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New Cigna + Oscar (C+O) small group sales and renewals will not be offered in 2025. At C+O’s request, all plans and rates have been removed from the quote engine. However, you can still quote or renew your C+O groups through December 15, 2024 by contacting us at quotes@claremontcompanies.com or 800.696.4543. Please note: the last day of coverage will be December 14, 2025.
For assistance, please contact our Quotes team at quotes@claremontcompanies.com or 800.696.4543.
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On June 17, the Governor approved Senate Bill (SB) 125. A section of SB 125 revises the definition of small employer for plan years commencing or renewing on or after January 1, 2016. The definition of small employer, for purposes of determining employer eligibility in the small group market, will no longer be based on a count of eligible employees, but shall instead be determined using the method for counting full-time employees and full-time equivalent employees set forth in Section 4980H(c)(2) of the Internal Revenue Code. Quickly see where new rules differ from prior rules by downloading the guide below.
Employer size under Section 4980H(c)(2) of the Internal Revenue Code is determined by taking the sum of the total number of full-time employees and full-time equivalent employees for a calendar month. To be a small employer in California, the result must be at least one, but no more than 100, on at least 50 percent of the preceding calendar quarter or preceding calendar year. The majority of these employees must be employed within California. The requirement that a bona fide employer-employee relationship exists still applies.
A full-time employee is someone employed an average of at least 30 hours of service per week. To calculate full-time equivalent employees, the number of hours of service for a calendar month of all employees who are not full-time are aggregated then divided by 120. No more than 120 hours of service can be credited for any employee who is not full-time. Hours of service includes both working hours and non-working hours for which an employee is paid or entitled to be paid, such as vacation, holiday, illness, incapacity, jury duty, military duty, and leave of absence.
The regulations of Section 4980H(c)(2) specify to include seasonal workers when counting the number of full-time employees and calculating the number of full-time equivalents. A seasonal worker is someone who performs labor or services on a seasonal basis. This employment is only done during certain periods and not throughout the year, such as those who only work during the holidays. Someone who works in agriculture, but performs different activities in different seasons, is considered seasonal, even if they are employed most of the year. A reasonable, good faith interpretation of the term seasonal worker may be applied.
As described above, SB 125 will result in significant changes to the small group market. However, the practical administration of this law has yet to be determined. Stay tuned for updates on this topic.
Questions?
Contact us at 800.696.4543 or info@claremontcompanies.com.