Archive for the ‘Broker Updates’ Category

Small Group Special Enrollment Period Ends December 15th

The small group Special Enrollment Period (SEP) is a valuable opportunity to grow your book and help small businesses that are typically ineligible for group coverage.

During the small group SEP, November 15 to December 15, insurance carriers are required by law to accept applications from small groups (1-100 employees) without participation or employer contribution requirements. This limited time opportunity is the perfect chance to offer coverage solutions, even to businesses that don’t meet the usual criteria.

Did You Know SEP Offers:

• Zero participation requirements: Only one enrolled employee is needed.
• No minimum employer contribution required: Greater flexibility for your clients.
• Coverage effective date: January 1, 2025.

SEP Is a Great Solution For:

• Small Business Owners Currently Enrolled in Individual Market Coverage
  The SEP permits small business owners to upgrade into group medical insurance, unlocking advantaged rates and plan offerings compared to individual and family policies. We can help you present these to your small business clients.
• Dual-Carrier Groups Struggling to Meet Participation Thresholds
  Small employers offering coverage from two carriers (aka dual-carrier groups) where meeting enrollment quotas with one carrier is problematic. The SEP waives these requirements – making compliance much easier.
• Groups Preferring Lower Employer Premium Contributions Than Are Otherwise Required
  Because the SEP eliminates monthly employer premium payment obligations, it empowers budget-conscious small businesses to enroll employees in group health benefits without increasing operating expenses.

Our easy-to-use Carrier SEP Guide for January 2025 medical coverage can help you and your small groups quickly compare carrier deadlines and details.

Carrier SEP Guide

Please note: the Special Enrollment Period is different than the relaxed participation promotions. These carrier promotions are usually offered for a specific time period and may be discontinued at any time.

Contact us today to help your clients take advantage of the SEP.

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

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Blue Shield of CA – 2025 Pharmacy and Network Updates

Blue Shield of California remains committed to providing small businesses and their employees with accessible, affordable, high-quality health benefits. Below is a summary of the 2025 updates to the pharmacy program and Tandem network.

Pharmacy Updates

As part of the Pharmacy Care Reimagined initiative, Blue Shield is implementing several pharmacy updates for 2025, including:

• Retail pharmacy network. Beginning in 2025, Navitus will manage Blue Shield’s retail pharmacy network for commercial, IFP, and medicare members. Impacted members will be notified in advance and provided with in-network retail and Amazon Pharmacy home delivery options. Learn more.
• Amazon Pharmacy home delivery. Prescription drug home delivery will shift from CVS Caremark Mail Service Pharmacy to Amazon Pharmacy on January 1, 2025. This applies to commercial, IFP, and medicare members.
• New member ID cards. Beginning with October 1 plan effective dates, Blue Shield members received new ID cards with updated pharmacy information. This applies to commercial, IFP, and medicare members.
• More information can be found on the Blue Shield Broker Update.

Tandem Network Updates

• The University of California, San Diego (UCSD) hospital will join the Tandem network in 2025, completing statewide access to all University of California (UC) hospitals and adding approximately 1,800 value-based primary care providers across California.
• Effective January 1, 2025, Stanford and Cedars-Sinai facilities will no longer be included in the Tandem network.
• To compare the Tandem network benefits to PPO coverage options, refer to the Network Plan Comparison Tool.

Reminder

New Small Business Incentive Program

• The new bonus program is in effect from February 1, 2025 through January 31, 2026.
• Brokers can earn points for each new member as follows:
  • 25 points per new enrolled medical member on all plans as part of the initial sale.
  • 10 points per new enrolled member in a small business dental plan.
  • 5 points per new enrolled member in a small business vision plan.
  • 5 points per new enrolled member in a small business life insurance plan.
  • 2x points for each new member enrolling in all three: dental, vision, and life (40 points total).
• The current Small Business Incentive Program is good through January 31, 2025. It includes the following:
  • 100 points per new enrolled member in a Tandem PPO or Virtual Blue plan as part of the initial sale.
  • 50 points per new enrolled medical member on all plans, excluding Tandem and Virtual Blue PPO plans as part of the initial sale.

