CoveredCa Update
April 2014
Chris Patton
Vice President of Sales
OPEN ENROLLMENT SUMMARY
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SHOP Enrollment
SHOP Enrollment January through April
960 Groups
6250 lives
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Small Business Health
Options Program (SHOP)
960 small businesses
representing over 6200 employees and their
dependents have enrolled for coverage
Averages
 5.11 employees per group
 2.51 dependents per group
 7.63 enrolled per group
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SHOP Overview
What are the products and services offered through
Covered California’s SHOP Market?
• Competing Health Insurance Plans
• Multiple Coverage Options
• Access to Tax Credits
• Benefits Administration
• Enrollment Support
• Expand Employer and Employee Options
• Employee only Coverage Available
• Multi-lingual Customer Service
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SHOP Overview
 SHOP Small Business
Health Options Program
Employer Defined Contribution
• Employer selects a single tier and contribution percentage
• Employer selects a benchmark or defined contribution plan
• Employer wins: Predictable costs and set budget
Employee Choice
• Employee selects any plan within a single tier
• Employee wins: Freedom to choose their own plan
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Qualified Health Plans
Participating SHOP Health Plans
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Plans by Rating Region
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SHOP Agent Commission
•
•
•
•
•
•
1st Year
2nd Year
3rd Year
4th Year
5th Year
6+ Years
6.5%
6.2%
5.9%
5.6%
5.3%
5.0%
SHOP Enrollment
60% General Agent
22% Agent Direct
18% Consumer Direct
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Certified Insurance Agent
Training & Certification
•
•
•
•
•
•
•
Registration on-line
In person training 8 hours
Review Training Modules: Agent Tools
Pass The Exam (80%)
Review and Sign Agent Agreement
$58.25 Admin fee
Certified Insurance Agent
Certified Insurance Agents
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Opportunity
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SHOP Sales
Covered California “Halo Effect”
What employers are asking
Employer sponsored vs Individual Market Place
Making the decision….
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Who is eligible for the Tax
Credit?
• Small businesses are eligible for a tax credit if…
o
They have fewer than 25 full-time employees
o
Their average annual wages <$50,000
o
They pay 50% of the premium cost*
• Starting in 2014, tax credits are only available for businesses that
purchase through the SHOP
• Tax credits do not cover premium expenses of owners or their
families; and cannot be claimed by the self-employed
• Employers are encouraged to consult with their tax
professional.
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SHOP Sales
Tax Credit
Deducible premium
Pre-tax employee premium
Employee only coverage
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SHOP Contacts
Vice President Chris Patton
Director: Rich Hines- Southern California
Director: Shawn Balsdon-Northern California
Inside Sales Specialists: 844 332-8384
Jake Mooney (jmooney@pinnacletpa.com)
David Guevara (dguevara@pinnacletpa.com)
Clarissa Sarabia (csarabia@pinnacletpa.com)
SHOP Service 877 453-9198
Email: agents@covered.ca.gov
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