Resources
Helpful agencies, programs, and rules for California employers offering group health, dental, vision, life, disability, medical reimbursement, and FSA benefits.
CDI regulates insurance companies and licenses agents and brokers in California. Use it to verify a broker's license or get help with a complaint about a PPO or indemnity plan. Consumer Hotline: 1-800-927-4357.
DMHC oversees most HMO plans and some PPO plans in California. Its Help Center assists consumers with grievances, independent medical reviews, and coverage disputes at 1-888-466-2219.
California's small business health insurance marketplace. Employers with fewer than 25 full-time equivalent employees and average wages under an IRS limit may qualify for the federal Small Business Health Care Tax Credit when purchasing through it.
In California, the small group market generally covers employers with 1–100 employees. Small group plans must be ACA-compliant and include the essential health benefits.
Employers with 50 or more full-time employees, including full-time equivalents, must offer affordable, minimum-value coverage to nearly all full-time employees and their dependents or may owe an IRS penalty. They must also file Forms 1094-C and 1095-C each year.
Most employers must give new hires a written notice about the Health Insurance Marketplace within 14 days of their start date, whether or not they offer health coverage. Group health plans must also provide a Summary of Benefits and Coverage (SBC), which the carrier typically prepares, along with other federal notices.
Federal COBRA generally applies to employers with 20 or more employees. Cal-COBRA extends continuation coverage to employees of groups with 2–19 employees and can extend coverage for some federal COBRA enrollees.
For employers with 20 or more employees, the group health plan generally pays first for active employees 65 and older, with Medicare paying second. For smaller groups, Medicare is usually primary. Employers that offer prescription drug coverage must notify Medicare-eligible employees each year before October 15 whether that coverage is creditable. California's Health Insurance Counseling and Advocacy Program (HICAP) offers free, unbiased Medicare counseling at 1-800-434-0222.
California SDI partially replaces wages for workers who can't work due to a non-work illness, injury, or pregnancy. Paid Family Leave (PFL) covers time off to bond with a new child or care for a seriously ill family member. Both are funded by employee payroll deductions, and employers must post the required EDD notice and give new hires the PFL brochure (DE 2511).
The California Family Rights Act (CFRA) gives eligible employees of businesses with 5 or more employees up to 12 weeks of job-protected leave, and employers must continue group health coverage during it on the same terms. Pregnancy Disability Leave applies to the same employers and allows up to four months.
IRS Publication 15-B explains how employee benefits are taxed, including Section 125 cafeteria plans, group term life over $50,000, and which business owners can participate. Publication 969 covers HSAs, FSAs, and HRAs, including the contribution limits the IRS adjusts most years.
California residents must have qualifying health coverage or pay a penalty unless they qualify for an exemption. Employers may need to provide coverage information to employees and the Franchise Tax Board (FTB).
We're happy to help you make sense of the rules that apply to your business.