California Choice Small Group Exchange

California Choice is a private small employer group health plan exchange. Employees can select from different health plans and metal tiers when California Choice are offered through the employer group.

Employers can offer a variety of different carriers to their employees including: Anthem Blue Cross, Health Net, Kaiser, Oscar, Sharp, Sutter, United Healthcare, and Western Health Advantage.

EMPLOYER ELIGIBILITY

An employer is required to:

• Be a California Company employing 1 to 100 eligible employees. Majority of eligible employees must reside in California. Eligible Employees must be permanent and actively working an average of 30+ hours per week over the course of a month, at the small employer’s regular place of business or 20+ hours per normal work week for at least 50% of the weeks in the previous calendar quarter. Ineligible employees include 1099, commissioned, permanent employees eligible for medical health care coverage offered by or through a labor union, part-time, seasonal, temporary or substitute and employees on a leave of absence not categorized as FMLA, Workers Compensation or Military.
• Contribute a minimum of 50% of the lowest cost medical benefit plan available to the employee based on employee zip code.
• Give ALL eligible employees the opportunity to enroll. This opportunity should also be extended to COBRA eligibles.
• Meet the participation requirements listed below. You do not have to count those who will be keeping another employer’s group health coverage as part of your total number of eligible employees, unless your contribution towards employee’s lowest cost premium is equal to 100%.
  • 1-2 Employees: 100% of all employees. All groups must include at least one medical enrolled employee who is not a business owner or spouse of business owner
  • 3-100 Employees: 70% of eligible employees enrolling in CaliforniaChoice®

Employee Eligibility

An Employee is required to:

• Meet the employer’s waiting period.
• Be permanent and actively working an average of 30+ hours per week over the course of a month, at the small employer’s regular place of business or 20+ hours per normal work week for at least 50% of the weeks in the previous calendar quarter.
• Be a permanent employee who is not eligible for medical healthcare coverage offered by or through a labor union.
• Be paid on a salary/hourly basis (not 1099, commissioned, or substitute).

Coverage for your Spouse

• If you enroll, your spouse may be eligible for coverage.
• Spouse: Spouse must be legally married to the employee.

Coverage for your Domestic Partner

• If you enroll, your Domestic Partner may also be eligible for coverage.
• For a Domestic Partner to qualify, Employee and Domestic Partner must:
• Not be married under either statutory, common law or part of another domestic partnership.
• Both be 18 years of age or older; or, if under 18, have a valid court order allowing partnership.
• Share an intimate and committed relationship.
• Agree to be jointly responsible for each other’s basic living expenses incurred during the domestic relationship.
• Both be mentally competent.
• Not related by blood to a degree of closeness that would prohibit marriage in this state.
• Agree to notify CaliforniaChoice® immediately upon termination of domestic partnership.

Coverage for your Dependent Children

• If you enroll your Dependent Children may also be eligible for coverage.
• For Medical, Chiropractic, Vision and SMILESAVER Dental:
• Must be born to, a step-child or legal ward of, adopted by, or have an established parent-child relationship with the eligible employee, employee spouse or domestic partner.
• Under age 26 (unless disabled, disability diagnosed prior to age 26)*

For AMERITAS Dental:

• Must be born to, a step-child or legal ward of, adopted by, or have an established parent-child relationship with the eligible employee, employee spouse or domestic partner.
• Financially dependent upon the employee per IRS guidelines.
• Unmarried or not involved in a domestic partnership.
• Under age 26 (unless disabled, disability diagnosed prior to age 26)*
• An Employee is required to notify CaliforniaChoice® immediately upon any of the above statements no longer being true.

*Dependents who are incapable of self-support because of continuous mental or physical disability that existed before the age limit are eligible for coverage until the incapacity ends. Documentation of disability will be requested. Once the child reaches the age limit for coverage, verification of eligibility will occur annually at the child’s birthday.

Continuity of Care

If you are in the middle of treatment AND your current physician is not contracted with the Health Plan you wish to select, please contact our Customer Service Center at (800) 558-8003 for further information and assistance.

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