• Who/What is CaliforniaChoice^®?
• Who is the Group Plan Administrator?
• Who is my Health Plan?
  • Can I change my Health Plan?
• Can each family member select a different Health Plan?
  • What is my benefit design/plan?
  • Can each family member select a different benefit plan?
• Can I change my benefit design/plan?
• When is my company's annual Renewal?
• When can dependents obtain coverage?
• How many health plans can I offer my employees?
• What benefits does CaliforniaChoice^® offer?
• Will CaliforniaChoice^® help me save money?
• Do the plans cover prescription drugs?
• What are the employer group eligibility requirements for CaliforniaChoice^®?
• What if an employee just does not want health care coverage?
• Can any employee or dependent be denied health coverage?
• Are there any waiting periods imposed before coverage begins?
• Is the cost of coverage guaranteed?
• Are my employees covered if they have pre-existing conditions?
• How long are pre-existing conditions not covered by CaliforniaChoice^®?
• What about my employees' dependents? Do they have to be covered, and, if so, does the employer have to pay for them?
• How does CaliforniaChoice^® define a dependent?
• When are children no longer considered dependents?
• Can my employer group be canceled because of too many claims?
• When should my employees choose dependent coverage?
• Will my employees and I be able to keep our current doctors?
• How are rates determined?
• Is there a monthly billing fee?
• How is CaliforniaChoice^® remunerated for the services it provides?
• Is out-of-state coverage available?
• What materials will I receive once I am enrolled?
• Additional Questions?

Who/What is CaliforniaChoice^®?
CaliforniaChoice^® is the TPA (Third Party Administrator)that has brought several insurance companies together to allow you and your employees the ability to select different plans of health coverage.

Who is the Group Plan Administrator?
The Group Plan Administrator is the employee selected by your company to be the main contact to CaliforniaChoice^®.

Who is my Health Plan?
Your Health Plan is the participating insurance company you selected under the CaliforniaChoice^® program to provide your health care. (i.e. Blue Shield, Health Net, Kaiser, Sharp, Western Health Advantage)

Can I change my Health Plan? (i.e. Blue Shield, Health Net, Kaiser, Sharp, Western Health Advantage)
Yes, but only during your group's annual renewal period... or if you move your residence to a location where there are no medical providers under your current Health Plan and you notify CaliforniaChoice^® within 30 days of your move.

Can each family member select a different Health Plan? (i.e. Blue Shield, Health Net, Kaiser, Sharp, Western Health Advantage)
No, all family members must select the same Health Plan, but each member may choose a different PCP.

What is my benefit design/plan? (i.e. HMO 15, HMO 25, HMO 25 Value, HMO 30, HMO 30 Value, HMO 40, HMO 40 Value, PPO 750, PPO 1000, PPO 2400, HSA 1500, HSA 2400, Active Choice 500)
The level of coverage/benefits that you selected related to co-payments or coverage for doctor visits, hospitalizations, etc. (i.e. HMO 15, HMO 25, HMO 25, HMO 30, HMO 30 Value, HMO 40, HMO 40 Value, PPO 750, PPO 1000, PPO 2400, HSA 1500, HSA 2400, Active Choice 500)

Can each family member select a different benefit plan? (i.e. HMO 15, HMO 25, HMO 25 Value, HMO 30, HMO 30 Value, HMO 40, HMO 40 Value, PPO 750, PPO 1000, PPO 2400, HSA 1500, HSA 2400, Active Choice 500)
No, all family members must select the same benefit plan.

Can I change my benefit design/plan? (i.e. HMO 15, HMO 25, HMO 25 Value, HMO 30, HMO 30 Value, HMO 40, HMO 40 Value, PPO 750, PPO 1000, PPO 2400, HSA 1500, HSA 2400, Active Choice 500)
Yes, but only during the annual renewal period for your company.

When is my company's annual renewal?
Your company's annual renewal period is usually two months prior to the anniversary date (your company's initial effective date). All changes made during annual renewal are effective on the company anniversary date. Check with the Group Plan Administrator for the exact date.

How many health plans can I offer my employees? (i.e. Blue Shield, Health Net, Kaiser, Sharp, Western Health Advantage)
Up to 4 based on the employee's resident zip code and it's still easy for you! Only through CaliforniaChoice^® can each employee choose a different health plan using one universal enrollment form, while you get one bill and write only one check a month, regardless of the number of health plans chosen by employees.

What benefits does CaliforniaChoice^® offer?
With CaliforniaChoice^® each employee can choose from up to 5 health plans and 22 benefit designs offered. The plans offer a variety of co-payments and network options. Benefits are standardized for easy comparison. Please see the benefit overview for details.