Specialty Bundled Savings Program

The 10% specialty discount is a perpetual program that is applied to the dental and/or vision premium when a dental and/or vision plan is added to a new or existing small business medical group. Learn more.

Relaxed Participation

The Relaxed Participation promotion has been extended through December 31, 2025.

Contact us today for a Blue Shield quote.

Get a Quote

Resources

• Q1-2025 Medical Sales Guide
• Q1-2025 Specialty Sales Guide
• 2025 Medical Plans Cheat Sheet
• 2025 Medical Plan Names
• Basic Life Insurance Quick Match Program
• Underwriting Guidelines
• Relaxed Participation
• Small Business Incentive Program
• Specialty Bundled Savings Program
• Blue Shield News Center
• Product Cycle Updates
• Employer Connection Plus (EC+)
• Employer Enrollment Platform Resources
• Broker Connection
• Plan Comparison Tool and Network Comparison Tool
• Wellvolution Mental Health
• Broker Bonus Calculator

COVID-19 Resources

• COVID-19 Member Resource Page
• California Coronavirus Response Website
• DMHC COVID-19 Response and Guidelines

Contact us today for a Blue Shield quote.

Get a Quote

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

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BASIC – 2025 Contribution Limits for Tax-Advantaged Plans

The Internal Revenue Service (IRS) has released the 2025 employee contribution and benefit limits for Flexible Spending Accounts (FSAs), Health Savings Accounts (HSAs), and commuter benefit plans. For a summary of the 2025 amounts and plan limits, check out BASIC’s overview and access the IRS official announcement.

Medical FSA Contribution and Rollover Limits

• 2025 Annual Contribution Limit
  $3,300 (increased from $3,200 in 2024).
• 2025 Annual Carryover Limit
  $660 (increased from $640 in 2024).

HSA Limits and HDHP Requirements

• 2025 HSA Contribution Limit
  Individual/Self Coverage – $4,300 (increased from $4,150 in 2024).
  Family Coverage – $8,550 (increased from $8,300 in 2024).
  Age 55+ Catch Up – $1,000 (same as 2024).
• 2025 HDHP Minimum Deductible
  Individual/Self Coverage – $1,650 (increased from $1,600 in 2024).
  Family Coverage – $3,300 (increased from $3,200 in 2024).
• 2025 HDHP Maximum Out-of-Pocket
  Individual/Self Coverage – $8,300 (increased from $8,050 in 2024).
  Family Coverage – $16,600 (increased from $16,100 in 2024).

Transportation and Parking Maximum Monthly Limit

• 2025 monthly limit $325 (increased from $315 in 2024).

To learn more visit BASIC and access the IRS announcement.

Contact us for help when you’re ready to enroll a group in a BASIC specialty account.

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

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Claremont’s Holiday Office Schedule

Christmas

• Closed at 3:30 pm on Thursday, December 12, 2024
• Closed at noon on Tuesday, December 24, 2024
• Closed on Wednesday, December 25, 2024
• Open on Thursday, December 26, 2024

New Year’s

• Closed at noon on Tuesday, December 31, 2024
• Closed on Wednesday, January 1, 2025
• Open on Thursday, January 2, 2025

We wish you a joyous and festive holiday season with your family and friends!

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

Get The Latest News with Text Messaging!

Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.

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New California State Law Impacts 2025 Dental Plans

AB 1048 – a recently passed California state law – impacts dental insurance plans in 2025. AB 1048 prohibits fully insured large group dental plans from imposing a dental waiting period or preexisting condition provision for any plan year beginning on or after January 1, 2025.

Humana

Humana is updating their fully insured Group Benefits dental plans in California to meet new state regulations effective January 1, 2025.

Removed from plans:

• Waiting periods for California Humana Group Benefits dental plans with 51+ enrolled employees.
• Missing tooth exclusion for all California Humana Group Benefits dental plans.

Details important to you and your clients:

• The changes apply to both new and existing fully insured Humana Dental groups starting January 1, 2025.
• New dental plan groups with effective dates starting January 1, 2025, will include these updates.
• The changes will automatically take effect on existing groups’ dental plans on January 1, 2025, no matter when their renewal dates are.
• The updates will not apply to benefits before January 1, 2025. No retroactive changes.
• You or your clients do not need to do anything.

