Tag Archive for: CalCPA Health

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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Practical Wellness Tips for a Busy Holiday Season

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The holidays are supposed to be about celebration and connection, and some rest (hopefully). But the month of December often feels more like a marathon to get places and check off your never-ending “to-do” list. Between work deadlines, family obligations, travel, and a social calendar that somehow fills itself, the whole season can start to feel overwhelming instead of joyful.

If you’re trying to balance your job, personal life, and a budget that’s getting stretched thin, you’re not alone. A few simple habits can help you get through the season without burning out.

Aim for some balance when it comes to eating and your health. One of the biggest traps this time of year is thinking you need to be super disciplined about health. Small tweaks matter more than you’d think. Grab a protein-rich snack before heading to the party because it will help keep your energy steady and help you avoid overindulging at the party! Drink more water than you think you need, especially if you’re traveling or celebrating. And after a big meal, even a quick 10-minute walk can help your digestion and lift your mood.

Don’t sacrifice sleep. Late nights and early mornings are basically the norm in December. Sleep is one of your best defenses against stress, brain fog, and getting sick. Try to keep your sleep schedule consistent and give yourself a wind-down routine – do some stretching, journal for a few minutes, or put your phone away earlier than usual.

Build in breathing room. Between the gatherings and the pressure to make everything perfect, stress can pile up fast. Taking five minutes to step outside, taking some deep breaths, or sitting quietly can reset your nervous system and support your overall well-being. Mindfulness doesn’t have to be complicated. Sometimes it’s just noticing your breath or feeling your feet on the ground.

Move your body. Exercise in December doesn’t need to be a formal workout. Take a walk around the neighborhood to check out the holiday lights. Stretch between work calls. Choose to take the stairs. These little moments of movement do help—they keep your energy up, lower stress, and improve your sleep and mood.

It’s fine to scale back. There tends to be the expectation that you’re supposed to do it all – attend every event, uphold every tradition, make everyone happy. Remember – it’s okay to say no, to skip things, to protect some time for yourself. The parts of the season that matter most are the ones you have the energy to enjoy.

The holiday season doesn’t have to overwhelm you. With a bit of intention and some realistic expectations, you can end the year feeling good about being grounded, present, and ready for whatever comes next.

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Health Insurance in 2026: Why Costs Are Rising — and What Employers and Individuals Can Do About It

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Health insurance premiums are climbing fast, affecting both employers and employees. Rising medical costs aren’t new, but the pace of increase today reflects several powerful forces coming together at once, from high-cost specialty drugs to “nuclear” claims and labor inflation. Understanding why premiums are increasing is the first step to managing them.

One of the biggest drivers is the growing number of extremely high-cost claims – or “nuclear” claims. A small number of cases are reshaping the health insurance landscape. Gene therapies often run $2 million or more per treatment, and other “miracle treatment” technologies come with high price tags. These advances improve outcomes, but their costs flow into premiums.

Prescription drug costs are another major factor. Drug spending continues to grow faster than overall medical inflation. More people are taking medications for more conditions, and specialty drugs, especially cancer therapies, carry steep price tags. GLP-1 drugs, used for diabetes and weight management, are adding additional pressure. They are widely used and carry a high cost, which creates both frequency and cost challenges.

At the same time, people are using more healthcare overall. Rates of obesity, diabetes, cardiovascular disease, and inflammatory conditions are contributing to more doctor visits, more tests, more hospitalizations, and more prescriptions. When utilization climbs, premiums follow.

Healthcare is heavily impacted by labor costs. Hospitals and medical groups face higher wages for nurses, physicians, and technicians. Because provider contracts are typically renegotiated every few years, recent inflation is now reflected in new pricing agreements.

Regulatory changes also play a role. New state and federal mandates, even well-intentioned ones, add cost. California’s requirements for IVF coverage and caps on insulin spending are recent examples. Each mandate contributes to what many call the “regulatory stack,” appearing in the premium cost structure.

Prescription drugs now account for roughly 20% of total medical spending. A small percentage of people drive more than half of all prescription drug costs, largely due to specialty treatments that can run $200,000–$400,000 (or more) annually. GLP-1 utilization continues to expand. Generics and biosimilars provide some relief, but for every drug that comes off patent, a more expensive one often takes its place.

Insurance companies are often blamed for rising costs, but many standard plan elements were originally created by them to control unnecessary spending and protect members from unknown prices and unneeded medical services. Examples include:

    • Prior authorizations and utilization reviews
    • Second surgical opinions
    • Provider networks (PPOs) with negotiated allowable charges
    • Case-rate agreements and billing compliance standards

Out-of-network providers typically avoid these controls, which is why their services cost more.

