WHA & Covered California

ACA Required Coverage for Small Groups

The Affordable Care Act (ACA) requires that employers offer coverage that is affordable and has a minimum value of 60 percent. This is accomplished by having four types of health insurance plans: Platinum, Gold, Silver, and Bronze. The metal levels of health insurance plans correspond to the percentage of coverage offered to members: with a Platinum plan, 90 percent of the cost of services is paid for by the insurer; Gold covers 80 percent, Silver 70 percent, and Bronze 60 percent. 

Brokers and agents who are certified by Covered California can help you with your buying decisions.

Purchasing Direct from WHA

In addition to our Capital Plans, that mirror our plans offered in Covered California's Small Business Health Options Program (SHOP), you will have access to our slate of Gateway Plans. These off-exchange plans are unique to WHA and are the most similar to our existing plans, giving you more choices and flexibility.

Purchasing through Covered CA

While most plans are available direct from WHA, some can also be purchased from Covered CA. As an employer, you choose the level of coverage and the amount you want to contribute toward your employees' premium and your employees choose their health plan. Even with the choice of different health plans, you will have a single bill.

Employer Q&A
What doctors can I see if I choose Western Health Advantage?

Whether purchasing direct from WHA or through Covered California, WHA offers access to nearly 3,000 primary and specialty care providers as well as 15 hospitals in Northern California - regardless of the plan you choose. WHA members have more choices because they aren’t locked into one medical group for specialty care. With our unique Advantage Referral program, members have the flexibility to choose from many specialist in our entire network, not just within a particular medical group. View the WHA Network.

Can my employees participate in the Covered California Individual Marketplace?

Without group coverage, your employees can shop on their own in the Covered California Individual Marketplace without the risk of being declined coverage because of previous illnesses or pre-existing health conditions. Depending on their household income, they may also qualify for financial assistance through cost-sharing and premium assistance.

When is the SHOP's Open Enrollment period?

The SHOP allows new groups to enroll throughout the year with effective dates on the first of every month.

How much is a small business owner required to contribute to employee premiums?

Employers must contribute a minimum of 50 percent of employee-only premium amounts for their selected anchor plan (base plan).

What is the definition of a small group?

The definition of a “small group” employer under the Affordable Care Act (ACA) expands on January 1, 2016 to include employers with up to 100 employees. (Previously, a small group was 1-50 members.) Therefore, any mid-size small group with 51-100 employees must be reclassified from a large group to a small group and be issued small group coverage. For the small businesses with 51 to 100 employees entering into this new classification, many likely will have to change their existing health plans into a new plan that meets the standards of today’s small group market.

What are the benefits of using SHOP to purchase group health coverage?
  1. Simplify Choices. Covered California will provide side-by-side comparisons of health plans, their benefits, premiums and quality.
  2. Expand Employee Options. Covered California will enable small businesses to offer employees a choice of any Qualified Health Plan in the SHOP, not just one or two carriers,
  3. Provide You Control. Small businesses will be able to decide whether and when to participate in Covered California. They can choose how much to contribute toward their employees’ coverage and make a single monthly payment through Covered California rather than to multiple plans.
  4. Premium Assistance. If a business has fewer than 25 employees, they may be eligible for small business tax credits when offering health coverage to employees through Covered California.
Can I still buy outside of SHOP?

Yes. Carriers with qualified health plans inside the exchange will offer the identical plans outside the exchange. In addition, WHA offers additional plans off-exchange that meet ACA guidelines. The employer will have greater choices and flexibility as to which plans they choose to offer their employees. 

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