California Group Health Insurance Guides & Resources

Complete group health insurance guides for California employers. ACA compliance, cost, open enrollment, COBRA, carriers, plan types, and benefits strategy.

34 Expert Guides

Group Health Insurance Guides for California Employers

This library covers everything California employers need to know about group health insurance — from basic plan mechanics to ACA compliance, from cost management to benefits strategy. Each guide is written for California-specific rules and market conditions, with citations from the IRS, California DOI, DMHC, and DOL.

Questions not answered here? Call 310-804-5017 or email aaron@bollinsure.com. As an independent broker (CA DOI #6013787) we provide free compliance guidance alongside group health brokerage services.

Getting Started

How Group Health Insurance Works

Step-by-step: the employer-carrier-employee relationship, premium equation, how claims work, and enrollment rules. Essential starting point.

Small Business Guide

Everything California small businesses (1–100 employees) need: community rating, participation requirements, SHOP exchange, and working with a broker.

Working with a Broker

Independent vs captive broker difference, what brokers do for employers, compensation transparency, and how to find a CA-licensed broker.

Group vs Individual Insurance

Why employer-sponsored group health is almost always better than individual coverage. Tax treatment, employer contribution, and network advantages.

ACA & Compliance

ACA Employer Mandate

50+ FTE threshold, FTE calculation, Penalty A vs B, affordability safe harbors, and IRS 1094-C/1095-C reporting requirements.

California Requirements

Knox-Keene Act, community rating, CA mental health parity, state-mandated benefits beyond ACA, and DMHC vs CDI jurisdiction.

ACA Affordability Rules

9.02% affordability threshold, W-2/Rate of Pay/FPL safe harbors, minimum value test, and penalty exposure for non-compliant plans.

California Individual Mandate

CA reinstated individual mandate (2020+). $900 penalty per adult. Employer implications and minimum essential coverage requirements.

ERISA Compliance

Plan documents, Summary Plan Description, Form 5500 filing, COBRA integration, and HIPAA special enrollment rights.

Small Business Tax Credit

Up to 50% of premiums back for qualifying small employers. Eligibility criteria, credit calculation, SHOP requirement, and claiming on Form 8941.

Plan Design & Cost

Cost Guide 2024

2024 HMO/PPO/EPO premium ranges by California region. Rating factors, employer vs employee cost split, and cost management strategies.

Employee Contribution Strategy

CA 50% minimum contribution rule, Section 125 pre-tax savings, flat vs percentage contribution structures, dependent contribution decisions.

Self-Funded vs Fully Insured

When to consider self-funding (75–100+ employees), ERISA preemption advantages, level-funded middle ground, stop-loss protection.

Fully Insured vs Level-Funded

Level-funded mechanics, potential refund in good claims years, who qualifies (5–100 employees), and risks vs rewards.

Section 125 Cafeteria Plans

How pre-tax premium deductions work, FICA savings for employer and employee, FSA and DCFSA options, plan document requirements.

Multi-State Coverage

Covering employees in multiple states. National PPO carriers, multi-state plans, self-funded with national TPA. Remote work era essentials.

Enrollment & Administration

Open Enrollment Guide

Timing, employer responsibilities, SBC distribution, employee communication, passive enrollment, and mid-year QLE changes.

Adding New Employees

Waiting periods, enrollment windows, coverage effective dates, what happens if employees miss enrollment, HIPAA special enrollment rights.

Waiting Periods Explained

ACA 90-day maximum, compliant period structures, part-time to full-time triggers, documentation requirements, and strategic considerations.

Part-Time Employee Coverage

ACA 30-hour threshold, look-back measurement method, voluntary coverage for part-timers, FTE calculation for mandate purposes.

Rate increase drivers, 90-day renewal timeline, when to switch carriers, mid-year changes, and employee communication best practices.

Open Enrollment Checklist

Employer step-by-step checklist: 90 days before, 45 days before, Day 1 of new year. Notice requirements, carrier switching, COBRA updates.

COBRA & Coverage Transitions

Federal COBRA (20+ employees) and Cal-COBRA (2–19). Qualifying events, timelines, cost (100% + 2%), and employer notice obligations.

COBRA vs Covered California

Help departing employees compare COBRA costs to ACA marketplace plans. Subsidy eligibility, timing, and when each option makes sense.

Plan Comparisons

The fundamental CA employer plan decision. Cost, network, referral requirements, and which workforce types benefit most from each.

EPO as the middle ground: no referrals like PPO, in-network only like HMO. When EPO wins vs HMO.

Is out-of-network coverage worth 10–18% more in monthly premiums? Framework for deciding between PPO and EPO for your group.

Kaiser vs Anthem

California's two dominant carriers head-to-head. Cost, network model, employee experience, and which fits your geography and workforce.

Small Group vs Large Group

California 2–100 vs 101+ employee market differences: community rating vs experience rating, ACA mandate thresholds, and plan flexibility.

Ancillary Benefits

Group Dental Guide

Group vs individual dental plans. Preventive/basic/major structure, annual maximums, Delta Dental vs Cigna vs MetLife in California.

Group Vision Guide

VSP vs EyeMed networks, benefit structure, LASIK discounts. Why $8–$15/employee is one of the highest-ROI benefits available.

Group Life Guide

$50,000 tax-free basic life, guaranteed issue, AD&D, voluntary supplemental. Why every employer should include basic life at $2–$5/month.

Group Disability Guide

STD vs LTD, coordination with California SDI, own-occupation definition, and why disability insurance is critical for professional employees.

Benefits Strategy

Building Your Benefits Package

How to design a competitive California benefits package from scratch. Medical + dental + vision + life + disability + 401k — prioritized by ROI.

Ready to apply what you've learned? Get a free group health quote comparing all California carriers. Same-day rate indications for most groups. Start your application ›

Sources

IRS Publication 15-B (Employer's Tax Guide to Fringe Benefits); US Department of Labor Employee Benefits Security Administration — ERISA; California Department of Managed Health Care (DMHC) — dmhc.ca.gov; California Department of Insurance (CDI) — insurance.ca.gov; IRS Notice 2012-58 (Look-Back Measurement Method); Covered California for Small Business — employers.coveredca.gov; SHRM Employee Benefits Survey 2024; Kaiser Family Foundation Employer Health Benefits Survey 2024.

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