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.
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.
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.