California Health News

News & Announcements about health insurance in California




  • Home
    • CHN File Explorer
  • About
  • Contact
  • Health Plans
    • Aetna
    • Anthem Blue Cross
    • Blue Shield
    • Centene
    • CoveredCA Small Group
    • CaliforniaChoice
    • Cigna
    • Health Net
    • Kaiser
    • L.A. Care Covered
    • Molina
    • Oscar
    • Sutter Health Plus
    • United Healthcare
    • Valley Health Plan
    • Western Health Advantage
  • Government
    • Affordable Care Act
    • CMS
    • CA DMHC
    • Cal DOI
    • Covered California
      • CalHEERS
      • Certified Agents
    • HHS
    • Healthcare.gov
    • IRS
    • Medicare
      • PDP
      • CMS
    • Medi-Cal

2016 changes to Covered California small group plans

November 25, 2015 By Kevin Knauss Leave a Comment

Covered California for Small Business Health Options Program

Covered California for Small Business Health Options Program

Small employer group plans acquired through Covered California for Small Business program will see benefit and coverage changes consistent with changes implemented for individual and family plans in 2016. Covered California has released a spread sheet comparing the 2015 benefit level to the new 2016 benefits by coverage type. The most significant changes will occur on Bronze level plans where coinsurance is rising from 30% to 100% after the deductible for many covered benefits. In addition, Kaiser and Health Net will be discontinuing their Silver 70 H.S.A. plans.

Bronze plans

Deductibles for virtually all Bronze level plans will be increasing, excluding some of the H.S.A. plans. Similar to the individual and family plans, coinsurance for a variety of covered benefits will jump from 30% to 100% for services such as X-rays, Emergency Room visits, outpatient facility fees, durable medical equipment, and inpatient hospital and surgeon fees. Bronze plans will gain a $40 lab testing copayment for in-network labs, not subject to the deductible. The pharmacy prescription costs will be capped at $500 per drug per month after any pharmacy deductible is met. The annual maximum out of pocket amount is increasing by $250 to $500 on all plans.

Silver Plans

The pharmacy deductible on several Silver plans is being reduced from $500 down to $250. On average, many of the copayments for routine coverage benefits such as office visits and labs are increasing $5 to $10. But some plans have decreased those copayments by a like amount. All of the Silver plans Tier 4 prescriptions will be capped at $250 per drug per month after any applicable pharmacy deductible. Many of the plans will have a higher maximum out of pocket for 2016 of $6,500. The Kaiser Silver 70 H.S.A and Health Net Silver 70 H.S.A. EPO are being discontinued. Health Net is adding a Silver 70 EPO Alternative plan with a $1,800 deductible and 50% coinsurance on the more expensive health care services such as inpatient hospitalization and imaging.

Gold and Platinum Plans

Gold and Platinum plans will have modest increases to many of their set copayments for routine services. Both will have Tier 4 prescriptions capped at $250 per drug per month. Kaiser will be introducing a new Platinum 90 HMO Alternate plan with no inpatient physician surgery fee, a lower mental health inpatient copayment, and lower acupuncture copayment.

Download 2016 Covered California Small Business comparison matrix and outline of major coverage benefits and costs.

  • 2016 Health Plan Change Summary
  • 2016 Outline of Health Plans and Summaries

 

 

Filed Under: Covered California, SHOP, Small Group Tagged With: Covered California, SHOP, Small Business, Small Group

About Kevin Knauss

Independent health insurance agent and Certified Insurance Agent for Covered California. Serving all of California. Editor of Health Plan News for California consumers. Feel free to call him for clarification on items posted on this website at 916-521-7216 or email on his contact page of
www.insuremekevin.com

Advertisement

Advertisement

Comparing Health Plan Video

Health, Insurance, Plan, Comparison

Using a table of in-network providers, hospitals, drugs, and rates to compare health plans

Kevin Knauss

California, Kevin Knauss, Rainbow, LGBT, Insurance, Author, Medicare

Education Before Enrollment

Phone: 916-521-7216

New Medicare Claim Numbers Coming

Medicare, Social Security

New Medicare Claim Numbers

Subscribe to Blog via Email

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Kevin Knauss - www.insuremekevin.com - CDI# 0H12644