Getting Ready for Q4: The Latest California Carrier Updates

Q4 Carrier Updates California

At Word & Brown, we want to work with you to help you maximize your California sales opportunities – and address more of your clients’ diverse needs – during fourth quarter.

Our recently concluded 2021 Carrier Con webinar series included presentations by 20+ of our carrier and administrator partners, where each highlighted important information about what’s new for Q4 and what to expect in 2022.

Below are highlights from our California presenters for those of you who were unable to take part in Carrier Con. (A summary of the Nevada presentations will appear in our blog next month. Be sure to watch for it.)

California Presenters, August 24-25, 2021:

(List is in order of presenting carriers/administrators)

Day 1 Presenters


-Rate pass for Q4 for HMO and PPO

-Renewing PPO customers seeing premium increases of 3.2% in Northern California and 2.6% in Southern California; HMO customers seeing 4.5% increases across the state

-Choice Simplified package offers any plan, any network, statewide

-Three network options in 2022 portfolio (Advantage network is ending); those remaining are Signature (full), Alliance (mid), and Harmony/Canopy (narrow)

-Available broker bonus through year-end on new sales with 10 or more enrolled; bonus of $100 per employee, with added comp for renewing groups in 2022 and 2023

-Level-funded product quoting now for November or later effective dates; offers maximum claims liability with Stop Loss; opportunity for year-end surplus payout (if claims are lower than expected; nationwide, about 36% of employers qualify; forecast for CA is higher; ask your W&B rep for details

-Available savings when Specialty products are packaged with Medical

-New Wellness benefits include HealthiestYou $0 virtual visits

-Detailed employer reporting, including claims and Rx utilization

-Beta testing underway for eServices for HMO groups (already offered on PPO groups)

-Coming in 2022: Peloton promotion, discounted pricing on bikes, free access to app for one year

Kaiser Permanente

-Kaiser Permanente is a stable partner in unpredictable times

-Among highest-rated health plans in CA five years in a row (National Committee for Quality Assurance); leading CA in 83 effectiveness-in-care measures

-Committed to balancing the work/life needs of members

-Broad provider network includes 17,169 doctors in 534 offices across California

-Adaptability: 15 million more virtual care encounters (2020 vs. 2019)

-Relaxed DE 9C and payroll for 6+ groups

-Reduced paperwork for start-up groups

-Reduced participation: 50% of eligible employees

-Multiple plan offerings: groups of 1-5 can have four enrolled in HMO and one in PPO; groups of 6+ can have one in PPO and others in one or HMO plan

-Relaxed out-of-state requirements: group may qualify with than 51% of eligible employees in CA

Health Net

-Strong PPO network statewide

-Five HMO network options (CommunityCare is only network with deductibles)

-Mix and match networks and ACA tiers

-Underwriting promotions: Enhanced Choice A, Enhanced Choice B, and Sell HMO 6

-No DE 9C required for 5+ enrolling

-Ask rep for details on savings available in regions across the state

-Voluntary and employer-sponsored Dental, Vision, and Life available with bundling discount

-Increased earnings potential with broker bonuses


-Range of funding options: Traditional Insured, Fully Insured Plans, Shared Returns® Fully Insured, Shared Returns® Minimum Premium, Self-Funded with Cigna Stop Loss, Level Funding (ASO for groups with 25+), Graded Funding

-Fully Insured Plus available in California for 200+ HMO groups available down to 100 employee PPO groups; outside of CA, available to groups of 51+

-On Fully Insured Plus plan, employer pays fixed monthly premium and Cigna pays covered claims; after year-end settlement (in month 15), if claims are lower than expected, renewing clients are eligible to receive 50% of savings in a refund – as a credit or payment via a check; if claims are higher, clients do not pay more

-Select HMO network now includes AppleCare in Los Angeles County


-Nine plans for Q4 (8 in 2022, with departure of Oscar for small business)

-20 provider networks

-123 plan options

-Newest addition (added for 7/1) is Cigna + Oscar, with eight plan options across all four ACA tiers

