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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


SHOP Delayed?

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Question: I read where the Small Business exchange was going to be delayed for a year. Is it true?

Answer: Not true in California. The HBEX board promises a fully functional SHOP exchange will be delivered on schedule. In the 33 states where the Federal government will facilitate the exchanges the employee choice model will not be available until 2015. In these states, the employer will have a choice of carriers as they do now, and the employee will choose a plan form the one carrier selected.This really removes the key selling point for the SHOP exchange, the ability for each employee to select the plan of the choice from one of many insurance carriers.

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Covered California has awarded a 3-year, $50 million Small Business Health Options Program (SHOP) runner contract to Pinnacle Claims Management Inc.

Pinnacle is a “third-party administrator” (TPA), or independent benefit plan administrator, has been managing benefit plans for about 800 small groups in California and Arizona.

The SHOP contract calls for Pinnacle to run an exchange, or Web-based health insurance supermarket, that could eventually help as many as 375,000 California small businesses shop for health coverage.

The California SHOP exchange staff will choose the health plans to be offered, manage exchange-plan relationships, and lead marketing efforts, officials said.

Pinnacle will handle eligibility, enrollment, marketing and fulfillment services, as well as agent and general agent sales management, financial management and small business call center services.

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