Claremont will keep you updated as other carriers announce their updates in response to the law.

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

Get The Latest News with Text Messaging!

Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.

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Beam Benefits – New Premium Mental Health Benefits Through Headspace Care Partnership

Offer your clients premium mental health benefits with Beam’s new partnership with Headspace.

By uniting therapy, psychiatry, on-demand coaching, and guided meditations, Headspace Care delivers an affordable, accessible, and connected system tailored to meet the diverse needs of employees and their families.

Key Features Include:

• 6 virtual therapy sessions per year (no in-person sessions).
• Unlimited access to mental health coaching.
• Full access to the comprehensive content library.
• $8.50 per employee per month, fully employer-paid, with 100% employee participation required.
• Available as a standalone offering. If sold with Beam products, billing will be handled separately.
• Enables employers to enhance their benefits package with mental health support without modifying their existing insurance coverage.
• 10% broker commission.

Learn more about the new premium mental health benefits, including the key differences compared to the Headspace benefits bundled with some California medical health plans.

Contact us today for a Beam Benefits quote.

Get a Quote

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

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Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.

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Humana – Dental Network Expansion, Q4 Broker Support

Humana continues to expand its dental network significantly, offering members more access and improved value. With an increased focus on delivering seamless experiences, brokers can rely on comprehensive tools, expert support, and efficient solutions to meet their needs and enhance member satisfaction during Q4 and beyond.

Dental Network Expansion

• 18,000+ net-new dentists added in 2024. Over 135,000 dentists nationwide.
• Since 2016 the Humana dental network increased by 86%, far outpacing the competition.
• Over 72% of claims processed in network at an average discount of 40%.
• Ranked top 3 in over 80% of the top 250 Metropolitan Statistical Areas.

Q4 Broker Support

• For efficient quoting of dental, vision, life, and disability plans, refer to the Group Benefits Quoting Requirements Guide.
• Save time by installing Launch My Group (LMG). For an overview and step-by-step instructions, refer to the LMG Member Enrollment Reference Guide.

As always, contact Claremont for details at 800.696.4543 or info@claremontcompanies.com.

Contact us today for a Humana quote!

Get a Quote

Reminder, Take Advantage of Humana Broker Bonus Programs

Disability Plans Bonus

Earn a bonus and provide extra financial protection for your clients’ employees.
To earn a bonus, place NEW Humana short- and/or long-term disability with an initial effective date of coverage between October 1, 2024 through January 1, 2025. The bonus can be earned in one of two ways:

New 5-49 Enrolled Humana Disability Cases:

• $200 bonus per bundled case.
  Get an extra $200 on top of earnings through the Dental Bundling Bonus. This means you could get up to an $800 bonus between the two bonus programs.
• $400 bonus per stand-alone case.

To learn more, download the Disability Plans Bonus flyer.

2024 Group Benefits Growth Bonus

Intended for specialty lines of coverage of all sizes, the Humana 2024 Group Benefits Growth Bonus (formerly known as the Specialty Growth Bonus) is paid once annually, within 60 days after the January 31, 2025 program end date.

Bonus Program Highlights

• Tiered structure allows you to earn more as you climb to the next level.
• Opportunities for selling new and retaining existing business – and for case sizes big and small.
• Rewarded for multi-line sales year-over-year so you don’t have to start fresh each year.
• Earn up to 7% book of business revenue.

Eligible Products

• Group Term Life (Including AD&D)
• Group Term Voluntary/Supplemental Life (Including AD&D)
• Group Vision (Including Voluntary Vision)
• Group Dental (Including Voluntary Dental)
• Group Long-Term Disability (Including Voluntary Long-Term Disability)
• Group Short-Term Disability (Including Voluntary Short-Term Disability)

The 2024 Group Benefits Growth Bonus qualifications remain the same as the 2023 Specialty Growth Bonus. To learn more, download the Group Benefits Bonus flyer and the 2024 Producer Partnership Plan brochure.