On the pharmacy side, Pharmacy Benefit Managers (PBMs) use formulary management, generic substitution, step therapy, GLP-1 oversight, and rebates to help contain costs. While not perfect, these strategies are designed to balance access and affordability.

For employers and individuals, the challenge is not just understanding why costs are rising, but how to respond.  Many receive just 3–6 months’ notice of annual premium increases. We know healthcare inflation is unpredictable, so having informed estimates can help prevent scrambling at renewal time.

Cost sensitivity continues to drive decisions. Whether selecting a plan as an employer or choosing coverage as an individual, there is often a focus on keeping premiums low. The key is to balance that with the level of financial risk you are willing to take on. Looking at total cost, not just premiums, can help you make an informed decision.

Guidance matters. Employers benefit from internal expertise or strong broker support, and individuals benefit from taking the time to understand their coverage. Health insurance is one of the largest expenses most people will face, and being informed can make a meaningful difference.

Many employers and employees “overbuy” or misjudge the trade-off between premiums and out-of-pocket exposure. Choosing a lower premium option with higher out-of-pocket exposure, or vice versa, should be done with a clear understanding of how the plan will be used. HSA-compatible plans can be effective, especially when used by participants who understand how to use them and take advantage of preventive care and cost comparison tools.

Guidance helps. Employers benefit from in-house expertise or strong broker support or other external resources. Individuals also benefit when they invest time in understanding their coverage and plan options. Health insurance is one of the largest lifetime expenses for most households, and being informed can make a meaningful difference.

When premiums spike, employers often explore alternative solutions. These options can offer savings in certain situations, but they also come with risk and should be carefully reviewed. ICHRAs (Individual Coverage HRAs) are also gaining attention, but in California they have not consistently proven to be cost-effective at scale.

The healthcare system is complicated, and most people have little training in how to navigate it. Being an informed consumer means understanding how your plan works, knowing where to find value, and making informed decisions.

For employers, health insurance is often the second-largest expense after payroll. For individuals, it is one of the top costs in the household budget. Taking the time to build knowledge or access reliable guidance can have a real impact.

Premium increases reflect a mix of breakthrough treatments, rising chronic disease, regulatory mandates, pharmaceutical inflation, and higher provider costs. While these trends are not likely to slow immediately, employers and individuals have options. Through thoughtful planning, proactive decision-making, and access to knowledgeable guidance, it is possible to manage these costs more effectively.

This article reflects data and trends from CMS, KFF, PwC Health Research Institute, and national pharmacy and actuarial reports.

 

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CalCPA Health Podcast Episode 3 – Navigating Health Info & Speaking Up (Dianne Pulleyblank)

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Misinformation is everywhere—and navigating the healthcare system can feel like a second job. This episode is about empowering listeners to cut through the noise. Learn how to identify trustworthy health sources, prepare for medical appointments, and advocate effectively for your needs. We’ll also share tips on having tough conversations with doctors and pharmacists.

Topics Covered:

    • How to spot credible health news
    • Red flags in medical misinformation
    • Preparing for appointments (health journaling, family history)
    • Patient-provider communication strategies
    • Questions every patient should ask
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CalCPA Health Podcast Episode 2 – Heart in Motion (Dianne Pulleyblank)

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In this energizing episode, we dive into the science behind cardiovascular health and the essential role of movement in protecting your heart. We’ll break down how different forms of cardio benefit your circulatory system, boost your mood, and increase longevity. Whether you’re already active or just starting out, you’ll gain actionable tips to build a heart-healthy routine that works for you.

Topics Covered:

  • How cardio strengthens your heart
  • Debunking fitness myths
  • Everyday ways to get your heart rate up
  • Motivation for consistency
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CalCPA Health Podcast Episode 1 – The Journey to Healthy Habits (Dianne Pulleyblank)

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This episode kicks off your journey toward healthy living. We’ll explore how to build sustainable habits, set realistic goals, and shift limiting belief systems. Learn how to use time management, habit stacking, and the power of small wins to drive lasting change. This motivational episode includes reflection prompts to help listeners take control of their health-starting with that first step.

Topics Covered:

  • The psychology of change and behavior
  • Habit stacking & micro-goals
  • Overcoming common barriers
  • The role of belief systems
  • Reflective journaling prompts for listener
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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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