-Cigna + Oscar includes LocalPlus EPO network (NorCal: 4,000+ PCPs, 19,000+ Specialists, and 63 hospitals; SoCal: 8,000+ PCPs, 28,000+ Specialists, and 189 hospitals)

-UnitedHealthcare Harmony HMO network now available in Southern California (seven new plans across three ACA tiers); five rating regions in SoCal; nearly 12,000 physicians and 144 hospitals in five SoCal counties (Los Angeles, Orange, San Diego, San Bernardino, and Riverside)

-Rate actions: Health Net now more competitive – double-digit decreases; limited rates actions by others in program

-Total Choice: plans in all ACA metal tiers; cost control for employer with Defined Contribution; very popular – with nearly 42% of new businesses offering CalChoice choosing Total Choice

-Underwriting enhancements: limited requirements for Start-Up Groups, 70% participation allowed for employers with 100% contribution (no ID cards req’d)

Blue Shield of California

-80+ years of serving Californians; 24% market share in Small Group market in California; #1 market share company in PPO marketplace, second-largest HMO market share

-Consistent rate actions since 2013 on an annual basis

-Retention 90-95% year-in, year-out

-Streamlined guidelines and relaxed participation available through 12/31/2021

-New Group Enrollment Checklist

-Trio HMO offers better care coordination; ACO chassis; in market for 10 years; typically lower copays than other products; self-referrals to Specialists in same medical group as PCP; access to $0 copay virtual-care with Teladoc, 24/7/365; Healthy Savings grocery discount; no-charge LifeSpring meal delivery and transportation support for seriously ill members; service from Shield Concierge dedicated support team; engaging, digitally enabled wellness programs

-Tandem PPO offers flexibility, affordability, and convenience; 12.5% savings compared to Full PPO for groups with out-of-state employees; $0 Teladoc consults; walk-in health care at CVS® MinuteClinic; Wellvolution top-rated programs

-Employer Enrollment just marked first-year anniversary; simplifies quote process (W&B was early adopter of program)

-Producer Rewards Bonus Program offers individual producer points that can be redeemed for cash, merchandise, and gift cards; point awards vary by product sales

-Opportunity for savings by bundling Dental, Vision, and Life with Medical; competitive products with rate guarantee on Dental

Anthem Blue Cross

-For September 2021 effective dates, Anthem is offering a 7% commission on new Medical business for the life of the case on 5+ enrolled employees in Small Group plans.

-For October 2021-January 2022 effective dates, Anthem is offering 6% commission on new Medical business for the life of the case on 10+ enrolled employees in Small Group plans.

-Statewide network flexibility program: employers can choose from two PPO networks alongside one HMO network or two HMO networks alongside one PPO network

-DE 9C not required with three or more subscribers enrolling; also no DE 9C required for Specialty; excludes Virgin groups

-Relaxed participation: 25% for 5+ groups; 65% for groups of four or fewer subscribers

-Embedded Employee Assistance Program (EAP) in all Medical plans; includes three visits (face to face, phone, or online); applies to household, not just enrolled employee

-Live Health Online (LHO): first three LHO visits free on most plans (some plans offer even more)

-PayForward offers members up to 15% cash back at 120,000 participating retailers

-Anthem Whole Health Connection® offers care management resources, Dental and Vision care alerts, patient health profiles, and more

-Promotions and financial incentives: 5% bundling discount; 24-month rate guarantee; no employer contribution to meet participation on Dental and Vision

-Specialty Broker Bonus available for 9/1/21-1/15/22 effective dates; earn up to $10 per enrolled contract; ask your W&B rep for details


-CVS MinuteClinic access through CVS HealthHUB locations (no-cost and low-cost services available; 125 services available, including lab work); quicker access to care with no copay

-Small Group updates: five HMO networks; OAMC PPO network; Aetna Whole HealthSM; Sutter Health network coming in 2022 offers savings; different price points for each network

-Pick 10 (formerly Pick 5) offers member access to any plan and any network; available for new business and renewals; groups can move to Pick 10 at renewal (enrollment not required in all 10 available plans)