Will CaliforniaChoice^® help me save money?
Yes. We all know health insurance is expensive, but CaliforniaChoice^® helps ease the uncertainty of rising health care costs by allowing you to base your contribution on a specific plan. Each employee can still pick whatever plan best fits his/her individual needs. If there's a difference between the employer contribution and the cost of the coverage the employee selected, it's paid through payroll deduction. The result is, you set a fixed benefit budget, while employees have the flexibility to individually select the benefit design and health plan they want.

Do the plans cover prescription drugs?
Yes, all 22 benefit designs include a variety of co-payments for generic and brand name prescriptions.

What are the employer group eligibility requirements for CaliforniaChoice^®?
CaliforniaChoice^® benefits are offered exclusively to small businesses with 2 to 50 full-time, eligible employees. However, businesses with more than 50 employees may be eligible if they had less than 50 full-time, eligible employees for 50% of the preceding calendar year or 50% of the preceding calendar quarter.

• You must be actively in business with a street address in California.
• Your home office must be in California.
• 51% of your employees must reside in California.
• You must have a California Federal Tax ID number.
• You must have Worker's Compensation Coverage effective on the requested CaliforniaChoice^® effective date.
• 70% of your eligible employees must enroll with CaliforniaChoice^® or have group spousal or governmental coverage.(i.e. Medicare, Tricare - formerly Champus)
• An eligible employee must work a minimum of 20 or 30 hours per week. You may set the minimum number of hours (20 or 30) for eligibility, but those hours must be consistent for all employees. We'll need applicable tax documentation to verify your eligible employees (such as a DE6).

What if an employee just does not want health care coverage?
An individual employee may decline coverage if he/she wishes; however, his/her dependents will not be able to enroll. In addition, the employee will not be able to enroll with CaliforniaChoice^® until the employer's next annual renewal period, unless employee has a qualifying event. (i.e. loss of other group coverage; proof must be provided) Remember, for your employer group to qualify for CaliforniaChoice^® coverage, 70% of your eligible employees must enroll with CaliforniaChoice^®.

Can any employee or dependent be denied health coverage due to health conditions?
No. In CaliforniaChoice^®, as with all small group health insurance, coverage is "guaranteed acceptance". This means your employees and their dependents cannot be turned down or their coverage dropped due to prior medical history or current health status. However, an employee or dependent may be denied only for failure to meet the eligibility requirements.

Are there any waiting periods imposed before coverage begins?
You, the employer, may establish a waiting period for new employees. This waiting period may be 30, 60, 90, 180 or 365 days from the employee's date of hire. This waiting period must be consistent for all employees since multiple waiting periods are not allowed. You may choose to waive the waiting period for your new employees during initial enrollment, but this also must be consistent for all employees. Newly hired employees added after initial enrollment will be covered under CaliforniaChoice^® on the 1^st day of the month following completion of the waiting period, provided the application is received no later than 30 days after the eligible effective date.

Is the cost of coverage guaranteed?
Yes. Once your business is enrolled, costs for the health plans chosen by your employees are guaranteed for 12 months. Once a year the case will go through a renewal process, during which time rates may increase. Employees will be allowed to switch plans for a lower or higher cost premium. The new rates at renewal will also be guaranteed for 12 months. Changes to an employee's age (i.e. changing to age 30, 40, 50, 55, 60, or 65) address, and dependent status may affect individual costs of coverage.

Are my employees covered if they have pre-existing conditions?
It depends on their previous coverage and the plan the employee selects. A pre-existing condition is any medical condition that has been treated during the previous 6 months. If an employee selects an HMO, he or she will be covered regardless of any pre-existing conditions. If a PPO plan is chosen, the employee or covered dependent may have to wait for a period of time (exclusionary period) before getting coverage for the pre-existing condition. Please note that all other contractually covered medical conditions will be covered during that period. If the employee or covered dependent had health insurance coverage continuously for at least 6 months prior to buying coverage through CaliforniaChoice^®, he/she would not have a required exclusionary period. Those that did not have previous coverage, are subject to the exclusionary period.

How long are pre-existing conditions not covered by CaliforniaChoice^®?
For those employees or covered dependents, electing a PPO plan, and who did not have previous coverage prior to the effective date of the new CaliforniaChoice^® plan, a one-time exclusionary period of up to 6 months must be observed. An important item to note, however, is that all other contractually covered medical conditions other than the pre-existing condition will be covered. Employees electing an HMO plan are never subject to an exclusionary period even when previous qualifying coverage did not exist.

