Medical Plans

Employer Eligibility

CalCPA Health (the Group Insurance Trust of CalCPA) is available exclusively to CalCPA member firms, including solo practitioners, and financial services firms, that are based in California. To be eligible and retain such eligibility, generally, more than 50% of all the Employer’s owners (principals, proprietors, partners, shareholders, or other owners) must be members of CalCPA in good standing. If you are a CPA, financial services professional, or firm administrator and not a member of CalCPA, click here to see how you can join. All employers deemed to be part of an affiliated group under Internal Revenue Code Sections 414 (b), (c), or (m) are considered to be a single employer. Solo practitioners (a CPA practicing on his/her own with no W-2 employees) are eligible to apply.

Participation and Guidelines

Firms of four (4) or more employees must enroll at least 75% of eligible employees in the medical program, and 100% of eligible employees in the ancillary programs.
The employer must contribute a minimum of 50% of the cost of the employee’s medical premiums, and 100% of the employee’s dental, vision, life, or long-term disability
premiums (does not include the cost of dependent coverage).
If the employer pays 100% of the premiums, then 100% of eligible employees must be covered.

All eligible employees must enroll or sign a waiver of coverage. Employees who waive coverage on the grounds that they have other coverage (spouse or dependent on another employer plan) or Medicare are not counted as eligible employees. Firms may mix-and-match the health plan offerings of their choosing. All CalCPA Health plans, or any subset of plans, may be offered to employees – there is no minimum enrollment per plan.

Employee Eligibility

To be eligible, employees must be:

Permanent W-2 employees. It is required that Form DE-9 is filled out when enrolling and needs to be filled out each year for annual eligibility verifications.
Must be working at least 20 hours per week (or 30 hours per week, if elected by the employer).

Note: Independent contractors (1099 income) are not eligible to participate.

Dependent Eligibility

Eligible dependents include a lawful spouse, Registered Domestic Partner, and dependent children of eligible employees through age 26. Disabled children of eligible employees who, with appropriate medical certification, are eligible for coverage at any age.

Group Medical Plans

Why Choose CalCPA Health

CalCPA Health offers medical benefits exclusively to CalCPA member firms. To provide outstanding service and value to our members, we have contracted with Anthem Blue Cross, which allows us to use its comprehensive provider network and process claims. The Standard Prudent Buyer network is Anthem’s largest network, consisting of over 70,000 participating physicians and roughly 430 hospitals. (Note that Kaiser offers 40 hospitals in California). CalCPA Health also offers Anthem’s Select Network for firms who seek a discount in return for a smaller network. This smaller network provides standard PPO and HMO networks but provides a premium savings range of approximately 2 to 12 percent, depending on the rating region or plan selected. It is your choice whether you go in-network and receive a higher benefit or go out-of-network and pay more. Just remember, when you choose participating network providers, you will take advantage of negotiated rates, which lowers out-of-pocket expenses.

CalCPA Health offers HMO plans through the Anthem Blue Cross network, which contracts with more than 56,000 physicians and approximately 430 hospitals in California. When enrolling in a HMO plan, each member chooses a doctor in the Anthem HMO network to be assigned as their Primary Care Physician (PCP).

Plan Brochure (PDF)

Group Medical: Co-Pay Plans

CalCPA Health offers PPO copay plan options – both in the Standard Prudent Buyer Network and the Select Network. PPO plans allow you to see any physician or other eligible provider without a referral. However, if you use out-of-network providers, you should expect to pay a significantly greater portion of the eligible charges. For questions call Banyan Administrators at 877-480-7923 or email.

Group Medical: Anthem Blue Cross HMO

Because our members value choice, we have partnered with Anthem Blue Cross of California to offer HMO plans. Anthem differs from CalCPA Health in that it is a fully-insured plan through Anthem Blue Cross of California. Anthem Blue Cross determines the rates and benefits and sets underwriting and administration policies. Your firm may offer only one of the HMO plans; however, you can pair an Anthem Blue Cross HMO plan with any, or all, of the CalCPA Health copay and HSA plans.

All Anthem Blue Cross HMO Plans Provide:

Access to quality healthcare through the Anthem Blue Cross network of HMO healthcare providers (both HMO and Select HMO networks)
Coverage for mental health and substance abuse services
Comprehensive coverage for a wide range of healthcare services
Emergency care coverage worldwide, 24 hours a day
Simplified procedures – no claim forms to fill out when you use in-network providers
Customer services exclusively dedicated to CalCPA Health Anthem Blue Cross members

Group Medical: Choose Multiple Plans

You May Mix and Match Your Health Plans

Although most employers will elect to offer a single plan, your firm may elect to enroll in and offer any combination of CalCPA Health’s copay, HSA and Anthem Blue Cross HMO plans. However, if the firm wishes to include an HMO option, only one of the Anthem Blue Cross HMO plans may be offered.

Group Medical: HSA Eligible Plans

Why Choose a Health Savings Account (HSA)

CalCPA Health’s HSA plans provide members with a unique program that offers low High Deductible Health Plan (HDHP) premiums and integrated banking and health claims administration through HealthEquity (or a financial institution of your choice). When an HSA is paired with an HSA-qualified health plan, you are able to make tax-free* contributions to an FDIC-insured savings account. Typically, these plans cost less than traditional plans and provide tax-saving opportunities.

Here are some reasons why HSA enrollment continues to grow at a steady pace:

Make pre-tax contributions
Tax-free distributions for qualified medical expenses
Tax-preferred investment savings
Unused contributions roll over each year and accumulate
HSA Guidebook

Spend smarter, save and invest in your future healthcare expenses. Learn more about HSA plans.

For details call Banyan Administrators directly at 877.480.7923 or CalCPAHealth@CalCPAHealth.com.

* Please consult a tax advisor regarding your state’s specific rules for HSAs.

# Dependent on the exact structure of the plan and contribution balance.

Solo: Medical Plans

If you would like an online quote, you may do so by clicking here.

For other questions, you may contact Banyan Administrators, Managers for the CalCPA Health Programs, at 877.480.7923 or email CalCPAHealth@CalCPAHealth.com.

Plan Types

Preferred Provider Organization (PPO)

Using medical providers in the PPO network reduces deductibles, coinsurance, and total out-of-pocket costs compared to providers outside the PPO network. In a PPO plan, you do not need referrals to see doctors (specialists).

An important difference between In-network and out-of-network providers is that in-network providers bill for services at predetermined contract rates, whereas there is no such control on non-network providers.

Also, note that provider referrals are different than procedure authorizations. PPO doctors, still obtain authorizations if the procedure requires it.

Exclusive Provider Organization (EPO)

An EPO is the same as a PPO, except there are no benefits for out-of-network providers (except in an emergency). CalCPA Health EPO does not use a gatekeeper/primary care physician (PCP), which some EPO plans in the market require.

Health Maintenance Organization (HMO)

With an HMO plan, you select a Primary Care Physician (PCP) within the HMO network of primary care providers. This PCP directs your total care and provides required referrals should you need specialties or services that the PCP does not provide. This PCP role is commonly referred to as a “gatekeeper”. There is no coverage for services for non-PCP providers without referrals, and referrals are typically made within the PCP’s medical group. Out-of-network providers/services are not covered (except in an emergency).

Health Savings Account (HSA)

An HSA is a tax-advantaged account designed to help you pay for qualified medical expenses, including medical, dental, vision and medications. HSA plans have two components, a qualified high-deductible health plan (HDHP) and a savings account to make contributions to. Investment earnings on the account are federal tax free (if used for qualified medical expenses). HSA plans help you save for future medical expenses and retirement healthcare costs.