-Rate update: rate reductions in both Northern and Southern California; reverses prior pull-back in Small Group market; ask for details

-Top-selling plans: some options available without infertility deliver savings; new options coming in 2022 with buy-up options; top-selling Bronze PPO plans

-25% participation promotion available thru Q1 2022 for groups of 5-100 employees; 60% for groups of five or fewer

-Attain by Aetna® app coming 2022 to Android (already for Apple®); customizable goals to members

-Producer Reward Program still going on for 75+ (total) enrolled on one or multiple groups; earn up to $150 per employee enrollee; similar program expected in 2022


Day 2 Presenters

Sharp Health Plan

-Largest health care system in San Diego; greatest share in market; membership tripled in last decade

-Not-for-profit serving 3.3 million residents in San Diego County

-Integrated delivery system: Seven hospitals (four Acute Care, three Specialty), two medical groups, and 22 outpatient clinics

-25 total plan options; mix and match; pick your plan and network

-Rated as best insurance provider in 2021 San Diego Union-Tribune readers’ poll; also recognized for multiple years as California’s highest-rated health plan

-Four HMO networks: Premier (core); Performance; Value; Choice

-Local health plan, but services and care available nationwide and online including Nurse Line, MinuteClinic, and Assist America

-Underwriting: 25% participation with 5+; no DE 9C with 5+ enrolled; can write a one person group (with W-2 employee); can offer Sharp Health Plan to groups in a PEO; Premier network available based on employee ZIP Code (6+ enrolled); cross-border and IFP are valid waivers

-Available to wrap with another plan (minimum of five enrolled on Sharp); can write alongside multiple carriers

-New POS plan replacing PPO as of 12/1 Sharp Choice Network + Aetna Open Choice national PPO network

-Carve-out possible

-Fiscal year 2021 retention is 90%; great trend over 10 years

MediExcel Health Plan

-Growing cross-border plan

-Rate pass for Q3 and Q4

-Small Group renewal: 1.47% increase

-Large Group renewal: 5% increase

-Lowest HMO rates in San Diego and Imperial counties

-Best-selling plan is P90 Platinum, which offers significant savings; available down to one employee (in current promotion); no minimum contribution requirement (or on Gold 80, MEP, and QEP)

-Dependent-only plan option

-Wrap with any carrier or multiple carriers

-1099 employees eligible (up to 25% of group)

-Will accept groups on (or coming off of) PEO

-DE 9C not required for quoting – just enrollment

-Coming for 10/1: Text MediExcel for brokers + member online portal

-New cross-border facility opening in Q4 2022 (new Medical Tower offering Primary Care, Pediatrics, OB/GYN, Dentistry, Urgent Care; new Trauma Center)

Cigna + Oscar

-True joint venture builds on success of companies independently (largest provider network, innovative technology, and unique telemedicine and Concierge services)

-Good PPO alternative

-Dual EPO networks in California: Local Plus® and Open Access Plus; LocalPlus in California includes 12,500 PCPs, 47,000+ Specialists, and 252 Hospitals; Open Access Plus includes 16,900+ Primary Care Physicians, 7,200+ Pediatricians, 60,500+ Specialists, 345 Hospitals, and 230 Urgent Care Centers

-Great mobile app with $0 virtual urgent care

-Competitive rates, rate pass for Q4 (16% savings on Platinum; 25% savings on Bronze)

-Write alongside any carrier; 60% overall enrollment to Cigna + Oscar; also available through CaliforniaChoice private exchange

-No DE 9C for 7+

-Broker bonus: $500 for each group with three or more enrolled employees for 10/1/2021 to 01/15/2022 effective dates

 Western Health Advantage

-Great option for Northern California clients (or employees in NorCal with a statewide employer)

-Sponsor owner is Dignity Health

-Serving 10 counties in Northern California, including 10/1 expansion into Humboldt County

-Choice is key; flexibility and freedom for members to go to any contracted medical group