Credit will be given for having qualifying coverage for part of the previous 6 months. The employee and/or dependent will be given partial or full credit for that period fulfilled under the previous qualifying coverage. For example, if the employee had fulfilled 4 months of a pre-existing condition limitation period, through the previous qualifying coverage, he/she would receive credit for those 4 months, thus leaving only a 2 month pre-existing condition exclusion period under the new CaliforniaChoice^® plan.

What about my employees' dependents? Do they have to be covered, and, if so, does the employer have to pay for them?
Dependents do not have to be covered and there is no participation requirement for dependents. The employer is not required to pay for the coverage of any dependent. All CaliforniaChoice^® plans are available to dependents if elected by the employee. If you, the Employer chooses to contribute towards dependent coverage, the cost for dependent coverage can be payroll deducted from the employee's paycheck. The contribution level must be consistent for all employees since multiple contribution levels are not allowed.

How does CaliforniaChoice^® define a dependent?
A dependent is a spouse, domestic partner or any unmarried child, including adopted child or stepchild, if under the age of:

• 19 – if not a full time student
• 25 – if a full time student

When are children no longer considered dependents?
A child is no longer eligible at the end of the month following marriage or when he/she reaches an ineligible age based on their current benefit design:

• If a full time student, at the end of the month following 25^th birthday
• If not full time student, at the end of the month following 19^th birthday

Can my employer group be canceled because of too many claims?
No. An employer group can be canceled only for non-payment or non-compliance with policy rules.

When should my employees choose dependent coverage?
It is very important to make the decision about who will be covered at the time the employee enrolls. After initial enrollment, an employee cannot add dependent coverage until the next renewal period, unless the employee has a qualifying "Life Event" (adoption, birth, marriage, domestic partner).

Will my employees and I be able to keep our current doctors?
Yes, if you select an HMO that your doctor is contracted with or if you elect a PPO Plan. If an HMO plan is chosen, benefits are payable only if HMO providers are used. A PPO plan gives employees incentives to use network doctors, but you may still choose to use out-of-network providers. Before you and your employees make a selection you will want to know the health plans in which your physician is a participant. For a listing of physicians and networks, go to the online provider directory or ask your broker for a printed physician directory.

How are rates determined?
CaliforniaChoice^® has a standardized set of benefits for the consumer. Prices will vary based on the health plan and the benefit design the employee chooses, as well as his/her family status. All rates are filed with and approved by the State of California. Once you purchase CaliforniaChoice^® your rates are guaranteed for 12 months.

Is there a monthly billing fee?
Yes. An billing fee based on number of covered employees as such:

How is CaliforniaChoice^® remunerated for the services it provides?
CaliforniaChoice^® is remunerated by the monthly billing fee and by the insurance company from the premium.

Is out-of-state coverage available?
Yes. The employee must enroll in one of the PPO benefit designs available to them based on their group's eligibility.

What materials will I receive once I am enrolled?
Upon enrollment, the employer group will receive a welcome kit from CaliforniaChoice^® confirming your effective date and containing administrative instructions, providing you complete information on how to administer your health insurance throughout the year. Also, the health plans you and your employees select will send information to your office or your employees' homes. This information explains benefits and exclusions, information on the network of providers (if applicable); instructions on how to use the health plan and benefit design selected and an identification card.

Additional Questions?
For additional questions about eligibility, enrollment, plans COBRA, administrative or customer services issues, please call our Customer Service Center at 800-558-8003 Monday through Friday 8:00 am. – 5:00 pm or e-mail us at CustomerService@Calchoice.com, and a CaliforniaChoice^® specialist will be glad to assist you.

For referral to a broker in your area call CaliforniaChoice^® at 888-542-4218.

CaliforniaChoice^® is dedicated to helping insure California small business. We look forward to serving you with quality, affordable health care choices.

What is a co-payment?
The amount the insured/member must pay for medical services (doctor visits, drug prescriptions, hospitalizations, etc.).

Who/What is my Primary Care Physician?
A Primary Care Physician can be a family practitioner, internist, or pediatrician. At the time of enrollment, you were asked to select a Primary Care Physician for yourself and each dependent. The Primary Care Physician coordinates all health care and medical needs including basic care, preventive services, referrals to specialists, and hospitalization arrangements.

Can each family member select a different Primary Care Physician?
Yes, each family member may choose a different Primary Care Physician, best suited to their needs. (i.e. the employee and spouse may want to select a general practitioner, while selecting a pediatrician for their depen