750
2022 $3,650 $7,300
2021 $3,600 $7,200
At age 55, members are allowed to contribute and additional $1,000 

What is a HSA? It is a tax-advantaged account, paired with a high-deductible health insurance plan (HDHP), that allows you to save pre-tax dollars for future qualified medical expenses. You can invest the funds in the HSA account tax-free and grow your savings. You own the account, it travels with you if you change jobs, change your health plan, or retire.

 

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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 Update

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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.