-Medical groups and hospitals throughout Sacramento, North Bay, and Humboldt County

-User-friendly MyWHA mobile app; 24/7 access to care also available through Teladoc and through Urgent Care provider network

-Behavioral health and alternative care included (Chiropractic and Acupuncture built into all plans; no buy-up required); Assist America also included for out-of-service/out-of-country care

-Competitive rates; rate increase of just 2% for 2022

Sutter Health Plus

-Serving 16 NorCal counties

-Broad provider network: 7,000 providers, 29 hospitals (20 in Bay Area; 9 in Valley Area), and 12 medical groups (8 in Bay Area, 4 in Valley Area); Placer and Nevada county expansion + 15 new ZIP Codes in Santa Clara County

-10 HMO plan designs for 2021, including High Deductible Health Plans that are HSA-compatible

-Participation: 50% of all eligible if sole carrier (or a carrier if alongside another)

-Available as Sole Carrier or Slice Carrier; will write alongside other carriers; minimum participation of two eligible employees in a Sutter Health Plus plan (less waivers); Sutter will allow up to three plans for Small Group; all eligible and dependents must live, work, or reside within Sutter service area

-DE 9C required for groups of 1-5 eligible and any size sole proprietor or partnership groups

-Competitive pricing; average annual rate increase of 5.5% over five year; new and renewing groups will see an average .5% increase average for Q4; select regions rate passed for Q4

-Good agent commission: 6.5% for 1-50; 5% for 51-100

-Q4 renewals available on broker portal

-Small Group account management, including open enrollment, eligibility and benefit questions, and broker and employer training

-Four IFP HMO plans available (one in each metal tier)

-Broker portal offers commission statements, renewal packets, account details, etc.

Total Benefit Solutions

-Great coverage alternative for employers with an international headquarters outside of the U.S. and 51 or more employees globally (look for “International” or “USA” in business name)

-Requires a minimum of two eligible/enrolling in the U.S.; no maximum on group growth

-Available in 49 states (not available in Hawaii)

-Nine plans for groups of 2-20 U.S.-based employees; all plans have a three-tier plan design with a PPO or OAMC network plan for U.S. care; standard deductibles from $0 to $3,000

-Customization of 21+ groups

-All “Access US” health plans underwritten by Aetna International

-Composite rates

-Multilingual member support 24/7

Allstate Benefits (formerly National General)

-Level-funded product

-Focus is on groups of 2-50; write up to 500 employees

-Multiple national networks

-Multiple plan choices based on enrolling employee count: groups of 3-15 can have two plans, groups of 16-24 can have up to three plans, and groups of 25+ can have up to four plans

-Carve-outs possible (e.g., managers, owners, out-of-state employees)

-No industry exclusions

-Multi-state coverage possible (except Hawaii)

-HSA and HRA plans available

Evolved Benefits

-Specialty niche GA experiencing considerable growth (up 177% in 2020)

-Target industries: security, hospitality, landscaping, staffing, trucking, assisted living facilities, construction, manufacturing, plumbing, restaurants, grocery stores, home health care, housekeeping and janitorial, agricultural/ranching, cannabis, and others

-Guaranteed Issue coverage is easy to write

-Shelf-rated products

-Easy administration with in-house TPA

-Level Funded solutions with variable admin fee

-Commission comparable to Major Medical: $10-$15 PEPM

-Employer sponsored, Voluntary, or combo

-Access to 700,000 health care professionals through PHCS Network

-National access to nearly 4,000 hospitals, 79,000 ancillary care facilities, and more than 700,000 health care professionals through PHCS network

-Telemedicine and Rx coverage on all solutions

-COBRA eligible and 1094/1095 reporting offered at no added cost

-Census enrolled

-Multiple plans available: Basic MEC, Virtual MEC, Ultra MEC, and Ultimate MEC

-Not a Major Medical replacement; an alternative for employers that need it

-Worksite product options to “fill the gaps” (limited Medical like Hospital, Intensive Care, off-the-job Accident, and Surgical and Anesthesia plus Accident, Critical Illness, Term Life, Dental, and Vision)