Dental Bundling Bonus – Extended Through January 2025

Sell a Bundle, Earn a Bundle! To earn a bonus, sell a new Humana dental line of coverage with at least one additional Group Benefits line of coverage with the same employer group with an initial effective date of coverage between April 1, 2024 through January 31, 2025.

• Groups with 5-49 eligible enrolled employees (must be at least 5 enrolled):
  – $100 bonus for dental + $100 for vision + $100 for life + $200 for disability coverage.
  – $100 more if you place all four lines of coverage with the same employer for a total of $600!
• Groups with 50+ eligible enrolled employees:
  – $200 bonus for dental + $100 for vision + $100 for life + $300 for disability coverage.
  – $100 more if you place all four lines of coverage with the same employer for a total of $800!

Group Benefits Lines of Coverage

• Group Term Life (Including AD&D)
• Group Term Supplemental Life (Including AD&D)
• Group Vision (Including Voluntary Vision)
• Group Dental (Including Voluntary Dental)
• Group Short-Term and Long-Term Disability

To learn more, download the Dental Bundling Bonus flyer.

Resources

• Group Benefits Marketing Kit
• Dental Plans At a Glance
• Dental Provider Search
• Dental: 3 Commonly Asked Coverage Questions
• Vision Plans At a Glance
• Vision Provider Search
• Disability Benefit Summaries
• Short-Term Disability Quick Reference Guide
• Long-Term Disability Quick Reference Guide
• Disability Plans At a Glance
• Life Plans At a Glance

Contact us today for a Humana quote and take advantage of the bonus programs!

Get a Quote

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

Get The Latest News with Text Messaging!

Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.

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Claremont Welcomes Kevin Carlin

Kevin has over 35 years of experience in the employee benefits industry, working with leading health and dental insurance companies, including California Dental Network and Humana. His expertise lies in consulting with brokers to develop tailored benefits solutions for their group clients across California.

Throughout his career, Kevin has built strong broker relationships by regularly attending networking events and staying engaged with the latest trends in employee benefits. His active presence on LinkedIn allows him to share valuable insights, helping brokers and industry peers navigate the evolving benefits marketplace. Kevin’s collaborative approach empowers brokers with the tools they need to grow their businesses.

Based in Huntington Beach, Kevin enjoys spending time with his family – his wife, Denise, and their two children, Taylor and Sean. He also loves exploring the natural beauty of Southern California, taking his French Bulldogs, Zoey and Lola, on walks around favorite local spots like the Bolsa Chica wetlands and Central Park.

You can reach Kevin at kevin@claremontcompanies.com or 925.296.8820.

Get The Latest News with Text Messaging!

Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.

Sign Up for Text Messaging

2025 Small Group SEP Carrier Guide

The small group Special Enrollment Period (SEP) is a valuable opportunity to grow your book and help small businesses that are typically ineligible for group coverage.

During the small group SEP, November 15 to December 15, insurance carriers are required by law to accept applications from small groups (1-100 employees) without participation or employer contribution requirements. This limited time opportunity is the perfect chance to offer coverage solutions, even to businesses that don’t meet the usual criteria.

Did You Know SEP Offers:

• Zero participation requirements: Only one enrolled employee is needed.
• No minimum employer contribution required: Greater flexibility for your clients.
• Coverage effective date: January 1, 2025.

SEP Is a Great Solution For:

• Small Business Owners Currently Enrolled in Individual Market Coverage
  The SEP permits small business owners to upgrade into group medical insurance, unlocking advantaged rates and plan offerings compared to individual and family policies. We can help you present these to your small business clients.
• Dual-Carrier Groups Struggling to Meet Participation Thresholds
  Small employers offering coverage from two carriers (aka dual-carrier groups) where meeting enrollment quotas with one carrier is problematic. The SEP waives these requirements – making compliance much easier.
• Groups Preferring Lower Employer Premium Contributions Than Are Otherwise Required
  Because the SEP eliminates monthly employer premium payment obligations, it empowers budget-conscious small businesses to enroll employees in group health benefits without increasing operating expenses.

Our easy-to-use Carrier SEP Guide for January 2025 medical coverage can help you and your small groups quickly compare carrier deadlines and details.