-Available to discuss, one on one, suitability of product offerings for clients; just ask

E.D.I.S. (Employer Driven Insurance Services)

-Third party administrator established in 1996

-HRA/MERP administration: ID cards, debit cards, EOB retrieval, ICHRA (individual coverage HRA)

-Level-funded Stop Loss: administration for Applicable Large Employers (ALEs); Stop Loss as low as $10,000 (Group level and member level); multiple network options; COBRA administration; 24/7 telemedicine; 100% of unused claims funds back to employer; no Health Risk Assessments for 25-150 employee groups; 50 or fewer requires 75% participation (minimum 26 enrolling); 51 or more requires 60% participation; coverage alongside Kaiser Permanente or union HMO plans; customizable agent commission; ask for details – and client testimonials

-Minimum Essential Coverage (MEC) plans: 100% ACA compliant; level-funded with Stop Loss; minimum of 30 employees required

-Broker Bonus of up to $4,000 per case, based on group size and products offered ($500, $1,500, $2,500, $4,000)

-High customer retention (90%+)

-Mobile-friendly web portal

-Comprehensive analysis/reporting

CalCPA Health

-Established in 1959; admitted carrier in California

-Lines of business: Medical, Dental, Vision, Life, and Long Term Disability for Individuals, Small Groups, and Large Groups through Anthem Blue Cross, Delta Dental, and VSP

-Not an association plan, so not affected by California Senate Bill 1375

-Long-term rate stability: 3.5% average increase over six years

-Large group benefits for smaller firms

-Strong retention (94% last year; half of book with CalCPA for 10 years)

-46% of enrollments in HSA plans – double the state average

-Offer the most HSAs of any carrier (46%+ enrollment in HSAs)

-Eligibility: accounting firms, general financial services, or related businesses domiciled in California; ownership must include CalCPA members (at least one person actively at work 20-30 hours weekly or more)

-Mix and match from 12 PPO, four HMO, and six HSA plans (times two with Select Network) with no per plan participation requirement

-75% employee participation

-50% employer contribution

-Can write Kaiser Permanente alongside with no minimum participation

-7% commission for 50 or fewer, 5% for 51+; same rate first year and renewal

-Prospects include CPAs, financial advisors, and general financial services firms; consider asking existing clients for referrals to their CPAs


-Largest cross-border health care network in the Southern California region

-Licensed by California Department of Managed Health Care; fully licensed Mexican HMO plan

-Plans are ACA compliant and meet Minimum Essential Value requirements, providing Essential Health Benefits (EHBs); facilities within walking distance of U.S./Mexico border

-Urgent care and emergency room services covered with a flat copay

-Underwriting requirements: minimum 50% employer contribution, minimum participation of five enrolled in SIMNSA (minimum of 10 for Large Groups); DE 9C required to confirm eligibility (30 hours per week)

-Serving employers in San Diego and Imperial counties

-No Q4 rate change

-Rates are 50% below trending carriers

-Available to wrap with other U.S.-based carriers

-New facility under construction and scheduled to open in 2022

 Nippon Life Benefits

-Offering LYNX to foreign-owned companies (with HQ outside of U.S.)

-Medical coverage for employer groups that operate in the U.S., but are controlled by a foreign parent company)

-We have a foreign parent, so we understand the business

-200 plan options from which to choose; multilingual customer service

-PPO network from Aetna Signature Administrators

-Includes Teladoc, Active+Fit, wellness, Lab Card/Lab Card Select, Mobile App, and more

-Available EAP, Dental, Vision, Life, Disability

-Coverage available in 14 states (for CA groups, must have 100 employees worldwide)

To access recordings of the Carrier Con 2010 California presenters, click here for Day 1 presentations or here for Day 2 presentations.


Have Questions or Want to Learn More?

To find out how Word & Brown can help you maximize your sales opportunities in Q4 – and all year long – contact your Word & Brown representative. Or, contact the Regional Vice President in any of the six Word & Brown regional offices across California and Nevada.



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