Carrier SEP Guide

Please note: the Special Enrollment Period is different than the relaxed participation promotions. These carrier promotions are usually offered for a specific time period and may be discontinued at any time.

Contact us today to help your clients take advantage of the SEP.

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

Get The Latest News with Text Messaging!

Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.

Sign Up for Text Messaging

KFF 2024 Employer Health Benefits Survey

In 2024, the average single premium increased by 6%, and the average family premium increased by 7% for employer-sponsored coverage. Over the last five years, the average premium for family coverage has increased 24%, compared to a 28% increase in workers’ wages and an inflation rate of 23%.

The KFF 2024 Employer Health Benefits Survey provides a comprehensive analysis of trends in employer-sponsored health coverage. This year’s report covers premium trends, employee contributions, cost-sharing provisions, wellness programs, and new questions on provider networks, abortion coverage, family building benefits, coverage for GLP-1 agonists (weight loss drugs), and programs for lower-wage workers. The 2024 survey was conducted through 2,142 interviews with non-federal public and private firms with three or more workers.

Key Findings

• Premiums and Employer Contributions
  • The average annual premiums for employer-sponsored health insurance in 2024 are $8,951 for single coverage and $25,572 for family coverage.
  • The average premiums for covered workers in high-deductible health plans with a savings option (HDHP/SO) were lower than the overall average premiums for both single coverage ($8,275) and family coverage ($24,196).
  • Most covered workers contribute to the cost of the premium. On average, covered workers contribute 16% of the premium for single coverage and 25% of the premium for family coverage, which is lower than the contribution percentages in 2023.
  • 37% of covered workers at small firms are enrolled in a plan where the employer pays the entire premium for single coverage. 26% of covered workers at small firms are in a plan where they must contribute more than half of the premium for family coverage.
  • Nearly a third (32%) of workers at small firms have deductibles of $2,000 or more for single coverage, which is similar to last year’s percentage (31%).
  • PPOs remain the most common plan type. In 2024, 48% of covered workers are enrolled in a PPO, 27% in a HDHP/SO, 13% in an HMO, 11% in a POS plan, and 1% in a conventional (also known as indemnity) plan.
  • In 2024, 54% of all firms offered some health benefits, similar to the percentage last year (53%). Large firms (200 or more workers) are much more likely than small firms to offer health benefits to at least some of their workers (98% vs. 53%).

Additional Findings

• Health and Wellness Programs
  • Many small businesses are expanding health and wellness programs to enhance employee well-being and engagement. These initiatives often focus on physical, mental, and preventive health measures, though the scope and investment in these programs tend to be smaller compared to large firms.
  • 54% of small firms and 79% of large firms offer a program in at least one of these areas: smoking cessation, weight management, and behavioral or lifestyle coaching.

• Telemedicine
  • Telemedicine has become a crucial benefit for small employers, providing cost-effective and convenient access to healthcare. A growing number of small businesses are adding telemedicine options to their plans, allowing employees to consult with healthcare providers remotely, often with reduced or no copays, which helps manage rising healthcare costs while improving access.
• Tiered and Narrow Networks
  • Small businesses are increasingly adopting tiered and narrow network health plans to manage costs. These plans limit the choice of healthcare providers in exchange for lower premiums, offering a more affordable option for both employers and employees. Narrow networks focus on a select group of healthcare providers, while tiered networks offer varying levels of coverage based on the provider chosen.
• GLP-1 Drug Coverage for Weight Loss
  • Coverage for costly GLP-1 drugs, like Wegovy, remains limited among small employers.
  • Only 18% of large firms (200+ workers) cover these drugs.
  • 53% of those covering the drugs impose conditions, such as dietitian consultations or participation in weight-loss programs.

Check out the KFF 2024 Employer Health Benefits Survey summary and news release to stay up to date on the latest employer-sponsored coverage trends and guide your groups through the evolving health care marketplace. Contact us today to develop tailored benefits solutions that address your clients’ needs.

KFF 2024 Employer Health Benefits Survey

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.

Get The Latest News with Text Messaging!

Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.

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